5 Misconceptions About Concussions

Concussions are one of the most misunderstood injuries. Despite growing awareness, many myths persist that can actually hinder recovery or lead to improper care. Let’s debunk five common misconceptions about concussions.

1. Rest is the Best Treatment

The Myth: Complete rest in a dark room until all symptoms resolve is the gold standard for concussion recovery.

The Reality: While a brief period of rest (24-48 hours) following a concussion is recommended, prolonged rest can actually be counterproductive. Research now shows that early, gradual return to light activity promotes faster recovery.

Extended bed rest can lead to:

• Physical deconditioning
• Increased sensitivity to stimuli
• Mood disturbances like anxiety and depression
• Prolonged recovery times

The current evidence-based approach involves:

• Initial rest period of 24-48 hours
• Gradual reintroduction of cognitive and physical activities
• Symptom-limited activity (doing activities up to the point where symptoms mildly increase)
• Individualized rehabilitation programs targeting specific deficits

2. You Must Lose Consciousness to Have a Concussion

The Myth: If you didn’t “black out” or lose consciousness, you couldn’t have sustained a concussion.

The Reality: Loss of consciousness occurs in less than 10% of all concussions. The vast majority of people who sustain a concussion remain conscious throughout the injury.

Concussion symptoms can include:

• Headache
• Dizziness or balance problems
• Confusion or feeling “foggy”
• Memory problems
• Sensitivity to light or noise
• Nausea
• Fatigue
• Sleep disturbances
• Mood changes

If you experience any of these symptoms following a blow to the head or body, you may have a concussion regardless of whether you lost consciousness.

3. Your Head Needs to Be Hit Directly

The Myth: A concussion can only occur if something directly strikes your head.

The Reality: A concussion results from the brain moving rapidly within the skull. This can happen without any direct contact to the head.

Common non-head-contact scenarios that can cause concussions:

• Whiplash injuries from car accidents (which can also cause neck pain)
• Falls where the body hits the ground but the head doesn’t
• Sudden deceleration or acceleration forces
• Blows to the body that transmit force to the head
• Blast injuries

Any force that causes the head to move rapidly can result in the brain shifting within the skull, potentially causing a concussion.

4. Understanding Coup-Contrecoup Injuries

The Myth: Brain injury only occurs at the point of impact.

The Reality: When the head experiences a force, the brain can be injured at multiple locations through what’s called a coup-contrecoup mechanism.

Here’s how it works:

• Coup injury: Occurs directly beneath the point of impact, where the brain strikes the inside of the skull
• Contrecoup injury: Occurs on the opposite side of the brain, as the brain rebounds and hits the opposite side of the skull

This explains why:

• Symptoms may not correlate with the location of impact
• Injuries can be more widespread than expected
• Comprehensive assessment is essential
• Different symptoms can arise from different areas of brain involvement

Understanding this mechanism helps explain why two people with seemingly similar injuries can present with very different symptoms.

5. You Can Resume Normal Activities When Symptoms Subside

The Myth: Once you feel better and your symptoms have resolved, you’re fully recovered and can return to all activities.

The Reality: The absence of symptoms at rest does not mean the brain has fully healed. Returning to activities too quickly can:

• Trigger symptom recurrence
• Prolong overall recovery
• Increase the risk of second impact syndrome (a rare but serious condition)
• Lead to persistent post-concussion symptoms

A structured return-to-activity protocol is essential:

Return to Learn/Work

1. Symptom-limited activity at home
2. Gradual reintroduction of cognitive tasks
3. Part-time return with accommodations
4. Full return with accommodations
5. Full return without accommodations

Return to Sport

1. Symptom-limited activity
2. Light aerobic exercise
3. Sport-specific exercise
4. Non-contact training drills
5. Full contact practice (medical clearance required)
6. Return to competition

Each stage should be at least 24 hours, and progression only occurs if symptoms don’t worsen. If symptoms return, step back to the previous stage.

The Bottom Line

Concussion management has evolved significantly in recent years. The best approach involves:

• Proper initial assessment and diagnosis
• Brief initial rest followed by gradual return to activity
• Individualized rehabilitation targeting specific deficits
• Structured return-to-activity protocols
• Medical clearance before returning to contact sports

If you’ve sustained a concussion or are experiencing ongoing symptoms, working with a healthcare provider trained in concussion management can help ensure optimal recovery.

Concerned about a potential concussion or struggling with recovery? Contact us to schedule an assessment with our concussion rehabilitation team.