Outlining the Research Behind a Proactive Approach to Post Concussion Syndrome

Why Can Post Concussion Symptoms Persist?

Most people improve within a few weeks, but recovery is different for everyone. Some people have symptoms for much longer - and research shows there can be identifiable reasons why. [1][2][3]

Having symptoms for months or even years is a recognised pattern, particularly after more than one concussion. [4]

A normal CT or MRI does not mean your symptoms aren't real. Concussion often affects how the brain and connected systems work, rather than something that can be seen on a scan. [5]

The key is to look for the drivers behind your symptoms, rather than simply treating the symptoms themselves.

Common drivers include:

Autonomic nervous system
Changes in how the nervous system regulates things such as heart rate and blood flow can contribute to exercise intolerance and other symptoms. [6][7]

Inflammation
Research has found signs of ongoing neuroinflammation in some people with persistent symptoms. [8]

Vision and balance
Problems with how the eyes and balance system work together can contribute to dizziness, reading difficulties and sensitivity to busy environments. [9]

The neck
Neck problems can contribute to headaches, dizziness and other symptoms, and can sometimes be present even when neck symptoms aren't obvious. [10]

Stress, mood and fear of symptoms
Stress and fear of symptoms can influence recovery. Avoiding activity because of fear can also contribute to ongoing problems. [11][2]

These drivers can overlap, which is why a systematic, individual approach can be more useful than simply trying one treatment after another.

What About Rest?

The evidence no longer supports prolonged rest as the main approach to concussion recovery.

A large analysis of more than 4,000 people found that prescribed rest did not speed recovery, while prolonged rest may actually worsen symptoms. [15]

For persistent symptoms, research also supports targeted rehabilitation, including:

  • Aerobic exercise [16][17][18]

  • Neck and vestibular rehabilitation [19]

  • Graded exposure to activities that have become difficult or feared [20]

The aim isn't to simply push through symptoms but to identify what is contributing to them and gradually work on the areas that need attention.

Taking a More Systematic Approach

If your recovery has stalled, consider:

1. Addressing the foundations
Sleep, daily activity, nutrition, nervous system regulation, education and reducing fear around symptoms.

2. Target the drivers
Where appropriate, work with a concussion trained clinical specialist on specific areas such as the neck, vision, balance or exercise tolerance.

3. Build back gradually
Increase activity progressively over time and monitor how you respond. Don’t give up!

Lingering symptoms don't mean your brain is permanently injured but may be an indication that one or more systems still need attention.

Understanding the possible drivers gives you a clearer starting point - and a more systematic way forwards.

Adapted from CompleteConcussions.com.

References:

  1. Dery V, et al. (2025). Recovery from Mild Traumatic Brain Injury in the Nonathletic Population: A Systematic Review.
    Finding: Most people improve within weeks to months, although recovery varies.

  2. King S, et al. (2025). Recovery Trajectories of Patients with Mild Traumatic Brain Injury.
    Finding: People follow different recovery patterns, with some experiencing persistent symptoms.

  3. Keatley E, et al. (2023). Longitudinal Trajectories of Post-Concussive Symptoms Following Mild Traumatic Brain Injury.
    Finding: Recovery follows different trajectories rather than one predictable path.

  4. Stenberg M, et al. (2024). Symptoms and Disability after Mild Traumatic Brain Injury: A Five-Year Follow-up.
    Finding: Some people continue to experience symptoms years after injury, particularly after repeated injury.

  5. Bishay AE, et al. (2025). Atypical Symptoms Following Concussion: A Comprehensive Review of Functional Deficits.
    Finding: Some concussion-related problems are not visible on standard imaging and may require targeted assessment.

  6. Pelo R, et al. (2023). Autonomic dysfunction and exercise intolerance in concussion: a scoping review.
    Finding: Autonomic changes and abnormal responses to exercise can occur after concussion.

  7. Wesolowski E, et al. (2024). History of concussion and lowered heart rate variability at rest beyond symptom recovery: a systematic review and meta-analysis.
    Finding: Changes in heart-rate regulation may persist beyond apparent symptom recovery.

  8. Gard A, et al. (2023). Cerebrospinal fluid levels of neuroinflammatory biomarkers are increased in athletes with persistent post-concussive symptoms.
    Finding: Some people with persistent symptoms show signs of ongoing neuroinflammation.

  9. Devani K, et al. (2024). Convergence insufficiency as a predictor of poor prognosis after acute mild traumatic brain injury.
    Finding: Problems with eye convergence are associated with poorer recovery.

  10. Kinney AET, et al. (2024). Cervical spine sensorimotor deficits persist in people post-concussion despite minimal symptoms.
    Finding: Neck-related problems can persist even when neck symptoms are minimal.

  11. Ornstein TJ, et al. (2022). The Mediating Role of Pain Catastrophizing in Mild Traumatic Brain Injury.
    Finding: Pain-related fear and psychological distress can contribute to functional difficulties.

  12. Iverson GL, et al. (2020). Systematic Review of Preinjury Mental Health Problems as a Vulnerability Factor for Worse Outcome After Sport-Related Concussion.
    Finding: Pre-existing mental health difficulties are associated with a greater risk of prolonged recovery.

  13. Martin AK, et al. (2020). Concussion symptomology and recovery in children and adolescents with pre-existing anxiety.
    Finding: Pre-existing anxiety is associated with more symptoms and slower recovery in young people.

  14. Robinson M, et al. (2022). Two Symptoms to Triage Acute Concussions.
    Finding: Early feelings of being in a fog or feeling down may help identify people at greater risk of prolonged recovery.

  15. Kontos AP, et al. (2023). The Effects of Rest on Concussion Symptom Resolution and Recovery Time.
    Finding: Prescribed rest did not speed recovery, while prolonged rest may be unhelpful.

  16. Leddy JJ, et al. (2023). Rest and exercise early after sport-related concussion: a systematic review and meta-analysis.
    Finding: Gentle activity and appropriately prescribed aerobic exercise can support recovery.

  17. Art K, et al. (2023). The Effectiveness of Physical Therapy Interventions for Athletes Post-Concussion.
    Finding: Aerobic and multimodal rehabilitation can improve symptoms and recovery.

  18. Mercier LJ, et al. (2025). Effect of Aerobic Exercise on Symptom Burden and Quality of Life in Adults With Persisting Post-concussive Symptoms.
    Finding: Supervised aerobic exercise can be safe and improve quality of life in adults with persistent symptoms.

  19. Langevin P, et al. (2022). Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury.
    Finding: Targeted neck and vestibular rehabilitation can improve relevant symptoms and function.

  20. Rioux M, et al. (2025). Graded exposure therapy for adults with persistent symptoms after mTBI.
    Finding: Gradually returning to activities that have become difficult or feared may help people with persistent symptoms.