Concussion

I’m by no means an expert but a shop i worked at had a doctor come in and give a talk about concussion best practices. 

Most important take away was to take a 2 week break after any rapid head deceleration incident (this includes both impacts and “whip lash”). Yes this sucks and is difficult advice to follow but the biggest risk after a concussion is repeated injury while the brain is trying to heal. 

This seminar was 6 years ago at this point so i would love for someone with more knowledge to let me know if my information needs updating. 

There's this but it was last updated in 2024; might still be some useful info in it: https://www.vitalmtb.com/forums/The-Hub,2/Mountain-Biking-and-Head-Inju…

I had a concussion around a year ago, which led to 5 months off the bike. While the hit itself was actually not that big (remember the whole thing, rode home after the crash etc) it started off a chain reaction that was alot to overcome. I am predisposed to ocular migranes, and it seems the head knock basically put my nervous system in a constant state of "fight or flight" mode - something I am still dealing with to a degree. It's a very, very long story but I did co-write an article with my concussion practitioner which was published in a print magazine. I will put the article in a reply below if anyone is interested.

TLDR, Some basic dot points from things I learnt:

- Find a concussion practitioner near you and get a baseline test done as a reference point
- Many GP's are quite behind on concussion diagnosis and treatment and will tell you to rest, this is no longer the ideal approach

- Everyone reacts very differently to a concussion and as such they all need to be treated seriously until the full extent of the injury and symptoms are known

- Early diagnosis and treatment with a qualified practitioner can greatly decrease the overall timespan which symptoms may exist 

Just a Concussion

Hayden Wright and Jaimi Parr

Far too often, the phrase “just a concussion” is used to downplay the severity of head injuries sustained in crashes. A knock to the head is frequently considered minor—especially when compared to broken bones or torn ligaments. But the reality is far more complex.

In early 2025 long-time contributor Hayden Wright experienced a crash, resulting in a concussion that brought with it symptoms which persisted for months. Though invisible to others, the effects were deeply debilitating, with impacts noticed through every part of day-to-day life. In search of answers and relief, Hayden turned to concussion practitioner Jaimi Parr, whose private practice focuses on rehabilitating individuals suffering from concussion-related symptoms.

Through months of dedicated treatment, Hayden and Jaimi worked together to gradually reduce the intensity of his symptoms and restore a sense of normalcy. It was a slow, demanding journey - but one that ultimately reclaimed the spark which was once smothered by silence, confusion, and pain. 

On Any Sunday (Hayden Wright)

Sunday, February 16th started like most weekend mornings do in my neck of the woods. The dull hum of an early morning alarm was met by my weary gaze, as I clumsily tried to hit the ‘snooze’ button on my phone before my wife’s sleep was also disturbed. Although the thought of staying wrapped up in the warm comfort of our bed was appealing, it was the one morning a week I had to myself and I was damned if I wasn’t going to make the most of it. 

Ask any parent with young kids and they’ll agree; guilt-free time to yourself is something that needs to be appreciated as much as it does taken advantage of. On offer today was a planned 3-hour morning trail ride with my good friend Bobby, covering some local trails which were running fast and rough thanks to a long, wet summer in south-east Queensland. 

After inhaling a gut full of Weet-Bix and a double shot coffee I snuck out of the kitchen, taking one last glance at the baby monitor on my way - everyone was still asleep. My first win of the morning. I was met by bluebird skies as I rolled out the garage doors and started pedalling to the trail head, a quick 10-minute ride from home. 

“Morning mate!” Bobby chirped as I rolled up next to his van. It seemed the 5:35am start time for our ride did little to dampen his mood. Bobby is one of those rare riding buddies that must be cherished as he possesses what I consider to be the perfect mix of reliability, easy-going humour and an opinionated enthusiasm towards mountain bikes that makes any ride in his company a joy. After a quick yarn we decide to head over to a trail called “Off The Back” for some laps. On our way to the top of the descent I caught Bobby up on my recent trip to Maydena, gushing through starry eyes about how much fun I had in the bike park and how sharp I felt as a result. Before I knew it we were at the top of our chosen trail, ready for our first lap. We were met by a short, steep descent characterised by a 200mm deep water rut which snakes its way down the middle of the narrow alignment. If you can stay out of the rut and navigate the tree laden edges of the trail you’re a hero, although you’re taking a fair bit of risk to do so at speed. The slower and safer alternative is to ride the rut and let it guide you down the hill like a slot car… but who wants to do that. Over the next 90 minutes Bobby and I lapped the trail 5 times, increasing the intensity with every run. I was having a blast, and in hindsight getting quite carried away with how fast I was pushing down the hill for nothing more than my own amusement. 

