Beyond Rest: A Brain-Based Approach to Concussion Recovery in Kids
Why pediatric concussion recovery should look beyond symptoms—and toward restoring how the brain, eyes, spine, balance system, body, and metabolism work together.
When a child suffers a concussion, the injury may be labeled “mild,” but the effects on the nervous system don't always feel mild. A child can look completely normal while struggling with headaches, dizziness, fatigue, brain fog, light sensitivity, irritability, anxiety, poor concentration, motion sensitivity, sleep changes, or difficulty getting through a normal school day.
This is because a concussion can temporarily disrupt much more than our perception of pain. It can affect the way the brain produces and uses energy, processes sensory information, controls eye movements, maintains balance, regulates the autonomic nervous system, coordinates movement, and responds to physical and cognitive stress. For years, concussion management largely centered around rest. We now understand that prolonged rest is usually not the goal and may actually hinder the healing process. After a short period of relative rest, current concussion guidelines support gradually reintroducing school, everyday activity, and appropriately prescribed physical exercise. When symptoms or neurological deficits persist, rehabilitation can become much more individualized. From a functional neurology perspective, this changes the question from simply, “Does the child still have a headache?” to “Are the neurological systems affected by the injury actually functioning normally again?”
Every Concussion Can Look Different
A concussion is a mild traumatic brain injury that initiates a complex physiological response inside the nervous system. Following the initial mechanical forces, the brain can experience temporary alterations in cellular energy metabolism, ion balance, cerebral physiology, autonomic regulation, inflammatory signaling, and communication between neural networks. This helps explain why two children who experience seemingly similar injuries can have completely different recoveries. One child may primarily experience headaches and neck pain while the other may become dizzy whenever they turn their head. Another child may struggle to read because their eyes no longer move smoothly across a page. Some children develop exercise intolerance, sleep disturbances, anxiety, emotional changes, poor working memory, slower processing speed, or difficulty tolerating busy environments. Effective rehabilitation should therefore begin by identifying the child's individual concussion profile rather than assuming that every concussion requires the same treatment.
Establishing a Baseline Before an Injury Happens
For young athletes and patients, baseline testing can be incredibly valuable because every brain is different. Rather than comparing a recovering athlete only with population averages, preseason testing gives us an individualized reference point for how that child's nervous system performed before an injury. A comprehensive baseline should look at multiple neurological domains. Symptom inventories can be combined with measurements of eye movements, including fixation, pursuits, saccades, convergence, and accommodation. Vestibular testing can examine the vestibulo-ocular reflex and visual-motion sensitivity, while tools such as the Vestibular/Ocular Motor Screening assessment, or VOMS, can help identify symptom provocation involving these systems.
Balance should also be examined through tasks such as Romberg, tandem stance, tandem gait, single-leg balance, or instrumented balance testing when available. Reaction time, processing speed, attention, working memory, and delayed recall provide another layer of information about cognitive performance. Eventually, these tasks can be combined with movement to examine dual-task performance, which is particularly important for athletes.
The cervical spine, autonomic nervous system, and exercise response deserve attention as well. Cervical range of motion, pain, muscular control, and proprioception can be assessed alongside resting heart rate, orthostatic heart-rate and blood-pressure responses, and symptom responses to positional changes. Graded aerobic testing can then help determine how the nervous system responds as cardiovascular demand increases. No single test should determine whether a child is ready to play again. The goal is to build a multidimensional picture of how the brain and body are functioning.
Functional Neurology: Rehabilitating What the Examination Finds
Functional neurological rehabilitation asks a simple but important question: Which neurological systems aren't functioning as efficiently as they should, and what inputs can we use to progressively retrain them? For example, if a child demonstrates impaired saccadic eye movements, rehabilitation might incorporate carefully progressed eye-movement exercises. If gaze becomes unstable when the head moves, vestibulo-ocular reflex exercises may be appropriate. Poor dynamic balance might lead to progressive combinations of visual, vestibular, and proprioceptive challenges. As recovery progresses, these systems should no longer be trained exclusively in isolation.
Think about what happens during a soccer game. A player must run while maintaining balance, stabilize their vision as their head moves, locate teammates, track a moving ball, ignore irrelevant visual information, make rapid decisions, and react—all within seconds. This is why later stages of rehabilitation may combine balance, eye movements, cognition, reaction time, and sport-specific movement. The goal isn't simply to become good at a rehabilitation exercise. The goal is to prepare the nervous system for the complexity of real life.
The Eyes and Vestibular System After Concussion
The visual and vestibular systems are particularly important after concussion because they are constantly working together.
The inner ear tells the brain how the head is moving and the visual system provides information about the surrounding environment. Proprioceptive receptors throughout the body, especially around the cervical spine, provide additional information about body position. The brain must continuously integrate these signals to determine where the body is in space and stabilize vision while we move.
When this system becomes disrupted, children may experience dizziness, blurred vision, headaches while reading, motion sensitivity, poor balance, nausea, difficulty focusing, or discomfort in visually complex environments such as school hallways, grocery stores, and sporting events.
