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[ Home ](https://mdster.com) 2. [ Blog ](https://mdster.com/blog) 3. [ Case Discussion ](https://mdster.com/blog?category=case-discussion) 4. Adolescent Concussion: A Case Discussion on Recovery and Return to Play [ Case Discussion ](https://mdster.com/blog?category=case-discussion) Adolescent Concussion: A Case Discussion on Recovery and Return to Play ========================================================================= A soccer player’s persistent symptoms test decisions about imaging, school support, rehabilitation, and sports clearance. [ MDster Editorial Team ](https://mdster.com/about) · Oct 12, 2026 · 6 min read · 45 [ Reviewed by Dr. Ali Ragab, MBBCH, MSc, MCAI ](https://mdster.com/medical-reviewers/dr-ali-ragab) [Editorial Policy](https://mdster.com/editorial-policy) | [Corrections Policy](https://mdster.com/corrections) [ Family Medicine ](https://mdster.com/blog?tag=family-medicine) [ Sports Medicine ](https://mdster.com/blog?tag=sports-medicine) [ Pediatric Concussion ](https://mdster.com/blog?tag=pediatric-concussion) [ Return to Play ](https://mdster.com/blog?tag=return-to-play) Share this article Share this post On this page 1. [ Clinical reasoning at the two-week visit ](#clinical-reasoning-at-the-two-week-visit) 2. [ Concussion is likely; grading adds little ](#concussion-is-likely-grading-adds-little) 3. [ Why ordinary tasks still provoke symptoms ](#why-ordinary-tasks-still-provoke-symptoms) 4. [ Investigation: identify danger before ordering tests ](#investigation-identify-danger-before-ordering-tests) 5. [ Re-examine what could change disposition ](#re-examine-what-could-change-disposition) 6. [ Management: restore function without another collision ](#management-restore-function-without-another-collision) 7. [ Treat symptoms while protecting recovery ](#treat-symptoms-while-protecting-recovery) 8. [ Separate exercise from return to soccer ](#separate-exercise-from-return-to-soccer) 9. [ Key Points for Board Exams ](#key-points-for-board-exams) 10. [ Frequently Asked Questions ](#blog-faqs) 11. [ References ](#references-heading) On this page 1. [ Clinical reasoning at the two-week visit ](#clinical-reasoning-at-the-two-week-visit) 2. [ Concussion is likely; grading adds little ](#concussion-is-likely-grading-adds-little) 3. [ Why ordinary tasks still provoke symptoms ](#why-ordinary-tasks-still-provoke-symptoms) 4. [ Investigation: identify danger before ordering tests ](#investigation-identify-danger-before-ordering-tests) 5. [ Re-examine what could change disposition ](#re-examine-what-could-change-disposition) 6. [ Management: restore function without another collision ](#management-restore-function-without-another-collision) 7. [ Treat symptoms while protecting recovery ](#treat-symptoms-while-protecting-recovery) 8. [ Separate exercise from return to soccer ](#separate-exercise-from-return-to-soccer) 9. [ Key Points for Board Exams ](#key-points-for-board-exams) 10. [ Frequently Asked Questions ](#blog-faqs) 11. [ References ](#references-heading) A 16-year-old soccer player remains out of sport two weeks after a head-to-head collision. He was briefly foggy without losing consciousness; now headache worsens with reading, teachers report poor concentration, and tandem gait is mildly unsteady. The immediate question is not when he can play—it is whether another injury or a treatable contributor to his symptoms has been missed. Clinical reasoning at the two-week visit ---------------------------------------- ### Concussion is likely; grading adds little The collision, acute confusion, and subsequent cognitive, sleep, mood, and balance symptoms support sport-related concussion. Loss of consciousness is not required. Although an older grading scheme might label several minutes of confusion “Grade 2,” contemporary care does **not** use that label to predict recovery or determine clearance; serial symptoms and examination matter more. [\[1\]](#cite-1 "Reference [1]") Two weeks of symptoms warrant reassessment, not an automatic diagnosis of post-concussion syndrome. The Amsterdam consensus uses **persisting symptoms** for symptoms lasting more than four weeks; meanwhile, CDC guidance supports referral when recovery is not proceeding as expected after two to four weeks. [\[1\]](#cite-1 "Reference [1]") The differential should remain active: - Intracranial injury if headache worsens, neurological findings