6 Stages of Concussion Recovery

Concussions come in all shapes and sizes, but the recovery generally follows a specific series of stages. Each comes with its challenges and best practices to ensure a full recovery.

This article will detail each stage, the most common symptoms within each one, and the best practices to ensure complete recovery. The world of concussions has changed considerably over the last decade.

Staying up to date with the current best practices is the best way to ensure you have the best chance to make it through without lingering symptoms.

 The 6 stages of recovery are as follows:

1: The Energy Crisis.

2: The Adaption Phase.

3: Symptom Management.

4: Stubborn Symptoms.

5: Real-Life Obstacles

6: Cruise Control.

The following sections will outline each one in detail. We will also recommend best practices and suggestions for care. 

1: Acute Stage: The Energy Crisis 

• The acute stage, often spanning a few days to a couple of weeks after the concussion, is characterized by the fallout from the injury. The brain is in a state of crisis. It has little extra energy for anything other than returning to a baseline. Think of it like the immediate aftermath of a tornado. No one plans how to rebuild until everyone is safe and accounted for.

Ion Channels

• The physiology of why this occurs involves repairing broken ion channels. Healthy nerves have something called a “sodium-potassium pump.” It helps transport ions in and out of the cell and requires energy to maintain a healthy charge on both sides of the cell.
• Concussions damage these pumps, and the brain uses all available power to repair them so the remaining tissue can function normally. This is commonly referred to as the “energy crisis” stage. It is the only stage where rest and darkness are appropriate.

Symptom Presentation

• During this stage, individuals experience a variety of debilitating symptoms, including persistent headaches, dizziness, heightened sensitivity, and cognitive impairments. It is important to avoid activities that worsen these symptoms, such as physical and mental exertion.
• Avoid alcohol, excessive caffeine, and screen time. Once you’ve rested for long enough to feel comfortable doing light activity, you transition to the next phase: adaption.

2: The Adaption Phase 

• The early recovery phase, usually lasting several weeks to a few months, marks a transition period as symptoms gradually decrease. There are intermittent improvements during this stage, but fluctuations and setbacks are common, so a flexible recovery plan is essential.
• The important thing to grasp in this section is the brain moves out of the crisis stage and into adaption. Staying with the tornado analogy, this is when the people in the city begin to clean up and plan to restore damaged areas. This fundamental shift is why sleeping in a dark room for too long is dangerous.
• Once the brain shifts into the adaption phase, you don’t want it to adapt to inactivity and darkness. This will prolong recovery and make it more challenging to move into later stages.

Light Activity

• Once you feel better, begin introducing light activity into your daily routine. This will help push your brain to adapt to activity and expose your limits.
• Once you’ve reached this stage, the best practice is to begin something called the Buffalo Concussion Treadmill Test. It’s a graded cardiovascular treadmill protocol to help identify the most problematic symptoms and reduce the likelihood of prolonged autonomic symptoms.
• One of the most significant predictors of a long recovery is lingering autonomic symptoms, so this step is crucial to ensuring a full and fast recovery.

BCTT Instructions

• Attached is a link to the instructions. The quick and dirty is as follows:

1. Get on a treadmill and warm up around 3.4 mph for 5 minutes or so.
2. Every minute, increase the incline by 1%.
3. Continue until you develop symptoms
4. Measure your heart rate and record symptoms
5. Take the heart rate at which symptoms occurred and multiply it by .8
6. That number is the new target heart rate until you re-test in a week

• Following this process will allow you to gradually regain endurance, help repair the damaged areas, and give you a good idea of which symptoms are the most stubborn. You can move to stage 3 when you can no longer produce symptoms with the test or reliably get symptoms at a specific heart rate each re-assessment.

• Stages 2 and 3 can overlap somewhat. However, for the sake of this article, we’ll separate them for clarity.

Stage 3: Symptom Management 

 The middle recovery stage, spanning several months, marks a substantial reduction in symptoms and an upswing in overall well-being. During this period, individuals slowly regain their capacity to engage in routine activities like work or school. Stubborn symptoms will emerge, and learning to set boundaries to limit crashes is crucial during this stage. Some common symptoms that present during this stage include:

• Headaches

Persistent or recurring headaches are a common symptom experienced during concussion recovery. Screens, busy visual environments, physical activity, or certain foods may bring them on. If you’re predisposed to migraines, they may become more frequent or intense.

