A concussion is a form of mild traumatic brain injury caused by a blow or jolt to the head, or an impact to the body that causes the brain to move rapidly within the skull.
Although a concussion does not always cause visible damage on standard brain imaging, changes can occur at a microscopic and cellular level. These changes can temporarily affect how brain cells produce energy, communicate with each other and regulate normal neurological function.
One important part of this response is neuroinflammation — the inflammatory response that occurs within the nervous system following an injury.
This helps explain why concussion can affect much more than just the head, potentially influencing thinking, vision, balance, movement, sleep, mood, energy and tolerance to physical or mental activity.
Inflammation is a normal part of the body's response to injury. In the brain and nervous system, this process is known as neuroinflammation.
Following a concussion, the initial trauma can trigger changes involving the blood-brain barrier, immune signalling and specialised immune cells within the brain called microglia. These cells normally help maintain and protect the environment around neurons and their connections.
When injury occurs, microglia become activated as part of the brain's response to damage. This inflammatory response is important during the early stages of recovery, helping the nervous system respond to and repair injured tissue.
The problem is not inflammation itself. The important question is whether this response resolves appropriately as recovery progresses.
If inflammatory signalling remains altered, it may affect the environment in which neurons communicate and recover. This is one reason why persistent symptoms following concussion need to be considered from a broader perspective rather than assuming that the original impact is the only ongoing problem.
Neuroinflammation is therefore one part of a much larger recovery process involving brain metabolism, energy availability, blood flow, neuronal communication and nervous system regulation.
Concussion recovery is different for everyone.
For some people, headaches and neck pain are the main problem. Others may experience dizziness, visual disturbances, balance problems, fatigue, poor concentration, sleep disruption or difficulty tolerating exercise.
Following the initial injury, the nervous system also needs to restore normal communication and energy regulation. Neuroinflammation forms part of this response, and inflammatory signalling can influence the environment surrounding neurons and their connections.
Recovery may also be influenced by sleep, stress, nutrition, physical activity, previous injuries, physical conditioning and the demands of work or sport.
Rather than viewing persistent symptoms as a single problem, concussion rehabilitation should consider how these different factors may interact and which ones are most relevant to the individual.
Following a concussion, you may experience:
Concussion symptoms can be broad and sometimes difficult to connect with the original injury, particularly when they persist after the initial trauma. These symptoms do not necessarily mean that ongoing neuroinflammation is their cause — persistent concussion symptoms can result from multiple overlapping factors, which is why identifying the individual pattern behind your symptoms is important.
My approach combines Physiotherapy, Osteopathy and Psychoneuroimmunology to assess both the physical consequences of concussion and the broader factors that may influence neurological recovery.
Assessment may consider your neck and musculoskeletal function, balance, neurological symptoms, exercise tolerance, sleep, stress, recovery, nutrition and lifestyle factors.
From there, rehabilitation is progressively adapted to your symptoms and capacity. Depending on your presentation, treatment may include manual therapy, exercise rehabilitation, aerobic conditioning, balance and movement exercises, and strategies aimed at managing factors associated with neuroinflammation and supporting brain recovery.
This may involve addressing areas such as physical activity, sleep, nutrition, stress and recovery, alongside the more traditional physical components of concussion rehabilitation.
The aim is not prolonged rest, but a safe and progressive return to activity, gradually increasing physical and cognitive demands as your tolerance improves.
Concussion rehabilitation works alongside appropriate medical care and does not replace medical assessment following a head injury, particularly when symptoms are severe, new or worsening.
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