Taking a punishing hit on the football field or soccer pitch; having your head jostle around during a car accident; experiencing a fall from a ladder. 
 
An estimated 3.8 million concussions occur each year throughout the U.S. as a result of sports and non-sports activities. While their severity can fluctuate based on a number of factors, more than half go unreported. And their elusiveness to medical imaging makes proper diagnosis and recovery all the more important.

“You can see a broken leg or a broken arm on an image, but the brain doesn’t look any different from a concussion,” said Dustin Clow, a physical therapy professor within UNLV’s School of Integrated Health Sciences. “Because there is no single test to confirm a concussion, it becomes a clinical diagnosis based on how the patient is feeling and signs the healthcare provider can see.”
 
Clow has been a physical therapist for nearly 15 years and has been a board-certified sports specialist since 2020. He says that if, following a hit to the head, you’re experiencing common concussion symptoms like dizziness and headaches, it’s best to see a medical professional.

The Danger of Concussions

When a person suffers a concussion, they experience a mild form of brain injury, resulting in a transient loss of function to certain parts of the brain. Clow says that, from a physiological perspective, concussions place individuals at-risk of having a more serious injury as a result.
 
“Concussions affect your balance, vision, tolerance for activity, focus, and your ability to react. And all of these things increase the risk of other, unrelated injuries,” he said. “If your brain isn’t able to process the way it used to before the concussion, you may not be able to do what you need to do to function on a daily basis.”
 
Each concussion is different and can impact the brain in multiple ways, depending on which part of the brain is injured. A provider will typically conduct a few different tests to determine if a person is concussed, including balance evaluations, reaction-time tests, and computerized neurocognitive exams.
 
“What makes it scary is that repeated concussions can cause permanent changes in the brain,” he said. “We have correlational research that shows multiple concussions are related to chronic traumatic encephalopathy.”
 
Chronic Traumatic Encephalopathy, or CTE, is a neurodegenerative disorder that can develop after multiple impacts or blows to the head, leading to the destruction of brain cells which can alter behavior and mental abilities over time.
 
While concussions can inhibit our ability to physically perform at our maximum level, Clow said the potential long-term impact of concussions can include reduction in cognitive and motor function. This can be especially apparent for athletes suffering from repeated head injuries. 
 
“If I see a ball flying at my face, do I process the fact that the ball is flying at my face quickly enough to do something about it?” he said. “If I can’t process things the way I used to, and I’m not recovering completely, I could get more injuries that hinder my ability to do what I’ve always done.” 

Non-Sports Concussions

While millions of sports-related concussions are reported each year, older populations endure some of the highest rates of concussions from the impact of falls.
 
People aged 75 and older had the highest numbers and rates of traumatic brain injury-related hospitalizations and deaths, accounting for nearly a third of related hospitalizations and a quarter of all related deaths.
 
As Clow points out, head injuries can often go overlooked among this population as more noticeable physical injuries often coincide with accidents and falls.
 
“An older person can suffer a fall and break their arm or hip and suffer a concussion, but we mostly focus on the broken bones instead of the possible brain injury if it doesn’t show up on a scan,” he said.

Treating a Concussion

For those diagnosed with a concussion, Clow says it is critical to take it easy for the first 48 hours, including getting plenty of sleep.
 
“Day three is when you want to start reintegrating activity, but monitor your symptoms to make sure you’re not overdoing it,” he said. “The old school way was to lock that person in a dark room until they felt better. That’s no longer the case as we can’t shut ourselves down or ignore the concussion, but we have to be in touch with our symptoms.”
 
Most concussions will be healed in about three-to-four weeks, Clow says, with as many as half recovering in approximately 10 days. Those with a history of migraines should allow more time to recover.
 
Clow adds that those who have suffered multiple concussions may have more complex symptoms and can also take longer to recover. The biggest change with multiple concussions likely involves imaging.
 
"Most concussions do not require imaging but concussions that have been going on for a long time, or someone with multiple concussions is more appropriate for imaging from their physician to check for any structural changes to the brain,” he said. “You can have mild impact but really bad symptoms, and the opposite is also true. Over the past 20 years, we’ve seen a much more active rehab process but during those first two days it is critical to take it nice and easy.”