emerge, or the history reveals additional risk factors. - Cervical injury or cervicogenic headache, particularly with neck pain or restricted movement. - Vestibular or oculomotor dysfunction contributing to imbalance and reading intolerance. - Migraine phenotype, sleep disruption, mood symptoms, or a pre-existing learning or attention difficulty amplifying symptom burden. [\[1\]](#cite-1 "Reference [1]") ### Why ordinary tasks still provoke symptoms Biomechanical strain triggers glutamate release, potassium efflux, and calcium influx. Restoring ionic gradients increases energy demand while cerebral blood flow and mitochondrial function may be impaired. This supply–demand mismatch helps explain sensitivity to cognitive and physical exertion; secondary axonal and inflammatory processes add complexity, but the cascade is not measured by routine office tests. [\[2\]](#cite-2 "Reference [2]") > **Clinical Pearl:** A normal conventional scan does not exclude concussion. Conversely, a concerning new examination finding should not be dismissed simply because the patient already has a concussion diagnosis. [\[3\]](#cite-3 "Reference [3]") Investigation: identify danger before ordering tests ---------------------------------------------------- ### Re-examine what could change disposition Clarify the headache trajectory, vomiting, amnesia, subsequent impacts, medication use, and school demands. Repeat a focused neurological and cervical examination, including gait and balance; assess eye movements and symptom provocation with visual or vestibular tasks. A validated symptom scale and the age-appropriate SCOAT6 can structure office follow-up at two weeks, but neither replaces clinical judgment. [\[3\]](#cite-3 "Reference [3]") Send him for **immediate emergency assessment** if he develops a worsening, unremitting headache; repeated vomiting; seizure; increasing confusion or difficulty awakening; unequal pupils; new weakness, numbness, or substantially worsening coordination. New midline cervical tenderness or neurological findings suggestive of spine injury require spinal precautions and urgent assessment rather than repeated neck testing. His mild tandem-gait difficulty deserves characterization and follow-up; if new or progressive, escalate promptly. [\[4\]](#cite-4 "Reference [4]") Do not order CT or MRI solely because symptoms have lasted two weeks. CDC guidance advises against routine imaging for pediatric mTBI; use examination, symptom evolution, and validated decision rules to evaluate concern for structural injury. Likewise, formal neuropsychological testing is selective—not mandatory at this visit—and may help if cognitive difficulties remain functionally significant or the diagnosis is uncertain. [\[3\]](#cite-3 "Reference [3]") Management: restore function without another collision ------------------------------------------------------ ### Treat symptoms while protecting recovery At two weeks, prolonged dark-room rest is counterproductive. Recommend regular sleep timing, hydration, meals, and manageable daytime activity. For headache, consider intermittent acetaminophen or ibuprofen when appropriate, review contraindications and frequency of use, and avoid opioids and analgesic overuse. Medication must not be used to conceal symptoms for sports clearance. [\[1\]](#cite-1 "Reference [1]") Arrange school accommodations with the student and family: reduced reading load when symptomatic, breaks, adjusted deadlines, and a plan to increase participation as tolerated. He need not be entirely symptom-free to attend school. Ask about irritability, anxiety, and sleep directly rather than attributing every difficulty to brain injury. [\[5\]](#cite-5 "Reference [5]") Light, noncontact aerobic activity can be advanced according to symptoms without waiting for complete recovery. Given persistent headache and imbalance, consider cervicovestibular rehabilitation, particularly if targeted examination supports it; the Amsterdam consensus recommends this approach when dizziness, neck pain, or headache persists beyond ten days. Reassess progress soon and consider specialist referral if improvement stalls. [\[1\]](#cite-1 "Reference [1]") ### Separate exercise from return to soccer Walking or stationary cycling is treatment, **not** clearance for heading drills or match play. Coordinate a graduated return-to-sport plan with the athletic trainer when available; monitor symptoms at each stage and