Questions and Answers about Concussion Management

What is a Concussion?

 A concussion is a form of mild traumatic brain injury (mTBI) caused by a rapid acceleration or deceleration of the brain in the skull leading to changes in cellular function within the brain. Mild traumatic brain injury (mTBI) can result from a blow, bump, or jolt to the head or body and can result in a variety of symptoms including headache, nausea, confusion, neck pain or dizziness. Each concussion can range in severity from mild to severe and can cause a wide range of symptoms. 

What are the symptoms of a concussion?

It is important to note that after sustaining a concussion, symptoms may or may not immediately show up and people who are suspected of sustaining a head injury should be closely supervised for the appearance of new symptoms.

New symptoms can appear in the next 24-48 hours after a head injury. The symptoms of a concussion can be wide ranging and can vary in intensity as well as from individual to individual. You do not have to have all of these symptoms to have a concussion. Symptoms vary from person to person and injury to injury. 

The most common symptoms of concussion include, but are not limited to:

  • Headache
  • Neck Pain
  • Dizziness
  • Nausea/vomiting
  • Feeling tired, “not right”, or emotional
  • Confusion
  • Ringing in the ears
  • Irritability
  • Sensitivity to light
  • Sensitivity to noise
  • Blurry vision
  • Difficulty concentrating
  • Fatigue or drowsiness
  • Mood changes
  • Difficulty sleeping

It is important to note that a person DOES NOT have to lose consciousness to sustain a mTBI. In fact, about 90% of concussions occur without a loss of consciousness. Remember that symptoms can vary in intensity as well as in the number of symptoms present.

It is also important to note that many of these symptoms can be a result of other injuries (whiplash, migraines, dehydration, etc). In order to distinguish between other pathologies and concussions, it is important to remember that a bump, blow, or jolt to the head or body MUST have occurred in order to be diagnosed a concussion. 


When should a person be evaluated by a medical professional?

Following a suspected concussion a person should be moved to a safe area and evaluated by a licensed healthcare professional who is familiar with head injuries. Healthcare professionals that can help with the diagnosis of a concussion include physical therapists, athletic trainers, nurses, PA’s, nurse practitioners, EMTs, and physicians.

A player should NOT be returned to play on that same day. Clink here to access Montana’s concussion laws.

After sustaining a concussion, a person should be monitored for worsening symptoms and seek emergency medical attention (call 9-1-1) if any of the below signs/symptoms are observed:

  • Vomiting
  • Seizure
  • Memory Loss
  • A headache “like no other”
  • Fluid or blood coming from the ears, nose or mouth
  • Slurring of speech
  • Numbness or tingling in the arms or legs
  • Increasing irritability or unusual behavior
  • Difference in pupil size
  • Black or blue discoloration below the eyes or behind the ears
  • Cessation of breathing
  • Loss of consciousness 

How long does it take to heal from a concussion?

We used to think that most mTBI symptoms would resolve in 7-14 days. However current research shows us that it takes much longer for the brain to heal.

Recovery from a concussion is a spectrum and varies from patient to patient. For some, recovery can mean complete resolution of symptoms and a return to baseline status. Unfortunately for others, recovery may mean managing multiple residual symptoms. Recent research studies show that taking an active role in concussion treatment can help ensure that you maximize healing. 

It is highly recommended to reduce the intensity of mental and physical activity for 24-48 hrs following a concussion and then gradually begin a step-wise program working toward a return to normal activities as symptoms allow. However, this should be determined on a case by case basis by a licensed healthcare professional after a complete evaluation. Symptoms lasting longer than a few weeks/months are often referred to as “post-concussion syndrome” or “persisting post-concussion symptoms” and may warrant further medical evaluation and specialized treatment.

How can Physical Therapy help with concussion related symptoms?

Every head injury is different and therefore requires a different, individualized treatment approach. The Physical Therapists at Optimal Sports Physical Therapy have specialized concussion training and will complete a thorough concussion evaluation assessing your orthopedic, neurological, and cardiovascular systems in order to prescribe a plan that fits your particular needs and helps you return to your normal activity level. 

Commonly, physical therapy interventions for concussion rehab will focus on symptom management, restoration of strength and endurance, reducing dizziness, reducing headaches and neck pain, improving balance, and more. Attention to safely progressing your return to daily activities and return to play is an important part of how our therapists can help you.

