5 Stages of Concussion Recovery

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Undoubtedly, you’ve heard of the five stages of grief. I believe that there are also five stages of recovery from concussion, and post-concussion syndrome in particular. Based on my experience, this is what I think they consist of. And while much progress has been made in recent months and the past few years, I imagine much of this still holds true.

View from the mountaintop

1: Injury

These are the days, weeks, and initial months immediately after the injury. Symptoms are at their worst. You have to rest a lot. Your life changes and you begin to adjust as best you can. Everyone around you is supportive.

You research on the web as much as you can. You want to know what is happening in your brain. You have tests done. You go from doctor to doctor, hoping to find something that works. Something might, but it may not.

If you’re lucky, the concussion resolves quickly and this is all you experience. You never get to stage 2 or anything after that. You resume life as you knew it before the injury.

If the concussion symptoms and recovery persist, you eventually find yourself at the second stage.

Important: A concussion can change in the first several days. Even if you’ve been cleared by a doctor or an emergency room, symptoms could change and worsen. If you have any questions or are wondering if you should call a doctor or go to the emergency room, review the information on the CDC site to help make that determination: CDC: Concussion Danger Signs.  (Update on this site 5/27/15)

Update: March 13, 2015 Much has changed since I first wrote this post. This initial stage is very important. There’s been much focus on Return to Play and Return to Learn. New guidelines have been coming out about that. If you’re in this stage, I recommend searching for those two topics (RTP and RTL) to find more information. Also, at this time, the amount of rest following concussion is an evolving, hot topic of discussion and debate. Also, check the information in my Concussion Guidelines for Physicians post. There are links to important guidelines released in 2014 that might be helpful to you.

What hasn’t changed is that if a concussion lingers, you still might have to deal with the situations I describe in the rest of this post. Read on!


2: Insult to Injury

It’s commonly expected that your concussion will resolve within days, weeks, and certainly within a few months. If it goes longer, people start to turn on you. Physicians and those in the medical community, and insurance companies in particular begin to look at you askance. Your character is questioned and attacked, your supposed “motives” looked at suspiciously. You begin to hear terms like malingering and anxiety and accusations of varied sorts. You may be told that you suffer from somatoform – that you have the type of personality that puts forth a “best effort” to recover but that, in actuality, you’re making the symptoms happen. In other words, you’re bringing it on yourself. In other words, it’s psychological, not physical. I disagree. Strongly.

All these accusations occur because concussions aren’t always visible on imaging tests. The MRIs and CT scans don’t always show indication of concussion. While everyone knows this, they still use it as some sort of proof that there’s nothing wrong with you. In my case, my doctors assured me that there was nothing physically wrong with me.

Cognitive tests may not show the problems entirely, either. I strongly believe that the time of day at which you take cognitive tests matters immensely. The tests should be taken when one is most fatigued, in my opinion. That’s the only way to really see how bad it is, I think.

Once you reach six weeks, the tone and approach by doctors might begin to change. Don’t be surprised if character attacks begin. You will learn what “insult to injury” really means. This is based on use of the “Miserable Minority” approach to treatment, I believe. I don’t agree with the term and think it’s very negative and derogatory. However, the medical community has been using this since 1995. I think that this is at the root of the change from treatment and recognition of the physical issues with concussion to a focus on emotional issues. Research that term and you’ll see how many in the medical community view and treat post-concussion syndrome.

This is the point at which you have to fight not only the concussion itself, but all the doctors and insurance companies, and possibly your place of employment or school as well.

3: Hunker Down

At some point in this you’ll realize that, for the most part, the medical community isn’t aware of problems with concussion, let alone how to treat it. Or you’ve taken it as far as you can with treatment you’ve received to date.

Noone.knows.much.about.concussion. This, you finally realize. You are on your own. You realize that further doctor visits, research, or discussion with others are pointless. You stop those activities.