“Shit mate, are you ok!?” Bobby shouted as he worriedly skidded to a stop behind me. Evidently, I had run out of talent on our 6th run and now found myself laying on my back with my bike another 5m further down the trail. While staring at the tree top canopy above me I did a quick head to toe status check. No sharp pains, all joints moving, no visible blood. 

Lucky. 

At the time it seemed I had escaped from this crash relatively unscathed. “Yeah, I think so...” I replied as I hoisted myself up and dusted myself off. “I got cross rutted and clipped that tree up there with my right hand” I said as I pointed quite a long way back up the steepest, straightest part of the trail. Undoubtedly, this was one of the biggest crashes I had ever had. A quick check over my helmet showed some damage right at the back; a noticeable dint and some decent scratches. “I know what I am buying this week” I joked to Bobby as I popped the damaged helmet back on my head. “Dude, that was a massive crash, are you sure you’re ok to ride home” he worriedly replied. “Yeah, I think I’m fine mate - I’ll just take it easy and spin back home. You'll have to enjoy the rest of the ride without me.”

It wasn’t until the next morning that I started to notice that something was amiss. Everything seemed really bright, loud and overstimulating. I felt as though I had a hangover which was strange given all I’d done the day prior was go for a ride, take my kids to swim school and spend the afternoon relaxing with family. My energy levels were also really low and I just generally felt foggy and out of touch. Maybe that head knock was worse than I first thought? A quick consultation with Dr. Google confirmed what I suspected - I had a concussion. At the time, I assumed it must have only been a minor one given I remembered the entire crash and didn’t lose consciousness or even see stars as a result of the impact. The first few websites I perused suggested that the symptoms should subside within a few days, and to visit my GP if they persisted for much longer. Taking that advice on board I decided to just continue on with my day confident I would feel better tomorrow.

More questions than answers (Hayden Wright)

Two weeks on, my symptoms had done nothing but intensify. The sensitivity to visual or audio input, unstable emotions, low energy, foggy mind and general depression were now following my every step like a dark cloud. Every morning I would wake up, hoping that my symptoms would have improved overnight. Every morning these hopes were shattered by the quick and sobering realisation that they were as present as ever. At this point I made an appointment with my GP. 

After explaining the crash and my symptoms she decided to send me off for a CT scan to see if there was any visible damage to my brain. The next day I found out that the CT scan came back all clear, and was advised to simply keep resting - if symptoms persist for another two weeks come back and she would advise me further. I was still optimistic that my concussion would soon fade, and I wouldn’t become one of those people I had read about who suffered from symptoms for months, even years. 

To try and decrease the mild headaches and brain fog I began cutting out anything that I felt could be attributing to how I felt. As a result pretty much everything I enjoyed in life was on the chopping block, including coffee, alcohol, music, podcasts, TV and exercise. My days now consisted of waking up, going to work, coming home and quietly playing with my kids until bed time. Their occasional bad moods became very difficult for me to deal with, as even the slightest scream or shout from one of them intensified my headaches and darkened my mood. Sunday morning swim school became a sensory overload, as all the joyful splashing and shrieking from the kids left me feeling like I had been hit over the head with a baseball bat. There was very little left in life for me to enjoy, given everything carried with it the weight of my mental condition and the growing dread attributed with not having a clear path to recovery. 

The GP was visually concerned when I returned 4 weeks post-accident, looking for answers. She sent me for a brain MRI, eye test, blood test and urine test to see if anything could be identified. Admittedly I was hoping to find an issue from one of these tests, anything that could be attributed to how I was feeling. Much to my dismay, they all came back negative as the results slowly rolled in over the next few weeks. 