obtain clinician authorization before activities with collision risk. Full return to learning should precede unrestricted sport, and contact activity requires resolution of concussion-related symptoms and findings at rest and with exertion. [\[1\]](#cite-1 "Reference [1]") Key Points for Board Exams -------------------------- - Brief confusion without loss of consciousness can establish a clinically plausible concussion; obsolete numerical grades should not drive management. [\[1\]](#cite-1 "Reference [1]") - Two-week symptoms prompt structured reassessment. Routine imaging and automatic neuropsychological testing are not indicated. [\[3\]](#cite-3 "Reference [3]") - Worsening neurological features change disposition; persistent but stable symptoms call for targeted treatment and follow-up. [\[4\]](#cite-4 "Reference [4]") - Support school participation and symptom-limited exercise while withholding collision-risk activity until appropriately cleared. [\[1\]](#cite-1 "Reference [1]") Repeated head impacts raise concern about long-term brain health, including CTE, but this teenager’s current symptoms do not diagnose or predict that disease. CTE can currently be confirmed only neuropathologically after death. For this visit, the defensible decision is practical: address his headache and balance findings, support school, and do not clear him for soccer contact yet. [\[6\]](#cite-6 "Reference [6]") Frequently Asked Questions ---------------------------- ### Does the absence of loss of consciousness rule out concussion? No. Acute confusion or fogginess after a head impact, followed by compatible symptoms, can support the diagnosis. [\[1\]](#cite-1 "Reference [1]") ### Does a headache lasting two weeks require a brain MRI? Not by itself. Reassess symptoms and examination; reserve imaging for concern about structural injury or concerning deterioration. [\[3\]](#cite-3 "Reference [3]") ### Can this student attend classes while he still has symptoms? Yes. Most students can attend with symptom-based accommodations and gradually increase their academic load. [\[5\]](#cite-5 "Reference [5]") ### Can he start exercising before he is cleared for soccer? Yes. Symptom-limited, noncontact aerobic activity differs from clearance for drills with collision risk or competition. [\[1\]](#cite-1 "Reference [1]") References (9) ------------------ 1. 1. [ doi.org/10.1136/BJSPORTS-2023-106898 ](https://doi.org/10.1136/BJSPORTS-2023-106898) [↩](#cite-ref-1-1 "Back to text") 2. 2. [ pmc.ncbi.nlm.nih.gov/articles/155411 ](https://pmc.ncbi.nlm.nih.gov/articles/155411/) [↩](#cite-ref-2-1 "Back to text") 3. 3. [ CDC. Safety Guidelines for Pediatric Mild TBI, updated 2025. ](https://www.cdc.gov/traumatic-brain-injury/hcp/clinical-guidance/pediatric-mtbi.html) [↩](#cite-ref-3-1 "Back to text") 4. 4. [ www.cdc.gov/heads-up/signs-symptoms ](https://www.cdc.gov/heads-up/signs-symptoms/) [↩](#cite-ref-4-1 "Back to text") 5. 5. [ CDC HEADS UP. Returning to School After a Concussion, 2025. ](https://www.cdc.gov/heads-up/guidelines/returning-to-school.html) [↩](#cite-ref-5-1 "Back to text") 6. 6. [ www.ninds.nih.gov/health-information/clinical-trials/diagnose-cte-research-project ](https://www.ninds.nih.gov/health-information/clinical-trials/diagnose-cte-research-project) [↩](#cite-ref-6-1 "Back to text") 7. 7. [ Patricios JS, et al. Consensus statement on concussion in sport: Amsterdam 2022. British Journal of Sports Medicine. 2023. ](https://bjsm.bmj.com/content/57/11/695) 8. 8. [ CDC HEADS UP. Returning to Sports, 2025. ](https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html) 9. 9. [ NIH. Severe CTE clearly linked to dementia, 2026. ](https://www.nih.gov/news-events/nih-research-matters/severe-cte-clearly-linked-dementia) Next Stay consistent in Family Medicine prep with a guided pathway --------------------------------------------------------------- - Broad coverage without the overwhelm - Short daily sessions that compound - See your progress and focus on weak areas [ Start practicing ](https://mdster.com/user/dashboard) [ Family Medicine ](https://mdster.com/speciality/family-medicine) [ View pricing ](https://mdster.com/pricing) [ Explore features ](https://mdster.com/features) No credit card required. Full access to all features\*. No commitment. Cancel anytime. \*AI SOE Examiner is limited to 10 cases monthly for Advanced & Bundle subscribers. 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