At this point, you hunker down and focus on your recovery, blocking out all else. You put on blinders and look firmly ahead, focus on the successes each day, no matter how small. You trudge on.

Never give up.

That became my motto. So I did, and eventually made it.

Note: This was my experience. This stage might be different for you. There’s much research being done right now and more is becoming known about concussion all the time. I’m hopeful that this is getting better and will continue to do so. I think it will take time, though, for knowledge of concussion to become widely known. So it wouldn’t surprise me to hear that you’ve tried to find doctors that know about it and how to treat it, but you’ve been unable to. If that’s the case, and you’re at this point, settle in. Keep researching, keep up with developments, keep trying, and focus on your recovery.

Update: March 14, 2013. I’m more hopeful than ever that this may be finally changing. I think the medical community is now more aware of concussion, at least. There is progress. However, I still hear about people having to deal with doctors who still know little about concussions and how to treat them. So, unfortunately, I don’t feel I can change this until I stop hearing that this is the case. Keep up with all the changes going on. There’s one way you can do so: follow my Twitter paper: the #Concussion Daily. Here’s a link, and you can also subscribe to it so it’s delivered in email: The #concussion Daily Paper.

Update: December 6, 2013. Wow. A day I never thought I’d see. Today, on Twitter, @the_jockdoc sent out a number of tweets about concussion and how it’s not just a functional issue. And that tests like fMRIs, PET, and more are needed. Made my day! Things are changing, folks. Things are changing. Yet I still long for the day when I can change this section entirely. Until then – hang in there! Stay hopeful!  And please follow @the_jockdoc on Twitter. He’s working hard on this issue. :)

Update: July 2, 2014 It’s getting much better regarding awareness and interest by the medical community. I have more hope than ever. There’s still much to do, but it’s getting there.

Update: February 2, 2015 I’m more hopeful than ever that this is changing. There’s been quite a bit of work in the last year in particular. However, I’m still hearing about difficulties with the medical community for those with PCS. So I can’t take this little section down just yet. Hopefully, that day will come sooner than later. Hang in there!

4: Mountaintop

One day, you find that you made it. You hunkered down and climbed a mountain. The problems and symptoms resolve to a point to where you have important pieces of your life back. Or, you find that you can do much more. Whatever the case, you realize one day that it’s behind you, for the most part. You made it.

The time it takes to reach this point varies from person to person, no doubt. For me, three years stands out, then four, then definitely five. At three years, I was finally able to ride my bike again. At four years, I finished a super-sprint triathlon. At five years – well, it’s part of my history now.

The triathlon was my mountaintop. I also received some recognition for my blog, which I had started as part of my recovery. So that fourth year was my turning point. I specifically remember being out jogging and feeling very strong in my run. I realized that I would be able to participate in the triathlon. That was the moment I crested the mountaintop. It was one sweet moment, let me tell you.

5: Transition

This stage was a big surprise to me. Once on the mountaintop, I was finally able to take off those blinders. I could look around at everything else. I no longer had to focus on my recovery so much. I could stop blocking things out and instead look at everything. Start doing more.

That was a transition period. After several years of hunkering down, it took some time to get out of that mode. I didn’t expect it, but there it was. It just took some time. It wasn’t difficult. In fact, it was a very good time in my life. Very different, though. Yet very rewarding, to say the least.

I won.

I hope you do as well, if you have a long-term concussion and are reading this. Just remember: never give up. Never let the insults deter you or bother you. Focus on yourself and your recovery. Trudge on and climb that mountain. You can do it. Always believe that.

Keep your eye on the prize: stages 4 and 5.