Depending on examination findings, vestibulo-ocular rehabilitation might incorporate pursuits, saccades, convergence, gaze stabilization, vestibulo-ocular reflex exercises, progressive visual-motion exposure, balance training, and eventually cognitive-motor challenges. The important word is targeted. More stimulation isn't necessarily better. The right neurological stimulus, delivered at the appropriate intensity and progressed according to the child's response, is what matters.
Where Chiropractic Care Fits in
The brain isn't the only structure affected by the forces involved in a concussion. The cervical spine experiences many of the same acceleration and deceleration forces. Cervical dysfunction can contribute to neck pain, headaches, dizziness, altered proprioception, and difficulty determining where the head is positioned relative to the body. This becomes particularly important because cervical proprioceptive information must integrate with visual and vestibular information for normal balance and spatial orientation.
For appropriately screened pediatric patients, chiropractic and manual therapy can therefore be incorporated into a broader cervicovestibular rehabilitation strategy when examination identifies cervical dysfunction. Appropriate manual care can be one part of restoring cervical mobility, reducing musculoskeletal contributors to symptoms, and improving the quality of sensory information entering the nervous system while visual, vestibular, balance, and exercise rehabilitation progress.
Movement Becomes Part of the Medicine
One of the biggest shifts in concussion care has been recognizing that prolonged inactivity can actually work against recovery. Following an initial period of relative rest, light physical activity can usually begin as tolerated. From there, controlled aerobic exercise can gradually challenge the cardiovascular and autonomic systems without substantially exacerbating symptoms. This can also become an objective measurement.
If a child consistently develops symptoms at a particular workload or heart rate, clinicians can establish an exercise threshold. Training can initially remain below that threshold and gradually progress as tolerance improves. For athletes, rehabilitation can eventually progress from walking and stationary cycling into jogging, running, multidirectional movement, agility, sport-specific drills, non-contact practice, and ultimately medically cleared contact activity.
Where EWOT May Fit
Exercise with oxygen therapy, or EWOT, combines cardiovascular exercise with supplemental oxygen. It is an interesting adjunct because appropriately prescribed aerobic exercise already plays an important role in modern concussion rehabilitation, while cerebral blood flow, oxygen utilization, mitochondrial metabolism, and autonomic regulation are all relevant areas of brain-injury research. However, these concepts shouldn't be confused with proof that EWOT itself is an established concussion treatment. Evidence supporting graded aerobic exercise after concussion is considerably stronger than evidence specifically supporting EWOT in children. In an integrative rehabilitation environment, EWOT may therefore be considered an adjunctive strategy for carefully selected patients rather than a replacement for established exercise rehabilitation.
Supporting Cellular Energy With Photobiomodulation
Another emerging area of interest is photobiomodulation, sometimes called red or near-infrared laser therapy. One reason researchers are interested in photobiomodulation after brain injury involves the mitochondria—the structures responsible for producing much of the cell's usable energy. Because concussion creates a significant metabolic challenge for neurons, therapies that may influence mitochondrial signaling, oxidative stress, blood flow, and cellular recovery are understandably being investigated. Early human concussion research has produced interesting but mixed results, meaning photobiomodulation should still be considered an emerging supportive therapy rather than a proven stand-alone treatment. In practice, I view supportive laser therapy through that lens: potentially useful as one component of a much larger rehabilitation program, while the primary work of restoring eye movements, vestibular function, balance, cognition, cervical function, exercise tolerance, sleep, and nutrition continues.
Hyperbaric Oxygen Therapy and Persistent Symptoms
Hyperbaric oxygen therapy, or HBOT, exposes a patient to oxygen within a pressurized chamber, increasing the amount of dissolved oxygen carried in the blood. Researchers have investigated HBOT for persistent post-concussion symptoms because of the effects on tissue oxygenation, neuroplasticity, vascular function, and cellular metabolism. Some studies have reported encouraging results, including pediatric research. Due to its wide range of potential benefits and limited risks, intensive HBOT therapy is a viable option if tolerated well by the child.
Feeding the Recovering Brain
Rehabilitation shouldn't stop when the child leaves the therapy room. The brain is an extraordinarily metabolically active organ, and concussion temporarily creates an environment in which cellular energy demands and energy availability can become mismatched. Nutrition therefore provides an opportunity to support the basic building blocks required for recovery. Instead of searching for one magical “brain food,” I prefer building the child's diet around nutrient-dense whole foods. Wild salmon and sardines provide EPA and DHA. Eggs provide protein, choline, and phospholipids. Extra-virgin olive oil, avocados, nuts, and seeds provide healthy fats. Leafy greens and cruciferous vegetables provide folate, minerals, and phytochemicals. Then bring in color- Blueberries, blackberries, cherries, and purple sweet potatoes are rich in colorful plant compounds such as anthocyanins. Herbs and spices such as turmeric can add additional polyphenols to the diet. The goal is to create a nutrient-dense dietary environment that provides the recovering nervous system with the raw materials it needs.
