How long does a concussion last?

Summary: The quick answer is that we expect your concussion symptoms to go away in about one week, and we expect a complete recovery (e.g., regular, symptom-free physical and cognitive activity) within about 3-4 weeks. But that's not always what we see. Learn more below.  

What is an expected concussion recovery timeline?

Let's talk about the "textbook" timeline first, and then we'll look at what we see in the crazy and wild world. 

• Day 0: Concussion/Injury

• Days 3-5: Symptoms tend to peak (be at their worst)

• Days 5-10: Symptoms begin to resolve/go away

• Days 21-30: Brain energy metabolism normalizes, and symptoms are usually gone. 

Something might look funny about this timeline: "Isn't the concussion return-to-play protocol only seven days? What's this three-week talk about?" 

Well, my friend, that seven-day protocol is far too short given what we know about dynamic (e.g., sport) exercise tolerance, reaction time, visual processing, and proprioception recovery times after a concussion. But don't just take my word for it. Let's look at some numbers and data - I made it digestible and not too nerdy. 

Study #1: A two-year study on 594 individuals with a concussion. 

You can see the recovery times (color-coded) by age group above. Generalized across all ages, we see that:

• ~45% of folks meet recovery criteria at two weeks.

• ~77% of folks meet recovery criteria at four weeks. 

• ~94% of folks will meet recovery criteria at eight weeks.

• ~5-6% of folks will take longer than eight weeks to recover.

What does recovery mean in this study?

• PCSS (i.e., symptom score) <5 for males

• PCSS (i.e., symptom score) <6 for females

• Resolution of any abnormal exam findings

• Normal Exercise Tolerance (85-90% HRmax without symptoms)

Study #2: A 2022 JAMA study on 991 patients with concussions diagnosed at an emergency department.

In this study, only 27% of individuals demonstrated functional recovery at two weeks, and 73% of individuals with incomplete recovery. Following it even further, only 44% of individuals showed functional recovery at six months. 

How did this impact these individuals' quality of life? Many of these folks reported:

• Difficulty returning to social activities outside of the home

• Disruptions in family/friend relationships

• Disruptions in work

• An inability to return to pre-injury/baseline life 

Key Points

• A standard concussion recovery (with rehab) should take approximately 3-4 weeks, and we see about 77% of people meet this mark. 

• Concussion recovery isn't just about symptom recovery, we also need to see regular exercise and cognitive tolerance. 

• Concussions, despite being considered "mild traumatic brain injuries," can have significant and long-lasting impacts on symptoms and overall quality of life. 

• The incomplete recovery and decreases in quality of life are multifactorial, but two significant factors that could minimize these risks are proper patient education and timely rehabilitation. 

For example, research shows that seeing a concussion specialist within the first week of your injury can improve your recovery time by 57-110 days! Recent research on early, prescribed aerobic exercise found a 48% decreased risk of persistent concussion symptoms (PCS) in adolescents. And we also know that just informing you (the patient) about what is going on, why you are feeling what you are feeling, and how we can improve your symptoms can be a weight off your shoulders by itself. 

Finding the right provider can be challenging, and providers can often bounce folks through the system from specialist to specialist with no real answers. If you're in this boat and looking for an organized, evidence-based online program to recover from your concussion/PCS, check out the Concussion Reset Program or the growing list of Concussion Mini-Courses from Arizona Vitality. 

Consider scheduling a discovery call for a comprehensive, one-on-one concussion recovery package with Dr. Mark. Throughout three visits, you will have a complete assessment (along with rehab prescriptions) of your autonomic, metabolic, visual, vestibular, and cervical spine systems, along with appropriate mental health and neurocognitive screening. 

References:

• Kara, S., Crosswell, H., Forch, K., Cavadino, A., McGeown, J., & Fulcher, M. (2020). Less than half of patients recover within 2 weeks of injury after a sports-related mild traumatic brain injury: a 2-year prospective study. Clinical journal of sport medicine, 30(2), 96-101.

• Madhok, D. Y., Rodriguez, R. M., Barber, J., Temkin, N. R., Markowitz, A. J., Kreitzer, N., ... & TRACK-TBI Investigators. (2022). Outcomes in patients with mild traumatic brain injury without acute intracranial traumatic injury. JAMA network open, 5(8), e2223245-e2223245.