This is where things all came to a head, at my 6-week post incident check in with the GP. I was as symptomatic as ever, and desperate for answers. Unfortunately all she could do was write me a referral to see a neurologist - who’s receptionist told me over the phone that there was a 6 week wait time for new patients. 

I couldn’t go another 6 weeks feeling like this.

I couldn’t go another 6 weeks with no path towards recovery.

If I had broken my wrist I would have already been near a full recovery, but instead this seemingly innocuous head knock had left me out of action with no clear way to get back to normal. The realisation of the severity of my condition was sobering and overwhelming. It was all too much at that moment. 

 As tears rolled down my cheeks I started Googling “Concussion specialist Brisbane” in the GP’s carpark to see what I could find. I needed answers, desperately. This is when I found Jaimi and her clinic, Headquarters Concussion Management. 

Assessment, rehabilitation and management (Jaimi Parr)

It was a normal day at the clinic for me when I greeted Hayden for his initial appointment at Headquarters. I already knew the foundation of his appointment based on the initial form that he filled out. He had a mountain bike crash 7 weeks ago, no abnormalities were found on brain imaging and he is still suffering with significant symptoms. His primary complaints were light sensitivity, headaches, fatigue, poor focus, poor concentration and eye strains when looking at screens, amongst other issues. Based on this, I was instantly curious about his visual system, neck, potential inflammatory issues and his nervous system. All of which were soon to be tested. 

In the consultation room, Hayden further emphasised that work was exhausting, he couldn’t exercise anymore, interacting with his kids was too difficult and his general daily activities were put to a halt. His GP told him to rest, and then keep resting some more. Whilst I try not to get frustrated at the general advice that is constantly given out for concussion injuries, it just electrifies my inner desire for more education on concussion management standards. It is people like Hayden that make me want to do what I do and pursue concussion management and rehabilitation. His life has been significantly affected by a concussion and there are so many things that I can do to help. 

An initial assessment encompasses a stack of testing including balance integration, cognitive function, visual stabilisation and control, reaction times, neck function and muscular endurance, heart rate testing and more. This provides us with a great understanding of how you are functioning after your concussion injury. 

We also want to monitor symptoms, which are subjective and can be vastly different for everyone. They can help identify potential areas of dysfunction and can let us know how much someone is being affected. There are generally 22 symptoms that we monitor with a concussion, although there can be more on this list. The most common symptoms that I see after a concussion are headaches, pressure in the head, fogginess, neck pain, light sensitivity, balance issues, concentration and cognitive difficulties. 

Whilst I had a general idea of the deficits that I may find, I always assess everything. Evidently, Hayden struggled to track and follow objects with his eyes, he struggled to move his eyes from one object to another efficiently and accurately and he struggled with the processes of depth perception and getting his eyes and brain to communicate accurately. The deficiencies in his eye function were definitely a cause of his ongoing symptoms. No wonder he was struggling with life so much. Hayden also had some deficits with his balance integration systems (the areas of his brain and body that are responsible for balance) and symptoms suggestive of neural inflammation and nervous system dysfunctions. These types of deficits can directly influence your ability to read, comprehend what you are reading, use screens, exercise, regulate emotions and more. All of which Hayden was struggling with. 

Hayden needed visual, vestibulo-ocular and balance rehabilitation. He needed to essentially recalibrate his eyes with his brain and retrain some of these pathways that were affected with his concussion injury. We worked through his first lot of tedious exercises, explaining what we need to do and why we need to do it. I also recommended sub-symptomatic aerobic exercise and suggested some supplements to help speed up brain healing and recovery, help reduce cellular imbalances that occur due to a concussion and help decrease his symptoms. 