Exercises and activities may also be performed for oculomotor rehab. Exercise progression will typically follow a step-wise progression working to get you back toward your normal activity level. Some of the most common physical therapy interventions include: manual therapy, therapeutic exercise, neuromuscular re-education, oculomotor rehab, vestibular rehab, and other treatments to help you maximize healing.  

I think I have a concussion. What should I do?

If you have sustained a blow, bump, or jolt to the head or body and are now experiencing symptoms, you should be evaluated by a licensed healthcare provider with specific training and education managing concussion as soon as possible. Research shows that the sooner you start treatment, the better. Studies show that light, appropriate, symptoms free activities can actually help the healing process.  Local options for concussion evaluation include:

  • Optimal Sports Physical Therapy
  • Urgent Care
  • Prompt Care
  • Performance Injury Care and Sports Medicine
  • Your Primary Care Provider (PCP)
  • Your pediatrician

Can I work after a concussion? 

This is a question that is best answered on an individual basis. For most people 24-48 hours of relative rest is recommended after sustaining a concussive injury. That rest can include a much lighter than normal level of activity as symptoms tolerate. Often, your specific job demands combined with your symptoms will likely determine how soon you can return to work.

While some people may be able to return to work after the initial rest period, others may require additional treatment or an individualized return-to-work process. Some people may require limited work duties, limited work hours, and work modifications initially and until symptoms allow a full return to normal, full duty activities. 


Will I make a full recovery after a concussion? 

“Recovery” is tough to predict for concussion injuries. Many people with a concussion do make a full recovery and are able to continue to live life without any limitations, however some individuals with traumatic brain injuries unfortunately continue to experience residual deficits and persisting symptoms. These deficits can include difficulty with memory, difficulty concentrating, difficulty with school and/or work, headaches, chronic pain, or balance problems and more. 

For your best chance of experiencing a full recovery, we recommend getting a thorough concussion evaluation with a trained concussion specialist. We also recommend starting active treatment as soon as possible so that Optimal Sports Physical Therapy can guide you in your concussion recovery process and help you achieve your goals. 

In addition to physical therapy, are there other things I can do to help recover from a concussion? 

Absolutely! Active rehab has been shown to help aid  concussion recovery. Current recommendations include 24-48 hours of relative rest after a concussion and then beginning a step-wise progression of exercise working toward a return to normal activities. Guidance on how to progress will be provided to you by your physical therapist. In addition to the exercises prescribed by your PT, proper nutrition and hydration can really help your healing process.

The current nutrition recommendations include:

  • A healthy, well balanced diet
  • Increase Omega3 foods
  • Increase protein consumption
  • Do not restrict caloric intake while healing
  • If experiencing nauseousness, eat a bland diet and smaller portions until normal appetite returns
  • Hydrate well throughout the day
  • Consider an electrolyte drink if needed
  • Avoid caffeine, alcohol, and smoking

For more details on nutrition for concussion recovery , visit NATA: 

Ask your healthcare provider if there are supplements that may help your brain heal. 

Are there specific concussion laws in Montana?

Yes! In Montana, many laws exist to protect your child athlete. Click here to see the MT Concussion Laws. The age of the child as well as what league and sport the athlete plays in will help determine which law(s) are applicable in your situation. As always, we recommend contacting a lawyer if you need legal assistance. 

For high school athletes, the Montana High School Athletic Association has several policies and procedures for concussions including insurance for athletes affected by concussion; education of parents, athletes, and coaches; removal from play if a concussion is suspected; and clearance by a licensed healthcare professional prior to returning to play. 

In 2013, the state legislature enacted the Dylan Steigers Protection of Youth Athlete Act requiring each high school to adopt policies removing athletes from play, seeking return to play clearance from a licensed healthcare provider, providing concussion education to parents, athletes, and coaches. 

In 2017, the state legislature enacted HB487 to expand the protection provided in the Dylan Steigers Protection of Youth Athlete Act to non-public schools and youth athletic organizations. This law would pertain to Helena Small Fry Football, HYSA, and other youth athletic leaques. 

For more information on Montana concussion laws for youth athletes, please check out the DPHHS website. 

If you are in need of more information on concussion or an evaluation of a concussion for yourself or your child, please contact Optimal Sports Physical Therapy. Our physical therapists are specifically trained on concussion recognition, assessment, and treatment. We can help guide you with treatment, recovery, and return to play decisions. Don’t delay, call today! 

 Additional  Concussion Information:

Get connected with concussion! Stay up-to-date with local concussion groups! For more information: