Concussions are often misunderstood because the injury may not appear on a routine brain scan, symptoms can develop later, and the person may never lose consciousness.
These misconceptions can cause people to dismiss an injury, delay treatment, or follow outdated advice that may prolong recovery.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Dr. Robert Bashuk of the Concussion Center about common concussion myths, the brain’s temporary energy crisis, and the growing role of carefully prescribed exercise in treatment.
A Concussion Is a Traumatic Brain Injury
Traumatic brain injuries are generally classified as mild, moderate, or severe.
A concussion is considered a mild traumatic brain injury. However, the word “mild” describes its medical classification and does not necessarily reflect how seriously it may affect a person’s life.
Headaches, dizziness, memory difficulties, fatigue, sleep disruption, and emotional changes can interfere with work, school, relationships, and normal daily activities.
Dr. Bashuk explained that concussions make up the majority of traumatic brain injuries, even though moderate and severe injuries may be more visible or immediately life-threatening.
You Do Not Have to Lose Consciousness
One of the most common myths is that a person must be knocked unconscious to have a concussion.
Dr. Bashuk explained that most concussion patients do not lose consciousness.
A person may remain awake throughout the accident and still experience a traumatic brain injury. They may feel dazed, confused, foggy, unsteady, or simply different from normal.
The absence of unconsciousness should not be used as proof that a concussion did not occur.
Symptoms May Be Delayed
Another misconception is that concussion symptoms must appear immediately.
Some symptoms begin at the time of the impact, while others may develop over the following hours or days.
A person may initially feel shaken but otherwise normal. The next day, they may develop a headache, fatigue, nausea, poor concentration, irritability, or dizziness.
Delayed symptoms do not automatically mean they are unrelated to the accident.
Patients should continue monitoring how they feel after a collision, fall, sports impact, or assault and report new or worsening symptoms to a qualified provider.
The Head Does Not Have to Strike Anything
A concussion can result from force transmitted through the head, neck, or body.
In a car accident, rapid acceleration and deceleration may cause the brain to move inside the skull even when the person’s head does not strike the steering wheel, window, or dashboard.
A hard impact to the body during a sport may also produce enough head movement to cause an injury.
The important factor is how force is transferred to the brain, not whether there is a visible bump or direct impact.
Seeing Stars Is Not Required
Some people report seeing stars or flashes after a concussion.
That symptom may be consistent with a brain injury, but many concussion patients never experience it.
The same principle applies to other familiar signs. A person does not need to vomit, collapse, or appear severely disoriented to have a concussion.
Concussions can present differently from one patient to the next.
A Normal MRI or CT Does Not Rule It Out
Routine CT scans and MRIs are valuable for identifying structural conditions such as bleeding, fractures, tumors, or other serious abnormalities.
A concussion, however, often involves functional, chemical, and metabolic changes rather than damage that can be seen clearly on standard imaging.
That is why a patient may have a normal scan while continuing to experience real symptoms.
Dr. Bashuk explained that available blood tests are generally used to help determine whether someone may need a CT scan rather than to provide a stand-alone concussion diagnosis.
A clinical evaluation and detailed history remain essential.
There Are Treatments for Concussion Symptoms
Another major myth is that nothing can be done for a concussion.
Treatment depends on the patient’s particular symptom pattern, sometimes called a concussion phenotype.
One person may primarily experience headaches and dizziness. Another may struggle with sleep, anxiety, or memory. A third may have problems involving vision, balance, the neck, or exercise tolerance.
Treatment may include:
- Controlled aerobic exercise
- Headache management
- Vestibular rehabilitation
- Eye-movement therapy
- Cervical treatment
- Sleep support
- Cognitive rehabilitation
- Mental health care
- Nutrition and hydration guidance
No single plan is appropriate for every patient.
The Biggest Myth: Rest Until Every Symptom Disappears
Dr. Bashuk identified prolonged rest as one of the most damaging concussion misconceptions.