A new day (Hayden Wright)

As I stepped out of Jaimi’s office with a written action plan in hand, it felt as though the weight of the world had been lifted off my shoulders. Yes, my symptoms were still there but through her intensive testing we had defined the underlying issues which were causing my symptoms to flare up, and a plan on how to rehabilitate them. Between the prescribed eye and balance exercises that I was completing 3 times daily and the 30 minute spins I was doing every morning on the Kickr, rehab was taking me around 90 minutes a day to complete. It felt like a massive undertaking at first, but with the support of my wife and understanding from my colleagues at work I stuck to the plan and slowly started to feel improvements. 

It wasn’t all roses though. I still had days that were very difficult, and I struggled to understand the non-linearity of my recovery. After hours upon hours of rehab and repeat visits to Jaimi I was improving, but there were still dark days mixed in with those where I felt closer to normal. Any minor deviation from my routine seemed to send my day into a tail spin, be it spending too long looking at my phone, skipping my morning exercise or having to work late due to project deadlines. All this did was further reinforce my commitment to recovery, and my trepidation towards reintroducing any of the things I had previously cut out. Over time, I did begin to start listening to some music and podcasts again - although alcohol and coffee haven’t made a return even at the time of writing this article 8 months post injury. 

Following multiple checkups with Jaimi at her clinic, we decided that I was feeling well enough to start doing some mountain biking again. For the first time in months I clipped on my helmet and headed out to the trails. Although that first ride was slow, cautious and somewhat foreign I still had an absolute ball cruising about on my hardtail. The ride didn’t cause any of my symptoms to flare up, which was a fantastic sign and testament to the rigorous treatment protocol I had been following with Jaimi’s guidance. Over the next few weeks I slowly started introducing longer, more technical rides until I worked up to the point where I finally met up with my mates for our usual weekend social ride. We’d not seen or really spoken to each other for months, such is the way friendships seem to go when they’re based entirely around sports from which you’ve had some time away from. This in itself was a sobering realisation, and one which has inspired me to intentionally maintain my friendships off the bike a little more. 

After around 6 months I felt like I was back in full swing on the bike, with my fitness and technical ability quickly returning back to its pre-injury level, although I was and still am having some symptomatic flare ups which Jaimi is helping me to understand and manage. 

Ongoing concussion management (Jaimi Parr)

A concussion is non-linear, there are so many variables that will affect recovery and affect how you may experience symptoms. A stressful day, a big drive, a noisy day, a bad sleep - these can all set you off. I recently discussed with Hayden that a previous head knock or concussion may also prolong and complicate recovery, to which sparked his memory that he actually had an undiagnosed concussion some years ago. Through seven sessions with Hayden we have continued to progress exercises, alter exercises, address other symptoms and slowly work towards getting him back to his regular self. Whilst he has made significant improvements, both symptomatically and functionally, there are still things that we need to work through which may have been complicated by his previous concussion injury. Regardless, I am so thrilled that Hayden is back doing the things that he loves, riding his mountain bike, playing with his kids and feeling more like himself. Returning to sport was obviously key to Hayden’s day to day mental and physical health, regardless of the potential risk of another injury. The benefits of participating in sport significantly outweighs the risk of a concussion, if it is managed appropriately. 

Moving forward (Hayden Wright)

“Just a concussion.”
 I wish I could take those words back.

Over the past eight months, I’ve been on a rollercoaster journey with this injury — one that still feels far from over. Not a day goes by that I don’t think about the crash, the symptoms, and the ongoing battle to reclaim my spark. Like Jaimi, I’ve become a passionate advocate for better concussion education, treatment, and awareness — not just in cycling, but across our wider community. If there’s one thing I hope you take from this story, it’s a deeper understanding of what a concussion really is: how it can be caused, how its symptoms might show up, and why early treatment by a specialist is so critical.

And if you or someone you know ever suffers a head injury, please — don’t call it “just a concussion.”

Thumbs up in a "definitely not good that you experienced it but thank you for going through something terrible and bringing back helpful info from the other side."

Thanks for sharing!

