Signs and Symptoms

The information provided on this page is for informational purposes only.  The definition of a concussion, signs and symptoms and management are according the 4th International Conference on Concussion in Sport (Zurich, November 2012).


Concussion is a brain injury and is defined as a complex pathophysiological process concussion-oaffecting the brain, induced by biomechanical forces.

  • Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.
  • Concussion typically results in the rapid onset of short-lived impairments of neurological function that resolves spontaneously.
  • The majority (80-90%) of concussions resolve in a short (7-10 day) period, although the recovery time frame may be longer in children and adolescents.


It is important to understand that the injury is within the brain that is inside of the skull. Axon connections that carry messages throughout the brain can be stretched and torn, resulting in damage. Many times CT scans and MRIs results will come back normal because the level of damage may not be detected on these scans. At times a concussion is thought of as a bruise on the brain, this is a cerebral contusion and not a concussion. Both can be present, but it is important to understand the difference. Also, cerebral contusions generally result after a severe TBI.

Diagnosis of a concussion is made by a medical professional by using various tools like a symptom questionnaire and cognitive testing. Thus, knowing the signs and symptoms of a concussions helps aid in the diagnosis process.

The diagnosis of concussion can include one or more of the following:

  1. Symptoms-somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional symptoms (eg, lability)
  2. Physical signs (eg, Loss of Consciousness (LOC), amnesia)
  3. Behavioral changes (eg, irritability)
  4. Cognitive impairments (eg, slowed reaction times)
  5. Sleep disturbance (eg, insomnia)


Following the diagnosis of a concussion, immediate physical and cognitive rest are important. Most concussions resolve within 7-10 days. If symptoms last longer, exercise my aid in the recovery process. Returning to play follows a progression to ensure the athlete’s symptoms don’t worsen. There are 6 steps in Return to Play. An athlete cannot move to the next step until they are symptom free and their symptoms are not worsened by increasing level of activity.

Step 1: No activity

Step 2: Light aerobic exercise for 5 to 10 minutes – walking, light jogging, or biking to increase heart rate –  no resistance training, <70% max heart rate

Step 3: Moderate exercise for a reduced time from typical routine – increase intensity of previous activities, can add moderate-intensity weightlifting – sport specific exercise with no head impact activities

Step 4: Non-contact exercise/training drills: increase intensity of previous activities and can add cognitive component – can start progressive resistance training

Step 5: Reintegrate into full contact practice

Step 6: Return to Play – Normal game play


A lot of focus is put on return to play for athletes. While this is definitely important to concussion management and to the athlete, equally important is returning to learn following a concussion. Cognitive rest can include taking breaks from school and athletes can fall behind in their work. Additionally, tasks at school can become more demanding then before a concussion. It is important for athletes and parents to work with school personnel and teachers for any accommodations that may be needed to assist the athlete in continuing to succeed in school during their recovery.

To read more on the 4th International Conference on Concussion in Sport, click here.