Older advice often instructed patients to remain inactive until they felt completely normal. Some people stayed in dark rooms, avoided nearly all movement, and withdrew from school, work, or social activity for extended periods.
Current concussion care may involve a brief period of relative rest followed by a gradual return to activity.
That does not mean ignoring symptoms or immediately returning to strenuous exercise. It means introducing movement at a level the recovering nervous system can tolerate.
Dr. Bashuk believes inactivity may contribute to continued exercise intolerance and make returning to normal life more difficult.
Exercise Must Be Done the Right Way
Exercise after a concussion is not the same as returning to a normal workout.
Dr. Bashuk uses the Buffalo Concussion Treadmill Test and Buffalo Concussion Bike Test to evaluate exercise tolerance.
During the test, the provider monitors heart rate and symptoms while gradually adjusting the activity.
The results help establish a heart-rate range that the patient can use during home exercise without significantly worsening symptoms.
Patients may then complete the prescribed activity several times each week.
The exercise usually involves walking rather than running. Intensity, incline, duration, and heart rate are adjusted according to the patient’s condition.
Someone should not simply decide to run several miles after a concussion because they heard that exercise can help. Excessive exertion may make symptoms worse.
Why Exercise May Support Recovery
Dr. Bashuk connected concussion symptoms with dysfunction involving the autonomic nervous system.
The autonomic nervous system controls processes that normally occur without conscious effort, such as heart rate, blood pressure, digestion, and certain responses to physical activity.
After a concussion, that system may not regulate exercise and blood flow normally.
Subsymptom aerobic exercise may help retrain the body’s response to exertion and gradually improve tolerance.
The length of treatment varies.
Someone evaluated shortly after an injury may require several weeks of prescribed exercise. A patient who has experienced symptoms for years may need a longer process.
The Brain Experiences “Electrical Chaos”
Dr. Bashuk described concussion as a temporary energy deficit caused by a neurometabolic cascade.
Immediately after the injury, large numbers of neurons may fire abnormally. He described this as electrical chaos.
That period is followed by reduced neuronal activity and an energy crisis.
The brain’s cells rely on ATP for energy. A concussion may interfere with the mitochondria that produce ATP, contributing to fatigue, brain fog, memory problems, and other symptoms.
Dr. Bashuk explained that this metabolic disruption may continue for several weeks, even when the patient begins feeling better sooner.
Neuroinflammation Can Drive Symptoms
A concussion may also trigger inflammation within the brain.
This neuroinflammation may contribute to symptoms such as:
- Headaches
- Fatigue
- Memory difficulties
- Poor concentration
- Dizziness
- Sleep problems
- Irritability
- Sensitivity to light or sound
The brain injury may also affect axons, which carry signals between nerve cells, and temporarily disrupt the blood-brain barrier.
These changes help explain why a concussion can feel serious even when the person’s appearance and routine imaging seem normal.
Seeing the Right Provider Matters
Dr. Bashuk emphasized the importance of working with a healthcare professional who understands current concussion evaluation and treatment.
A provider who relies on outdated advice may recommend prolonged inactivity without examining vision, balance, exercise tolerance, headaches, sleep, or neck function.
The correct professional does not necessarily need to have one specific title. The important issue is whether they are trained in concussion care and understand how to evaluate the patient’s individual symptoms.
Early education and appropriate treatment may reduce confusion and help the patient avoid unnecessary delays.
Take Every Suspected Concussion Seriously
A concussion does not require loss of consciousness, an abnormal scan, a direct hit to the head, or immediate symptoms.
It is a real traumatic brain injury involving changes in how the brain functions and produces energy.
Recovery should not be based solely on waiting for symptoms to disappear.
A complete approach may involve medical evaluation, controlled activity, symptom-specific rehabilitation, education, and continued monitoring.
The sooner a patient receives accurate information, the sooner they can begin following a recovery plan based on current concussion care rather than outdated myths.
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