I've had a few, including one of the "lights-out, KOed for 10 minutes" variety. That was a strange feeling! I was at a motocross race and apparently I correctly told the ambulance personnel my name, the date, and who the president was. I don't remember any of this. I vaguely remember the cause of the crash, but not the impact with the ground, and in my first memories of coming to I was already walking back to the pits. I had my friend guiding me to our pit setup because I had no idea where it was. I recognized the environment but I had no way of knowing where we were parked, which direction was North, or which direction the entrance to the facility was. After resting for a short while the fog lifted all of a sudden and I realized, "Whoa! I was knocked out!" All my friends got a laugh at that one. (This was before the days of serious concussion protocols.)

Fortunately, I don't seem to have any long-term effects from that one, although I did get a more recent ring to the bell which left my vision a little foggy for a few minutes. 

Remember: Get a new helmet! Every time! The old one did its job. 

There are a lot of resources around managing concussion, but the most important thing that is consistently not explained or managed is that emotional disturbances are normal, and can be severe.

Depression, anxiety, disorientation, and at the extreme, suicide, are very common symptoms of head injuries.

It’s really important for people around the concussed person to be aware of this, and for a plan to be in place to help. 

Primary care doc here. 
There’s 4 symptom domains that concussions effect - the physical (headaches, light/sound sensitivity, balance and disequilibrium), cognitive (word finding difficulty, brain fog), emotional (frustration, depression, emotional lability, anger), and sleep (hypersomnolence or insomnia). 

 Someone above suggests you obtain baseline testing. And that’s all well and good, though my experience as a doctor who has treated A LOT of concussions (though I’m not a sports med doc and don’t claim to be a concussion expert)  is that the testing quantifies and scores a lot of things that I already knew from a few simple observations and has never changed my decision or diagnosis. I have a few tests I run people through and each of those, combined with the reported symptoms, determines how much of an exam I’ll do (that is, if you are struggling to balance standing with your feet together, I’m not about to ask you to close your eyes, or stand on one foot, or trying pushing you). And because of gradual return to play, we know when someone is back to baseline. But there is zero harm in having measured baselines and someone who has seen you at 100%. That can only serve in your favor. So if his point speaks to you, go for it!

There’s a comprehensive test we use called a SCAT5 to judge severity from the incident, and the non-medical version is the CRT5. I highly recommend familiarity with this. Every cyclist should know what to lookout for and when to bring their buddy to the emergency room, or better yet when the ambulance is a better choice than the bed of your Tacoma. This also provides you some vocabulary so that you know what to tell a medic or ER doc. https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097508CRT5.full.pdf

ok, so what to do once recovery begins? Years ago we told people to rest, rest, rest, but over-rest is as bad as under resting, because movement improves blood and lymphatic flow. It also wards off the adverse emotion toll concussions can take. But you must gradually increase activity and stop if symptoms begin (then go back a step). We use gradual return to play protocols which start with activities of daily living that do not induce symptoms (washing dishes, vacuuming, all the stuff you didn’t want to do). If you can do this without inducing any symptoms, now you can go out walking or riding a stationary bike with no resistance. No symptoms? Now you can do light resistance exercise and sport-specific training drills but must avoid any activity that could lead to another head hit (for example, a basketball player can’t get rebounds or do layups). Got it? Now try passing drills and progressively increasing resistance training. After that you’re into full contact practice, and then back to game ready. For a cyclist, this might look like around the house activity, then walking and riding the trainer but keep HR below 100. Then increase pace/resistance. Then go for a ride on the bike path, then a light trail ride. At each step, underestimate how much you can do and STOP if your symptoms return. If that happens, you’re not ready to move on. Try again in a few days. 

in terms of treating symptoms, remember the 4 domains - physical, cognitive, emotional, sleep. Physical therapy (particularly vestibular therapy) to help with balance and dysequilibrium. Massage and gentle body work to help with whiplash injuries and myofascial strain. Wear sunglasses or earplugs indoors if light/sound are troublesome. 
Avoid prolonged staring at screens. 
 Speech therapists can help with a lot of the cognitive complaints - memory, word finding difficulty). I will sometimes use ADHD meds in these circumstances if symptoms are prolonged in this domain while improving in others. The Emotional domain is a challenge. It is SO NORMAL to experience depression, sadness, and anger. The injury has taken you away from an activity you love, it has made you feel like you are not you. Seek out the counseling you need. I’ll often connect a patient with a therapist so they have a means of expressing their frustrations and someone to help guide them in management. I don’t hesitate to use antidepressants here, they can be helpful for getting people through this period. I especially go for meds that can also help with sleep since I find insomnia is common despite fatigue and low energy also being common symptoms. So, amitriptyline and trazodone are the first ones I often consider. which brings us to that final domain. Prioritize sleep. For some folks whose symptoms are severe, I have them taking a nap midday and two other breaks where they close their eyes in a dark room for 10-15 minutes. 

