Question 1

What is a concussion?

Accepted Answer

A concussion is a mild traumatic brain injury caused by a blow, bump, or jolt to the head — or by a hit to the body that causes the head and brain to move rapidly back and forth. The sudden movement can cause the brain to bounce or twist inside the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. Concussions do not always involve loss of consciousness; in fact, most concussions do not. Symptoms can include headache, dizziness, confusion, memory problems, light and noise sensitivity, and sleep disruption.

Question 2

How long does a concussion take to heal?

Accepted Answer

Most concussions in adults resolve within 2 to 4 weeks with appropriate management. In adolescents and children, recovery may take somewhat longer — typically 4 to 6 weeks. When symptoms persist beyond these windows, the condition is often referred to as post-concussion syndrome or persistent concussion. Persistent symptoms do not mean the brain is permanently damaged; they typically indicate that one or more neurologic systems remain dysregulated and require targeted rehabilitation.

Question 3

Can you have a concussion without losing consciousness?

Accepted Answer

Yes. Loss of consciousness occurs in fewer than 10% of concussions. The absence of loss of consciousness does not reduce the severity of a concussion or the risk of persistent symptoms. Concussion is defined by its neurologic effects — not by whether the person was knocked out.

Question 4

What is post-concussion syndrome?

Accepted Answer

Post-concussion syndrome (PCS) is a clinical pattern in which concussion symptoms persist beyond the expected recovery window — typically more than 4 weeks in adults. PCS is not a single condition but a presentation that can involve multiple neurologic systems, including the vestibular system (balance and spatial orientation), the visual system (oculomotor function), the autonomic nervous system (heart rate, blood pressure, energy regulation), and sensorimotor integration. Identifying which system is the primary driver of symptoms is the starting point for effective treatment.

Question 5

Is post-concussion syndrome permanent?

Accepted Answer

No. Post-concussion syndrome is not a permanent condition for the vast majority of patients. Persistent symptoms indicate that neurologic systems remain dysregulated — not that the brain has been permanently altered. With appropriate neurologic evaluation and targeted rehabilitation, most patients with post-concussion syndrome achieve significant improvement. The key is identifying the specific constraint limiting recovery and addressing it in the correct sequence.

Question 6

What are the most common symptoms of a concussion?

Accepted Answer

Common concussion symptoms include headache (the most frequent), dizziness, balance problems, nausea, fatigue, difficulty concentrating, memory problems, light sensitivity (photophobia), noise sensitivity (phonophobia), sleep disturbances, irritability, and emotional changes. Symptoms typically appear within minutes to hours of the injury, though some may not become apparent until days later.

Question 7

Why do I feel dizzy after a concussion?

Accepted Answer

Dizziness after concussion can arise from several distinct neurologic sources: the vestibular system (inner ear and its central connections), the visual system (oculomotor dysfunction causing visual-vestibular mismatch), the cervical spine (cervicogenic dizziness from neck injury that often accompanies concussion), or the autonomic nervous system (orthostatic intolerance causing lightheadedness with position changes). Because these sources require different treatments, accurate differentiation through neurologic evaluation is essential before beginning rehabilitation.

Question 8

Why do I get headaches after a concussion?

Accepted Answer

Post-concussion headaches can arise from multiple sources including cervicogenic mechanisms (neck injury co-occurring with concussion), vestibular dysfunction, oculomotor strain, autonomic dysregulation, or central sensitization. The most common post-concussion headache pattern resembles tension-type or cervicogenic headache rather than migraine, though migraine-pattern headaches also occur. Identifying the primary driver of headache is important because cervicogenic, vestibular, and autonomic headaches each respond to different interventions.

Question 9

Why can't I exercise after my concussion?

Accepted Answer

Exercise intolerance after concussion — the inability to sustain physical exertion without provoking symptoms — is typically caused by autonomic nervous system dysregulation. After concussion, the autonomic nervous system may fail to appropriately increase cerebral blood flow in response to physical demand, causing symptoms to emerge at relatively low exertion levels. This is not a reason to avoid exercise entirely; rather, it indicates that graded exertion rehabilitation — beginning below the symptom threshold and progressively increasing — is the appropriate treatment approach.

Question 10

Why does my brain fog get worse in busy environments?

Accepted Answer

Increased cognitive load in busy or visually complex environments — shopping malls, crowded hallways, screens — is a hallmark of post-concussion syndrome. After concussion, the brain's ability to filter and integrate competing sensory inputs is reduced. The visual system, vestibular system, and prefrontal cortex must work harder to process the environment, consuming more cognitive resources and producing fatigue, confusion, and symptom exacerbation. This is a treatable neurologic pattern, not a sign of permanent cognitive impairment.

Question 11

Why am I having trouble sleeping after my concussion?

Accepted Answer

Sleep disruption after concussion is very common and can involve difficulty falling asleep, frequent waking, excessive daytime sleepiness, or altered sleep architecture. Contributing factors include autonomic dysregulation (which affects the sleep-wake cycle), pain (headache or neck pain disrupting sleep), anxiety, and direct effects of the injury on brainstem sleep-regulating centers. Addressing the underlying neurologic constraints — rather than treating sleep symptoms in isolation — typically produces more durable improvement.