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  1. Hannah says

    Julie- thank you so much for this. I am 13 years old, and have been diagnosed with post concussive syndrome. 3 weeks ago, I was sledding down a hill, but I was unaware there was a 6 foot tall retaining wall at the bottom. I got turned around backwards and ended up falling off the wall and landing on my head. This is my third concussion. I have been having some of the symptoms above, and was overwhelmed from the symptoms and what everyone else has been saying. This site is so helpful to my mom and I in dealing with all of the questions we had, and I’ve learned more about concussions in general. Hearing everyone else’s stories in the comments is so inspiring, as well as your responses. Thank you for everything you do, this site has such a positive impact. :)

  2. Meaghan says

    Thank you for posting this, I experienced my second traumatic brain injury in 6 months in June of 2014. I have been to brain injury rehab which claims it could make me better in 8 weeks after spending two months prior working with a physio therapist. I continue still to have problems with my memory, get agitated easily, and certain sounds drive me crazy that I used to like. I have problems with vertigo and just really regained my ability to read.I have lost my insurance benefits and am going bankrupt. I will lose my car and my condo at the end of this month and am unable to work. The supposed experts I have seen say I should have fully recovered in 12 weeks which I agree is because they are an insurance company that doesn’t want to pay for the medical care of injured workers. I was badly assaulted while at work and everyone keeps referring to it as an accident and trying to tell me I am depressed and that I don’t have a brain injury. I am somewhere between stage 2 and 3 of your stages of concussion. I just wanted you to know that reading this has made me feel not alone for the first time in 8 months.

    • dean says

      Hi, my mane is Dean. Thanks a lot for your help. As far back as I can remember, I can count about 14-15 concussions. Most of these I was knocked unconscious The last one was a tornado.It’s been about four years now,and people just don’t understand. They think just get over it. Well just WISH, it was that simple..But I know I will win this situation.Thanks to God and good people. Thanks again, your friend Dean. p,s, If I can do it, so can you.

  3. Mark says

    Hey Julie,

    First and foremost thank you very much for taking the time to produce this website, it has acted as a life saver for me over the last several months. I struck my head on the underside of a porch 5 months ago and began feeling symptoms about two weeks afterward. These primarily manifested themselves as tiredness, headaches, and a nebulous mental fogginess. Now, five months onward, I am still feeling them although the symptoms are beginning to fade intermittently. I was hoping that you could comment on the transition of your symptoms as you recovered.

    Thank you again for all your help

    • Julie Norris says

      Hi Mark,

      Thanks for the nice comment. I appreciate it! Sorry to hear that you hit your head that way. Ouch! I’m glad to hear that you’re seeing some improvement. I don’t recall anything specific offhand regarding transition of symptoms. My recovery took quite a few years. It was slow, and was a progression, I suppose.

  4. Colin says

    Well it’s been 5 months since I was assaulted
    And I’ve finally been seen by a doctor
    I’m still suffering from dizzy spells and it’s driving me mad
    The good news is the neurosurgeon said I haven’t got anything that requires surgery
    He believes that I’m suffering from post concussion syndrome
    I got home and Googled it, I’ve read the symptoms and it seems spot on, that’s what I’ve got, I just wish it would bugger off
    Now to wait till the 25th March for the neurologist I’m lead to believe he might help these symptoms

    • Julie Norris says

      Hi Colin,

      Your mention of dizzy spells caught my eye. Have your doctors mentioned anything about vestibular physical therapy? That might be something to ask them about. A number of guidelines were released last year, too. Take a look at my Concussion Guidelines for Physicians post. Maybe there’s something in there that would help.

      Good luck, and don’t give up!

  5. Kristen says

    Hi. Was crying while reading this. I sustained an mTBI from a motor vehicle accident in 2004. I’d had a prior concussion in 1999. Since the accident, I’ve had 3 more confirmed concussions. My daily life is a constant struggle although I try to hide it because no one understands. They think because I look fine on the outside that all is well. Can’t go around with a bandage on my head. Simple things like jogging aross the road have sent me in to a tailspin. I’m back with an osteopathic doctor who says I have severe post concussive syndrome. I don’t give up but it’s hard to be paranoid about the slightest movement which is where I’m at. And I’m not an athlete. I wish they’d study the rest of us. If I have to go through all this I wish it could be used to help others. Thanks for your writing.

