If you had a concussion twenty years ago, you were told to lie in a dark room until the symptoms went away. That advice has been reversed, and a great deal of what's still circulating — including from well-meaning coaches and relatives — predates the change.
First: when it's an emergency
Go to A&E, or call emergency services, if after a head injury there is any of:
- Loss of consciousness, or drowsiness that doesn't lift
- Repeated vomiting
- A seizure
- Weakness, numbness, or difficulty speaking or understanding — which are also the signs of stroke
- Clear fluid from the nose or ears
- A headache that keeps worsening
- Confusion that is getting worse rather than better
- Anyone on blood-thinning medication, or any child with a significant head impact
Concussion itself is a clinical diagnosis. Most concussions do not show on a CT scan, which is not reassurance that nothing happened — the scan is looking for bleeding, not for concussion.
What changed
The 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2023) sets out a protocol that looks quite different from the old one:
Relative rest for the first 24 to 48 hours only — including limited screen time. Light activity such as walking is fine during this period where there's no risk of another impact.
Progressive aerobic exercise starting between 2 and 10 days after the injury, increasing as tolerated, provided there is no risk of head impact or collision.
The reason for the change is that extended complete rest appears to slow recovery rather than speed it, and carries its own costs — deconditioning, isolation, low mood, and anxiety about symptoms.
How to judge "as tolerated"
The consensus gives a usable rule. During activity, a mild increase in symptoms — 1 to 2 points on a 10-point scale — is acceptable, provided it settles within about an hour.
Symptoms rising more than that, or not settling within the hour, mean stop and try a lower level next time.
So the instruction is not "push through" and not "do nothing." It is to work at a level that provokes very little, and step up gradually.
Return to school and return to sport
The first three stages of return-to-sport are treated as part of the treatment, with that same mild-symptom allowance, in non-contact activity. The last three stages — the ones involving contact — come only after symptoms have resolved and a clinician has cleared the person.
For children and adolescents, return to school takes priority and can run alongside the return-to-sport stages.
The contact stages are where the stakes are. Returning to collision sport before clearance risks a second injury while the brain is still recovering, and that is the scenario the entire protocol exists to prevent.
If symptoms persist
Most concussions resolve within the expected window. When cognitive symptoms do not, it is worth looking at the other things that cause them rather than assuming everything is attributable to the injury, and at whether sleep has been disrupted, since poor sleep both follows head injury and slows recovery from it.
Where we sit
No supplement treats concussion, ours included. There is a lively market suggesting otherwise and we'd treat it with suspicion.
The things that help recovery are sleep, gradual and monitored activity, and clinical follow-up if symptoms persist beyond the expected window. Traumatic brain injury also appears on the list of modifiable dementia risk factors, which is a reason to take head protection seriously long before any of this applies — and the full list of fourteen is worth reading alongside it.
Based on the 6th International Consensus Statement on Concussion in Sport (Amsterdam, 2023). This article is not medical advice, and concussion management — particularly in children — requires clinical assessment.