• Dizziness

Feelings of lightheadedness, dizziness, or loss of balance are frequently reported symptoms. Lightheadedness may also occur after standing up quickly or getting out of bed. It’s important to distinguish these 2 symptoms as different, even though they often present together.

• Nausea or vomiting

Some individuals may experience sickness or vomiting due to the concussion. Note when and where this occurs, as it helps your healthcare provider pinpoint the source of the symptoms.

• Sensitivity to light and noise

Bright lights and loud noises can exacerbate symptoms and lead to discomfort. This indicates dysfunction in a brainstem region called the midbrain and requires specialized practitioners trained in assessing this area.

• Fatigue

Feeling tired, lacking energy, or experiencing excessive sleepiness may be common symptoms during recovery. If these symptoms don’t improve during the adaption phase, they are likely due to dysfunction in an area other than the autonomic system.

• Difficulty concentrating

After a concussion, people often report problems with focus, attention, and memory. Be sure to set limits on bouts of focused work. Gradually increase the amount of time you dedicate to one thing. Nutritional guidelines and supplementation can often help with these symptoms.

• Emotional changes

 Mood swings, irritability, anxiety, or depression can manifest during the recovery period. Getting the proper support and a self-care routine can help support mood during recovery—tools like meditation, journaling, and neurofeedback are valuable, helpful therapies to improve coping skills.

• Sleep disturbances

Concussions can lead to disturbances in sleep patterns, causing difficulty falling asleep, staying asleep, or excessive sleepiness. Having a good sleep routine, such as the 3-2-1 principle, and limiting caffeine can help improve sleep.

• Balance and coordination problems

Difficulties with balance, coordination, an unsteady gait, or feeling uncoordinated may occur. A thorough vestibular assessment, specifically one that uses a VNG test, can help identify underlying vestibular dysfunction. Specialized vestibular clinics and functional neurologists often use this assessment to guide treatment.

• Visual changes

Blurred vision, double vision, trouble focusing, and eye strain are common visual symptoms. Note when and where these occur to help guide your interventions. Optometrists, neuro-ophthalmologists, and functional neurologists commonly treat these symptoms with vision therapy. They also may prescribe prism lenses to mitigate symptoms. 

• Anxiety or nervousness

Feeling anxious, on edge, or more nervous than usual can be present during the recovery process. Dysfunction in multiple sensory systems can lead to a “sensory mismatch.” This automatic production of stress occurs when your brain receives differing inputs simultaneously. It’s the same sensation you get when you see the car next to you move at a stop light, and you aren’t sure if it’s your vehicle moving. Over time, this stress response accumulates and is perceived as anxiety.

What to do if Symptoms Persist

• Concussion symptoms can vary in intensity and duration from person to person and may change throughout different stages of recovery. It’s crucial to catch these signs early in recovery, ideally at the tail end of your phase 2 practices.
• Consult with a healthcare professional specializing in concussions for an accurate diagnosis, proper management, and personalized guidance during this stage of recovery.

4: Stubborn Symptoms and Continued Resilience 

• The duration of this stage can vary widely, ranging from several months to a year or more, depending on the severity of the concussion. Many who enter this stage have tried a considerable number of therapies, often with little to no success. This is when the actual search for relief can get frustrating and, at times, dire.

• During this stage, it is important to focus on building a recovery-friendly lifestyle and finding integrated rehab. Prioritizing a holistic approach, including maintaining a healthy lifestyle through regular exercise, balanced nutrition, stress management techniques, and social support, is crucial. Below are some of the most common reasons people get stuck during rehab.

1: Immune-related issues.

• Concussions have a way of affecting more than just the brain. They can affect immune function in several ways that often go unchecked in traditional concussion management. Old infections effectively walled off can re-emerge when the brain is recovering. Things like mold, Lyme disease, and Epstein Barr Virus are all things to re-visit if you’ve had them before your concussion.

2: Gut Related Issues

• Concussions often affect the lining of the stomach, digestion, and nutrient absorption. The stomach lining becomes “leaky” and no longer prevents harmful pathogens from being filtered into the stomach. This is called “leaky gut” and is common in prolonged concussion recovery.

• The microbiome can also become disrupted, leading to something called SIBO (small intestinal bacterial overgrowth). This means the balance of good and bad bacteria in the small intestine gets thrown off. Indigestion, heartburn, diarrhea, and a host of other GI-related symptoms can present with SIBO. A comprehensive stool analysis is an excellent place to start if you deal with these symptoms.