    • Julie Norris says

      Hi Kristen,

      I’m so glad you dropped by and left a comment. I’m sorry to hear about your accident and the impact it’s had. I know that the public doesn’t really understand what it’s like. Only those who have or had a concussion can really understand it, I think. There are lots of folks that do understand. Check out the big NeuroTalk online forum (there’s a link in my Big List of support resources, which is on this site).

      I try and get more attention on concussions that occur that aren’t sports-related. It’s difficult. I think I’ll try and start working it in more, because I hear from people periodically such as yourself who’ve experienced it. Sports is driving all this concussion research and awareness, which is good and bad. Without it, I think it wouldn’t have as much attention or interest. But, it’s time to also look at other injuries. I’ll keep trying. Your comment helps with that, so thanks! You’re helping.

      Hang in there!

    • Michele says

      Wow I know exactly how you feel! I had my first concussion last January while I was on vacation. I was a passenger in a car stopped at a red light and someone rear-ended us. It was more like a tap, nothing serious and I wasn’t even aware I had a concussion until I came home and the symptoms were horrible. I started improving, and then in May I was again a passenger in a car and hit a bump in the road and my head hit the head rest. Well, then it started all over again. During this time I had to undergo breast surgery which was even more stressful which as you probably know does not help the concussion symptoms. I started going to vision therapy which was a tremendous help. About three weeks ago I bumped into the corner of the door, and you guessed it, bam! The symptoms weren’t as horrible but still enough to be very aggravating. Then about a week ago I bumped myself again and my symptoms are now back to square one. I do understand about feeling fragile and being paranoid about every move now. It really breaks you down when you see yourself trying to recover and then your recovery is stopped by something that seems so minor. I’m grateful to have found this site though, it is extremely hard to find stories about PCS that are actually positive. There is a lot of gloom and doom out there. Right now I am just continuing to truck along and trying to be positive even though there are many times where that is difficult, especially since I have had a chronic headache 24/7 for over a year now. Frustrating does not even begin to cover it. I just can’t wait for the light at the end of the tunnel.

      • Julie Norris says

        Hi Michele,

        Thanks for stopping by and leaving a note. That’s a tough situation you’re in. Sorry it’s taking so long. I know how hard it is to stay positive over such a long period of time. Some days I had to dig deep to find something for any particular day, but I did. If I couldn’t, I pulled out my trusty, sure-fire ways to figure it out. I’d think of some way it could be worse (which wasn’t difficult to do) and I also knew that there were people rooting for me (family & friends) so somehow I got through it. So, just know that on the tough days, I’m thinking about ya. That’s what all this website and everything else is about. Stay strong!!!

  6. Maryanne says

    Dear Julie, You are a breath of fresh air, thank you for sharing your story and wise words. I took a terrible fall October 12, 2014, I lost my footing while moving a piece of furniture, I fell back and my head hit our door knob and deadbolt lock. Also had terrible bruising on my one leg where they still have not gone away completely. My eye lids were purple, I was a mess. Did the CT, MRI, one test showed 3 abnormalities both “specialist” neurologist told me they were from me getting older. I went in for IV treatments for 3 days, each one 3 hours. They did nothing. They gave me at least 5 different medicines they did nothing except put 12 lbs if weight on, I did not know they contained steroids. On my last visit which I decided was “my last visit” it was your description in Step 2. Wow it sure was insult to injury! I felt insulted and lost, “now what do I do?” Well I’m a forge ahead type of person and that is what I have been doing. What bothers me the most are the set backs. I over did it this weekend working and going and now I am in bed with a horrific headache. I still feel there is something that is not quite right but again I agree with your insight and philosophy regarding that 6 month cutoff with insurance. I am so glad I happened upon your article, I now will be following your blog as well as receiving your emails on updates. Thank you again for giving hope!