It goes without saying, I should hope, that alcohol, marijuana, and eating shitty food won’t help you get better. But you’d be surprised how many people try. Does creatine, fish oil, magnesium, Prevagen, or anything else speed up recovery? I’m skeptical (which doesn’t stop me from taking creatine myself) but if you’ve got things you find helpful, who am I to argue. I posit that nothing is a replacement for getting nutrients from food, so if you think magnesium will help, eat more foods high in magnesium. Fish oil is predominantly for keeping fish oily, so just eat some damn fish if that’s what you’re after. There is magic in the wholeness of food. Eat it whole, stop with the smoothies and AG1.

This is neither comprehensive nor individualized, just a general overview of my approach to concussion management in routine primary care with recreational athletes and healthy folks (very different than an emergency or sideline setting). as a final note, Big Dos points out that a lot of GPs are behind the times on concussion management. Maybe so, but a lot are also right on the money so don’t hesitate to connect with them and find out. 

Notably, severity of the inciting event often doesn’t correlate with severity of concussion. I’ve seen severe concussions from seemingly innocuous events (low speed fall), and people knocked unconscious who have minimal/no residual symptoms. 🤷

Personal experience though, I’d add the “seeing stars/hearing knocked out” type to your list. Take a hit and get sparkles in your vision and the sound gets turned off for a moment. I usually get a flash of a non-iron metallic taste in my mouth, too. Interestingly, some folks report metallic taste in their mouth before a seizure, so it’s probably a bad neurological thing (to be technical about it). 

Reckon we all experience this differently but there are trends. 

@Smelly - Thanks for the detailed breakdown. I wish all GP's had your level of expertise on this topic. 

@Big Dos they should. Gradual return to play has been the standard for at least 15 years now (I learned about it back then in med school, don’t know when it came out). If I’m being blunt, if your GP isn’t familiar with it, it may be time for a new one. This is pretty basic primary care stuff these days. If nothing else, they’d send you to PT for the whiplash and the PT would recommend all this other stuff and work through return to play protocols. We had a concussion rehab program in my residency so maybe I got more training than many, but the testing and protocols have been printed in every primary journal at least once and are easy to find online. So, no excuses. 

One of the huge challenges is that there’s a lot of scientific mumbo jumbo surrounding how concussion occurs and what treatments work, and Virginia Tech is trying to improve our helmets, but at the end of the day, you got what you got and there’s only so much we can do. There is a helluva lot more theory than intervention. This isn’t like a broken collarbone we can put a plate on, or a heart arrhythmia we can ablate. Recovery takes time, gentle activity increases, and often and most challenging - time off from work/life. There’s no better way to make a concussion worse/prolonged than the push through it. I very frequently sign forms for my patients to take a week or two off work so they can recover - the same way they might need thing they’d broken their leg. 

I'd like to emphasize the part about severity of event & concussion.  I got a very bad concussion while surfing in college... walking back to the beach, a wave splashed the surfboard and it bonked me on the chin.  I didn't know my name / year / etc., and had pretty serious mental symptoms for over a month afterwards.  Conversely, I've also taken really hard slams indoor rock climbing (like 10' onto back on crash pad and had wind knocked out of me) and been perfectly fine.

One question related to the CRT5 guidelines... one of the Step 1 Red Flags is loss of consciousness.  If you weren't there to witness the crash, how do you distinguish the common symptom of "I don't remember what happened" from loss of consciousness?

You wouldn’t. Observers would have to tell you what happened. The red flags pertain to events during and immediately after the trauma, so it would be based on eyewitness report.