Question 12

What is the treatment for a concussion?

Accepted Answer

Acute concussion management involves relative rest for the first 24 to 48 hours, followed by a gradual return to activity. Prolonged complete rest is no longer recommended; early, sub-symptom-threshold activity has been shown to support recovery. For persistent concussion symptoms, treatment should be guided by neurologic evaluation to identify the specific systems involved. Vestibular rehabilitation, oculomotor therapy, autonomic rehabilitation (graded exertion), cervical spine treatment, and sensorimotor integration training are the primary evidence-based interventions for post-concussion syndrome.

Question 13

Should I rest completely after a concussion?

Accepted Answer

Complete rest beyond the first 24 to 48 hours is no longer recommended by most concussion guidelines. Early return to light, sub-symptom-threshold activity — including walking and light cognitive tasks — has been shown to support recovery and reduce the risk of prolonged symptoms. The key is staying below the threshold at which symptoms are provoked. Patients who remain completely inactive for extended periods often have worse outcomes than those who engage in appropriately graded activity.

Question 14

What is vestibular rehabilitation for concussion?

Accepted Answer

Vestibular rehabilitation is a targeted exercise-based treatment for dizziness, balance problems, and visual-vestibular mismatch after concussion. It involves specific exercises designed to recalibrate the vestibular system and its connections to the visual and sensorimotor systems. Vestibular rehabilitation is one of the most evidence-supported treatments for post-concussion dizziness and is a standard component of care at Pittsford Performance Care.

Question 15

What is oculomotor therapy for concussion?

Accepted Answer

Oculomotor therapy addresses dysfunction in the eye movement systems — smooth pursuit, saccades, convergence, and gaze stabilization — that commonly occur after concussion. These deficits can cause headaches, reading difficulty, difficulty with screens, and visual-vestibular mismatch. Oculomotor therapy involves structured exercises that retrain the neural pathways governing eye movement and their integration with the vestibular and sensorimotor systems.

Question 16

How many visits does concussion treatment take?

Accepted Answer

The number of visits required depends on the complexity of the presentation, the number of neurologic systems involved, and how long symptoms have been present. Patients with straightforward presentations — a single primary constraint identified early — may achieve significant improvement in 6 to 10 visits. More complex presentations involving multiple systems or long-standing symptoms may require more visits. At Pittsford Performance Care, progress is measured objectively at the start and at discharge, so patients have clear data on their improvement throughout care.

Question 17

Where is Pittsford Performance Care located?

Accepted Answer

Pittsford Performance Care is located at 3800 Monroe Ave, Suite 22, Pittsford, NY 14534. The practice is easily accessible from Pittsford, Brighton, Fairport, Victor, Penfield, Webster, and the greater Rochester area. Most Rochester neighborhoods are within 20 minutes of the office.

Question 18

Do I need a referral to see a concussion specialist in Pittsford?

Accepted Answer

No referral is required. Patients can schedule directly through the website or by phone. If your primary care physician, pediatrician, or emergency provider has already evaluated you, bringing any imaging reports or clinical notes to your first visit is helpful but not required.

Question 19

Does Pittsford Performance Care treat pediatric concussion?

Accepted Answer

Yes. Pittsford Performance Care evaluates and treats concussion in patients of all ages, including children and adolescents. Student athletes from Pittsford Sutherland, Pittsford Mendon, and other Monroe County schools are regularly seen for concussion evaluation and return-to-sport management. Pediatric concussion evaluation follows the same neurologic constraint framework as adult evaluation, with age-appropriate modifications to the assessment and treatment protocols.

Question 20

Do you treat patients from outside the Rochester area?

Accepted Answer

Yes. Because persistent concussion and complex dizziness conditions often require specialized neurologic evaluation, Pittsford Performance Care regularly sees patients traveling from other parts of New York and the Northeast. Patients who have not found resolution through standard care frequently seek out specialist evaluation when symptoms have not responded to conventional treatment. Out-of-area patients can also request a remote clinical case review before scheduling an in-person evaluation.

Question 21

What should I bring to my first concussion evaluation?

Accepted Answer

Bring any imaging reports (MRI, CT) if available, a list of current medications, and notes on your symptom history — when symptoms started, what makes them better or worse, and what treatments you have already tried. If you have been seen by other providers for this condition, a brief summary of their findings is helpful. You do not need to bring anything specific; the evaluation is comprehensive and does not depend on prior documentation.

Question 22

Does Pittsford Performance Care accept insurance?

Accepted Answer

Please contact the office directly at (585) 678-5900 or through the website to discuss insurance and payment options. Coverage varies by plan and by the specific services provided.

Question 23

When can a student athlete return to sport after a concussion?

