Concussion – the risk of secondary concussion

Why is full recovery from concussion so important before returning to play?

Many people who participate in sport each year suffer from a concussion. Whilst they are all too frequent in contact sports, they often occur in non-contact sports as well. Recovery from the symptoms of concussion generally takes 7-10 days, which is why often individuals have returned to their chosen sport a week after suffering from a concussion. Unfortunately there is a growing body of research to show that this is far from safe and could lead to permanent brain injury if there is a secondary concussion occurring before your brain has completed its full recovery.


The graph below looks at the brain energy levels (or ATP) in relation to time, with relation to concussion injuries.

The first blue line indicates normal health brain levels. When you receive a concussion you generally lose about 20% of ATP in the brain.

Provided you allow the 3 – 4 weeks of recovery, your brain will often get back to normal brain energy levels and you’ll likely have no long term effects from cell death. This is why you may read from many concussion researchers or have heard the phrase ‘most concussions recover on their own.’ After this full recovery our brains will look the same as someone who did not receive a concussion. 

Now, if you go back too early…. Lets say at 7 – 10 days after injury (which is when a lot of people do go back – you see this a lot in professional sports although it is slowly changing) and receive another concussion, here’s what happens. Your brain energy levels can go down to around 60% and now your vulnerability period has increased to 3 – 4 months, meaning much more time spent on the sidelines and potentially now risking permanent brain cell death.

So what happens if you go back in 1-2 months and receive another concussion? 

Now your brain energy level can go as low as 40% of it’s normal level and the vulnerability period has expanded to up over a year. This is the reason you see a lot of professional athletes out for long periods of time and why they are having so many problems with their concussion resolution. Basically we are returning athletes to play too soon, based mostly on symptoms and getting through the return to play (RTP) process as quickly as possible. Essentially what’s happening in these cases is these athletes can’t ever get out of the vulnerability period.  

Here is the scary part…  Anything below the 60% brain energy levels (or the red line) can cause cell death. Meaning you can lose functions in the brain that you will NEVER get back. 

Is there a risk of brain cell death if I return to play after I have fully physiologically recovered? 

The current research tells us there is no risk. Below is a graph of what happens if you fully recover and then receive another concussion. As we have learned, with each concussion, your brain energy levels will go down 20%. What is known is that provided you allow time for complete physiological recovery, your brain will return to its normal energy levels, just as it was prior to your concussion. If you allow this to happen, another concussion will result in no cell death or long-term complications. 

It doesn’t matter if you get 10 concussions over 5 years. As long as you recover from each one, you’re good to go!!


What is important to understand is that concussions are a multifaceted injury, so whilst your brain energy levels may fully recover, this does not necessarily indicate that you are fully recovered from every symptom. Research shows that several factors need to be addressed to help deal with your injury properly. This includes a combination of:

– visual

– oculomotor

– exercise

– passive and active treatment of the neck

– vestibular

– diet


AND they need to be done simultaneously.

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