Nutraceuticals: Omega-3s, Vitamin D, Magnesium, Curcumin—and Creatine
Nutraceuticals are another rapidly developing area of concussion research, but this is an area where we have to separate an exciting biological rationale from established clinical evidence.
Omega-3 fatty acids, particularly DHA and EPA, are important structural components of neuronal cell membranes and have been extensively investigated in brain-health and traumatic-brain-injury research. They are particularly interesting because neuronal membranes and inflammatory signaling are both relevant following brain injury, although optimal therapeutic dosing for pediatric concussion has not yet been established.
Vitamin D also plays roles far beyond bone health. Vitamin D receptors are found throughout the nervous system, and vitamin D participates in immune regulation and numerous cellular processes. Rather than blindly giving every child high doses, testing vitamin D status and correcting an identified deficiency is a more individualized approach.
Magnesium participates in hundreds of biochemical reactions and is intimately involved in neuronal signaling and cellular energy metabolism. It remains another nutrient of interest in brain-injury research, although supplementation should account for the child's diet, medical history, age, and individual needs.
Curcumin, one of the best-known compounds in turmeric, has generated considerable interest because of its effects on oxidative and inflammatory signaling in experimental research. Much of the traumatic-brain-injury evidence remains preclinical, however, so curcumin should be viewed as a potentially supportive nutritional compound rather than a proven concussion therapy.
One of the most interesting additions to this conversation is creatine. Most people associate creatine with muscle and athletic performance, but the brain also relies on the creatine-phosphocreatine system as a rapid energy buffer. Creatine helps cells regenerate ATP, the energy currency used to power cellular processes. That becomes particularly intriguing after concussion because one of the hallmark physiological problems following traumatic brain injury is a temporary disturbance in cerebral energy metabolism. Creatine is therefore being studied for its potential neuroprotective and bioenergetic roles, not simply for building muscle. Experimental research is encouraging, and limited human work in pediatric traumatic brain injury has also generated interest in outcomes such as headaches, fatigue, cognition, sleep, and neurological recovery. Creatine may ultimately become an increasingly useful component of concussion nutrition, particularly for athletes, but pediatric supplementation should still be individualized with consideration for age, body size, diet, kidney health, medications, and the overall clinical picture. This is why I prefer a food-first, deficiency-aware, individualized approach rather than handing every concussed child the same supplement stack.
Return to Play Should Mean More Than “I Feel Fine”
Perhaps the most important concept for parents and young athletes is that symptom resolution and neurological recovery are related—but they aren't necessarily identical. A child saying, “My headache is gone,” is certainly encouraging. But before sending an athlete back into an environment where another collision could occur, we should be asking more questions. Can their eyes rapidly move between targets without symptoms or significant errors? Can they stabilize their vision while their head moves? Has convergence normalized? Can they maintain balance when visual information is reduced? Can they run at high intensity without dizziness or headache? Has their reaction time returned toward baseline? Can they process information while simultaneously moving? Can they tolerate an entire school day? Can they complete sport-specific drills at game speed while maintaining coordination and decision-making?
This is where objective measurements become so valuable. Ideally, return-to-play decisions combine symptom status with neurological examination findings, vestibular and ocular performance, balance, cognition, exercise tolerance, and progressive sport-specific challenges. When preseason baseline data exist, post-injury performance can also be compared with the child's own previous measurements rather than relying exclusively on population averages. Return to sport should then progress gradually through increasingly demanding stages. If concussion-related symptoms return during progression, that is information—not something the athlete should simply push through.
Building the Brain Back Up
Ultimately, concussion rehabilitation shouldn't be about endlessly protecting the brain from stimulation. After the appropriate acute period, the goal becomes progressively rebuilding the brain's capacity to handle the demands of everyday life. Restore sleep and circadian rhythm. Support hydration and nutrition. Gradually reintroduce school. Address cervical dysfunction when present. Retrain the visual and vestibular systems when testing identifies deficits. Restore balance and coordination. Progress aerobic capacity. Introduce cognitive challenges. Combine cognition with movement. Add reaction time and decision-making. Finally, layer in sport-specific demands before unrestricted competition.
Adjunctive therapies such as photobiomodulation, EWOT, HBOT, and targeted nutraceuticals may have a place within this larger picture, but they should support—not replace—the fundamentals of active neurological rehabilitation. The developing brain has an extraordinary capacity for adaptation and neuroplasticity. Our job isn't to rush that process, nor is it to simply wait and hope symptoms disappear. Our job is to identify what isn't working, provide the appropriate environment and neurological inputs for recovery, measure progress objectively, and progressively prepare that child for the demands they want to return to. Because ultimately, the most important question isn't simply:
“Do you feel better?”
It's:
“Is your brain and body ready for what you're asking them to do next?”
This article is for educational purposes only and is not a substitute for individualized medical care. Children with suspected concussion should be evaluated by an appropriately qualified healthcare professional. Return-to-sport decisions should follow an appropriate graduated protocol and medical clearance.
Yours in Health and Healing,
Dr. Austin
The Weekly Reset