Accepted Answer

Return to sport after concussion should follow a structured, stepwise protocol — not be based on symptom resolution alone. The standard approach involves five stages: symptom-limited activity, light aerobic exercise, sport-specific exercise, non-contact training drills, and full-contact practice before return to competition. At Pittsford Performance Care, return-to-sport readiness is confirmed through objective neurologic assessment, not symptom self-report alone. An athlete who reports feeling fine may still have measurable neurologic deficits that increase re-injury risk.

Question 24

What is the risk of returning to sport too early after a concussion?

Accepted Answer

Returning to contact sport before neurologic recovery is complete significantly increases the risk of second-impact syndrome — a rare but potentially catastrophic condition in which a second concussion occurs before the first has resolved. It also increases the risk of prolonged recovery from the second injury. For these reasons, objective neurologic clearance — not symptom resolution alone — is the appropriate standard for return-to-sport decisions in student athletes.

Question 25

What is second-impact syndrome?

Accepted Answer

Second-impact syndrome occurs when a second concussion is sustained before the first has fully resolved. The brain, still in a vulnerable metabolic state from the initial injury, responds to the second impact with rapid, diffuse cerebral swelling that can be life-threatening. Second-impact syndrome is rare but disproportionately affects adolescents. It is the primary reason that objective neurologic clearance — not symptom resolution alone — is required before return to contact sport.

Question 26

What is autonomic dysfunction after concussion?

Accepted Answer

Autonomic dysfunction after concussion refers to dysregulation of the autonomic nervous system — the system that controls heart rate, blood pressure, breathing, digestion, and energy availability. After concussion, the autonomic nervous system may fail to appropriately regulate these functions, producing symptoms including fatigue, exercise intolerance, heart rate variability, orthostatic intolerance (dizziness when standing), anxiety, and sleep disruption. Autonomic dysfunction is one of the most common and most underdiagnosed contributors to persistent concussion symptoms.

Question 27

What is POTS and how is it related to concussion?

Accepted Answer

Postural Orthostatic Tachycardia Syndrome (POTS) is a form of autonomic dysfunction characterized by an abnormal increase in heart rate (typically 30+ beats per minute) upon standing. POTS can develop after concussion or other triggering events and produces symptoms including dizziness, lightheadedness, fatigue, brain fog, and exercise intolerance. POTS is diagnosed through tilt-table testing or active stand testing and is treated with a combination of autonomic rehabilitation, graded exertion, and in some cases medication.

Question 28

What is BPPV and can it occur after a concussion?

Accepted Answer

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and occurs when calcium carbonate crystals (otoconia) become dislodged from the utricle and migrate into the semicircular canals of the inner ear. BPPV can occur after head trauma, including concussion. It produces brief, intense episodes of spinning vertigo triggered by specific head positions. BPPV is highly treatable with canalith repositioning maneuvers (such as the Epley maneuver) and typically resolves within 1 to 3 sessions.

Question 29

What is visual-vestibular mismatch?

Accepted Answer

Visual-vestibular mismatch is a condition in which the visual system and the vestibular system send conflicting signals to the brain about the body's position and movement in space. After concussion, this mismatch can produce dizziness, nausea, disorientation in visually complex environments, and difficulty with moving visual stimuli (scrolling screens, traffic, crowds). Treatment involves vestibular rehabilitation exercises that specifically target the integration of visual and vestibular inputs.

Question 30

What happens during a concussion evaluation at Pittsford Performance Care?

Accepted Answer

The initial evaluation typically takes 60 to 90 minutes. It includes a detailed symptom history and review of prior care, vestibular testing (balance, gaze stability, head impulse testing), oculomotor assessment (smooth pursuit, saccades, convergence, VOR cancellation), autonomic evaluation (heart rate response to exertion, orthostatic testing), sensorimotor assessment, and cervical spine evaluation. The evaluation identifies the primary neurologic constraint and produces a sequenced care plan with objective criteria for progression.

Question 31

What is a neurologic constraint?

Accepted Answer

A neurologic constraint is the specific dysfunction within the nervous system that is generating the most significant symptom burden and limiting recovery. In post-concussion syndrome, the constraint is typically located in one of four systems: the vestibular system, the visual/oculomotor system, the autonomic nervous system, or sensorimotor integration. Identifying the primary constraint — rather than treating all symptoms simultaneously — allows treatment to be sequenced correctly, which produces faster and more durable outcomes.

Question 32

What is Constraint-Based Medicine?

Accepted Answer

Constraint-Based Medicine is a clinical framework developed at Pittsford Performance Care that organizes neurologic evaluation and treatment around the concept of the primary constraint — the single dysfunction most responsible for limiting recovery. Rather than treating all symptoms in parallel, Constraint-Based Medicine identifies the constraint, addresses it first, and then reassesses to determine whether additional constraints remain. This sequenced approach is particularly effective for complex, multi-system presentations like post-concussion syndrome.

Concussion FAQ

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Related Resources

Persistent Concussion Guide

Understanding Dizziness After Concussion

Autonomic Dysfunction After Concussion

Post-Concussion Syndrome Hub

Concussion Specialist — Pittsford, NY

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