Etiology — what causes it
Traumatic biomechanical force applied to the brain — direct head impact or impulsive force transmitted through the body. The resulting neurometabolic cascade includes ionic flux, mitochondrial dysfunction, and altered cerebral blood flow. Structural imaging is typically normal.
Epidemiology — who gets it
Annual incidence in adolescent contact sport is around 5–10 per 10,000 athlete exposures (Pfister et al., BJSM). Higher rates in collision sports (football, rugby, hockey).
Clinical signs
Symptom checklist (SCAT-6), Vestibular/Ocular Motor Screening (VOMS), balance assessment (modified BESS), neurocognitive testing. Important — most cases have no visible findings on standard imaging.
Symptoms
Headache, dizziness, fogginess, light/noise sensitivity, fatigue, sleep disturbance, irritability, slowed thinking, neck pain. Symptoms may evolve over the first 24–72 hours.
Best evidence for chiropractic treatment
The Amsterdam 2022 consensus (Patricios et al., BJSM 2023) sets the modern standard. Initial 24–48 hours — relative rest. After 24–48 hours, sub-symptom-threshold aerobic exercise is supported (Leddy et al., Pediatrics 2019) and accelerates recovery. Graded return-to-learn and return-to-sport progressions. Strict rest is no longer recommended.
When to seek emergency care
Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.
Bottom line
Strict rest is out. Sub-symptom-threshold aerobic exercise after 24–48 hours speeds concussion recovery — Amsterdam consensus is the standard.