    • Julie Norris says

      Thanks for the nice comments, Maryanne. I appreciate it.

      Good heavens, what an experience you’ve had! I can’t believe the doctors attributed issues to aging. That’s a new one for me. I wonder what they mean. You think you’ve heard it all, and then something like this comes up.

      Yeah, setbacks can be tough. Frustrating. They’re inevitable, though. Just ride them out and keep going. Did you see my post about setbacks? Maybe there’s something in that post that would be of interest to you.

      Don’t ever give up hope. Always think that better days are ahead. Sometimes you have to take a leap and believe that it will turn out Ok, even if you can’t see it yet. That’s what I did. Little by little, inch by inch, day by day.

      Stay strong!

  7. says

    THANK YOU JULIE We will never stop fighting and knowledge of Post Concussion needs to be educated throughout sports clubs schools medical world like the AIDS commercials in the 80s to wake up the world and help people recover and be treated like valued members of society Ignorance is Bliss Education is wealth……….. I am available to support your website as a parent and Carer to educate the wider community. My son has lost friends is in limbo and goes with the flow patiently confused and saying he is a burden to his family ..friends who now have never called again after 10 weeks. My heart bleeds for his future re employment and life style back who am I to complain … Dignity is ability not disability ……………..

    • Julie Norris says

      Hi Rachela –

      Please tell your son that there are people who understand what he’s going through. I’m sure there are folks in the PCS recovery communities that can perhaps help, some new friends to find who would know what he’s experiencing. I still think that the only people who really understand concussion and PCS are those who experience it. It’s difficult to describe how your head feels and feeling trapped by a broken brain sometimes. And knowing that the medical community doesn’t know enough yet. It’s not fun to have your life pulled from underneath your feet. In any case, people know what he’s experiencing. It was hard for me to have to ask people for rides to doctor appointments because I couldn’t drive for a long time, and to not be able to help as much at home. Please tell him not to feel as though he’s a burden. :)

      I know it’s hard, but this is what I tell people: hang in there, and always believe that there are better days ahead. Those days aren’t always visible, but you have to believe and just get through each day.

      Thanks for your offer to help support my site and work. I appreciate it!!

      – Julie

  8. Meredith Lueck says

    Thank you for this writing. I was hit in the head at work June 30, 2013. I had all of the symptoms stated above. After a year and a half I’m healed enough to function day to day, but I still struggle with a lot. I was so confused about what was happening, but every time I think I’m on top of it, I get overwhelmed again. It’s so hard because my doctor who has stood by me up to this point now tells me “It’s mind over matter”. To bad my mind doesn’t work right. I fear having to accept this as my new normal and that it wont come back. No one really knows. But it’s nice to know I am not alone.

    • says

      Rachela OH my God Just when I as a mother thought I was alone with my Chiropractor e Doctor waiting patiently for a light at the end of the tunnel at 10 weeks I read your post by chance of internet I see a LIGHT for our son 24 year old academic sport orientated amazing caring young man who doesn’t drive his car not use his mob phone become a recluse almost I begin to believe in all the steps we have taken are for the recovery of Franks life please email me I need all the help I can get a knowledge of education research and willingness to learn has stopped my son from being mis diagnosed medicated and left in the hospital system thank youuuuuuuuuuuuuuuu from the bottom of my heart you are an amazing person as at 3.20 in the morning I continue to research and look for answers an Angel of God has answered my prays I want to meet you please Rachela Caiapich Adelaide South Australia

      • Julie Norris says

        Hi Rachela,

        I’m so glad you found this site and that it’s helpful. I really do appreciate it. I provided more information in my other comment, so please take a look at that. :)

        Sending thoughts your way –

    • Julie Norris says

      Hi Meredith,

      Thanks for your comment. I’m sorry to hear about your concussion and that it’s taking so long. It’s frustrating when doctors don’t understand it. Just hang in there and don’t give up. I’m not just saying that, either. I know it’s hard to do.

      Take care!

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