The Invisible Injury: How Concussions Can Impact both Physical and Mental Health

Concussions are a form of traumatic brain injury that can occur from a high velocity force applied to the head, with or without contact, that causes the brain to move rapidly within the skull.1 This rapid movement results in an ‘electrical storm’ where the majority of the brain’s neurons (cells within the brain) activate all at once and deplete a substantial amount of energy. This energy loss can last for 15-30 days post injury and is a primary cause of the symptoms felt by individuals post-concussion. 

Some Common Physical Concussion Symptoms Include:

  • Headaches
  • Neck pain 
  • Dizziness and nausea 
  • Fatigue and drowsiness
  • Blurred vision
  • Problems with balance
  • Sensitivity to light or noise

Anyone who sustains a substantial force to the head can experience a concussion. Unfortunately, concussions are very complex and difficult to treat and diagnose, as there are limited objective clinical tests to confirm the diagnosis.2 Although concussions typically resolve within 1-4 weeks, some individuals experience persistent symptoms.3 Rehabilitation specialists, including physiotherapists, can address many areas associated with concussion symptoms including dizziness, neck pain, headaches, and balance problems. However, there has been substantial research to show that there are also mental health factors that should be considered when managing a concussion.4 Moreover, these psychological factors can persist even when the person has made a full physical recovery. 

What is the Link between Concussion and Mental Health?

Research has demonstrated that 1 in 5 people who suffer a concussion may be at risk of developing mental health concerns such as depressionanxiety, and post-traumatic stress disorder up to 6 months after injury.4,5 Concussions may result in additional symptoms that impact mental health including:

  • Drastic mood swings
  • Irritability
  • Depressive mood
  • Panic attacks and anxiety
  • Confusion
  • Sleep difficulties
  • Difficulty concentrating or remembering

A concussion may cause the brain to release abnormal amounts of neurotransmitters (chemicals that transmit signals in the brain) which can alter a person’s behaviour, mood, and thoughts and can further contribute to the development of mental health concerns. Additionally, concussions are also associated with increased inflammation and structural changes in the brain that can affect how the brain interprets and processes emotional and cognitive information.

So, How Can We Manage Concussion Risk?

To manage the risks associated with concussions and mental health:

  • Take precautions. When engaging in sports that have a risk of head injury, wear appropriate protective gear such as helmets and padding to minimize the risk of injury. Following a concussion, it is also important to follow appropriate return-to-play guidelines, as a person who has already suffered a concussion may be at increased risk of suffering another one. Falls can also cause serious head injury, so be sure to use extra caution when walking on slick surfaces, using ladders, consuming alcohol, etc. 
  • When in doubt, sit out. If there is any suspicion of concussion, it is better to STOP the activity or sport immediately. The risk of more severe injury with a second impact is very high during the acute phase of a concussion. 
  • Watch for signs of injury. Be aware of both the physical and mental signs and symptoms of injury. This also includes long-term monitoring to ensure an individual has fully recovered, and be mindful of persistent symptoms or changes in behaviour. 
  • Seek medical attention. It is important to see a medical professional who has experience treating concussions as soon as possible. While doctors can provide the initial diagnosis, the sooner you get into a concussion-specific health provider, the better the outcome. 
  • Rest, but do what you can. It is important to respect the healing and energy deficit associated with a concussion; however, prolonged rest can actually be detrimental to recovery. Rest is encouraged for the first 24-48 hours, but people are encouraged to start incorporating as much of their daily activities as they can within their symptom-limited threshold. That is, it is recommended that you engage in regular activities of daily living or light cognitive tasks, but that you STOP when your symptoms increase) 
  • Take care of your body. Drink more water, eat more fruits and vegetables, avoid caffeine and alcohol while recovering from a concussion. In addition, be sure to maintain good sleep hygiene at night and avoid taking naps during the day. 
  • Address the mental health factors. To cope with mental health symptoms (e.g., depression or anxiety), a medical professional may recommend therapies, such as cognitive-behavioural therapy (CBT), which focuses on changing negative patterns of thought and behaviour.
  • Educate yourself and others. Providing education about concussions and the importance of reporting them can help individuals understand the seriousness of the injury and the potential consequences of not seeking medical attention. This may include information about the signs and symptoms, the long-term effects of concussion, and risks of returning to a sport too soon. 
  • Provide support. Because concussions are often considered a ‘subjective injury’, they can be frustrating for people in recovery. Be patient, understanding, and supportive of those managing concussion symptoms. For sports in particular, create a culture in which athletes feel comfortable and encouraged to report an injury. As a coach or parent, you play a critical role in protecting athletes from concussions, and you can help ensure that protocols are followed, ensuring that athletes receive the care and support they need to fully recover.

This post was co-written by Julia Hochstein (Registered Physiotherapist) and Cindy McDowell (WellIntel Talks co-founder) to increase access to evidence-based wellness information. 

Julia has been working as a physiotherapist for over 6 years, with extensive experience in sports and concussion rehabilitation. Julia, along with our team at Allan McGavin Sports Medicine Clinic (AMSMC), provide rehabilitation for those suffering from concussions. This includes visual, vestibular, and cervical treatment modalities. AMSMC recognizes the importance of not only physical but also mental health components of rehabilitation, and each clinician seeks to provide a holistic approach to managing concussions. 

Cindy (MSc. in Psychology) is a brain and cognitive health researcher and the cofounder of WellIntel Talks. WellIntel Talks is a collective of Speakers that provide evidence-based mental health and wellness education talks to businesses and organizations in the community. They are working to ensure that Canadians have the knowledge and tools they need to start managing and promoting their own mental health and wellness. If you’re interested in learning more about concussion risk and management, including the complex interplay between mental and physical health, get in touch! 

Written by:

Julia Hochstein, MScPT, Registered Physiotherapist 
Cindy McDowell, MSc., WellIntel Talks Co-Founder, Cognitive Health Researcher


​​1. Centres for Disease Control and Prevention. (2019, February 12). What is a Concussion? Retrieved from

2.  McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017-0976993. 

3. Mayo Clinic. (2017, July 28). Post-concussion syndrome. Retrieved from

4. Finkbeiner NW, Max JE, Longman S, Debert C. Knowing What We Don’t Know: Long-Term Psychiatric Outcomes following Adult Concussion in Sports. Can J Psychiatry. 2016;61(5):270-276. doi:10.1177/0706743716644953

5. Stein MB, Jain S, Giacino JT, et al. Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study. JAMA Psychiatry. 2019;76(3):249-258. doi:10.1001/jamapsychiatry.2018.4288