3: Segmented Rehab

• One of the most common things we see in prolonged recoveries is siloed rehab programs. America loves its specialists, which is a good thing in most cases. In concussion care, it can be detrimental.
• The problem lies in the different licenses that handle each specialty. Eye doctors usually treat eye-tracking issues. Physical therapists often handle vestibular problems. Chiropractors generally treat neck pain and headaches. Medical doctors deal with initial screenings for structural damage. These are all different licenses that may or may not understand what the others are doing. This results in differing opinions regarding care and leaves patients confused.
• We’ve found the way past this plateau through integrated rehab. To overcome this fragmented approach, a program that borrows pieces from each discipline into a cohesive, singular program is needed.
• Even if you’ve tried every type of care on its own, combining them into a program performed all at once is a huge missing piece in stubborn concussion management. This is the pillar of what we do at The Neural Connection. Click here to talk with one of our doctors if this resonates with you.

Stage 5: Real Life Obstacles

At this point, you’ve completed the therapies, taken the supplements, and seen all the doctors. Now, it’s time to test all the work you’ve done against the real world. This is a chance to see which aspects of the rehab will hold up under natural circumstances and which ones need more work. In our experience, people will respond to these limitations in 2 distinct and different ways.

1: Disappointment that the therapies “didn’t work.”

2: Feeling encouraged because they can slowly do more and more.

At this stage of recovery, it’s essential to acknowledge the following mantra: “After rehab is done, real life becomes the rehab.”

This means that driving the entire system in real-life situations and having it fatigue is just another part of the recovery process. It’s not an indication of failure. In rehab, you isolate systems, challenge them so they develop and grow, and sometimes you push too hard and feel temporarily worse.

This stage of rehab is no different. You’re just in the game instead of practicing in a safe place. Please remember: it’s not a setback if you develop symptoms after rehab. It’s an essential part of the rehab process that helps the in-clinic rehab develop into more real-life durability.

 Stage 6: Cruise Control

Stage 6 of concussion recovery is the stage in which your symptoms are relatively stable. The new normal is well understood; you’re aware of any limitations you have, and you’re slowly improving these limits over time. If you get to this stage and feel normal, then congratulations. You’ve made it through the six stages of concussion recovery!

If you’re here and there are still unresolved issues, you will likely return to stage 4 and continue through the remaining stages until your symptoms resolve. A majority of the people we see clinically will have been looping through stages 4-6 for months, sometimes years. If this resonates with you, our advice to you is this: Don’t give up.

We understand sometimes it feels impossible to navigate healthcare to find relief. We get you’ve seen countless doctors and run so many tests despite them being “normal.” We get that most people still wonder why you’re still going to doctor’s visits because “they had a concussion once, and it healed on its own.”

Lastly, we get some days when it seems impossible you’ll ever get back to who you were before the accident. This is the norm for most of the patients we see. If this is your situation, we see you, hear you, and we’re sorry the struggle has been tough. Keep going. You’re one good decision away from finding relief.

Concussion Stages Can Help You Understand Your Care Moving Forward

Recovering from a concussion often feels like an uphill battle. Factors like the severity of the injury, previous medical history, and lifestyle choices influence it. Understanding these stages and factors can help you navigate the path to wellness with resilience.

It’s essential to recognize that recovery times can vary, and there is no one-size-fits-all solution to relief. Cultivate patience, communicate openly with healthcare professionals, and build a robust support system. Although the journey may be challenging, set limits and surround yourself with the support you need to keep pushing forward.

It’s OK not to be OK, and we’re here to help with whatever questions you may have.

Click here to read our 88+ 5-star Google reviews from people who have suffered with post-concussion symptoms and improved with care in our office!

And see what Kim had to say about her experience at The Neural Connection:

“Dr. Reis is an incredible practitioner who helped me so much in my recovery from a mild traumatic brain injury (concussion) sustained three years ago. Not only did he provide therapies that improved my symptoms in a remarkable way, he gave me hope that I would get my life back and that my future was bright!

I highly recommend Dr. Reis for TBI recovery (concussion) and chiropractic care.”

If you or a loved one is struggling with the effects of a concussion, click here to set up a consultation call with one of the doctors at The Neural Connection.

*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Thus, patients are advised to consult their medical provider or primary care physician before trying any therapies at home.