Second-Impact Syndrome: The Hidden Danger of Returning to Activity Too Soon After a Concussion

A concussion is a type of traumatic brain injury (TBI) that can happen after a bump, blow, or jolt to the head. While many people recover fully with proper care, failing to take the right precautions can have serious consequences. One of the most dangerous risks of an untreated or mismanaged concussion is Second-Impact Syndrome, a rare but life-threatening condition that can lead to severe brain swelling, permanent disability, or even death.

At Daviess Community Hospital's CORE Center locations in Washington and Odon, our experienced therapists provide evidence-based concussion rehabilitation to help patients recover safely and prevent complications like Second-Impact Syndrome. If you or someone you know has suffered a concussion, understanding the risks and taking the proper steps for recovery is essential.

What Is Second-Impact Syndrome?

Second-Impact Syndrome occurs when a person sustains a second concussion before the brain has fully healed from the first. This second injury can cause rapid and uncontrollable brain swelling, leading to severe neurological damage, coma, or even fatal outcomes.

"One of the biggest misconceptions about concussions is that rest alone is enough for recovery," said Nathan Sterling, MS, LAT, ATC, Certified Athletic Trainer at CORE Center. "While rest is important, structured rehabilitation is often necessary to prevent symptoms from lingering for weeks or even months. Second-Impact Syndrome is rare but devastating—it can result in permanent disability or even death within minutes of the second impact."

How Does a Concussion Lead to Second-Impact Syndrome?

According to the National Athletic Training Association (NATA), a concussion is defined as a "trauma-induced alteration in mental status that may or may not involve loss of consciousness." This means that even a mild hit to the head or body that causes the brain to move rapidly back and forth can result in a concussion.

Without proper management, individuals recovering from a concussion may return to activity too soon, putting them at risk for another impact. This is especially dangerous because the brain is in a vulnerable state, and a second injury can trigger catastrophic swelling almost immediately.

Who Is at Risk for Second-Impact Syndrome?

Athletes are among the most vulnerable, particularly those involved in high-contact sports such as:

• Football
• Soccer
• Basketball
• Hockey
• Wrestling

"I have personally seen concussions occur in sports like basketball, where players collide going after a loose ball, and soccer, where goalies hit their heads diving for the ball," Sterling said. "Even a simple fall in a non-contact sport can lead to a concussion."

However, Second-Impact Syndrome isn’t limited to athletes. It can also happen in everyday situations such as:

• Falls, especially in young children or older adults
• Car accidents
• Workplace injuries in physically demanding jobs
• Bike accidents
• Physical altercations or assaults

Signs and Symptoms of a Concussion

Recognizing a concussion early is key to preventing further injury. Symptoms may appear immediately or take days to develop and include:

• Headache or pressure in the head
• Dizziness or loss of balance
• Nausea or vomiting
• Blurred vision
• Sensitivity to light or sound
• Difficulty concentrating or feeling mentally "foggy"
• Changes in mood, behavior, or personality

In more serious cases, warning signs of a medical emergency include:

• Worsening headaches
• Seizures
• Unequal pupil size
• Persistent vomiting
• Severe drowsiness or difficulty waking up
• Loss of consciousness
• Blood or fluid coming from the nose or ears

If any of these symptoms occur, seek immediate medical attention.

How to Prevent Second-Impact Syndrome

The best way to prevent Second-Impact Syndrome is to follow proper concussion management protocols and ensure a full recovery before returning to physical activity.

"If you have a concussion, you need to be fully cleared by a trained medical professional before resuming any physical activity," Sterling said. "This isn’t just about sports—it applies to work, school, and daily life as well."

The Return-to-Play Protocol helps ensure that athletes gradually increase activity levels while being monitored for symptoms. This step-by-step process includes:

1. Light aerobic activity – Running, jogging, or biking for 15-20 minutes
2. Moderate aerobic activity – Increased intensity with 30-45 minutes of exercise
3. Sport-specific exercises – Non-contact drills to assess movement and coordination
4. Non-contact training drills – Agility and conditioning with teammates
5. Full-contact practice – If symptom-free, the athlete may return to normal play

Any recurrence of symptoms means the athlete must stop immediately and restart the protocol from the previous step.

How CORE Center Can Help with Concussion Recovery

At CORE Center, we offer specialized concussion rehabilitation designed to help patients recover safely and reduce the risk of long-term complications. Our concussion rehab program includes:

✔ Neurological re-education – Retraining the brain to restore balance, coordination, and cognitive function
✔ Vestibular therapy – Treating dizziness, motion sensitivity, and balance issues
✔ Manual therapy – Addressing headaches and neck pain with hands-on techniques
✔ Cognitive rehabilitation – Improving focus, memory, and processing speed
✔ Vision training – Strengthening visual coordination after a concussion
✔ Gradual return-to-play programs – Ensuring a safe transition back to sports or physical activity

Without proper rehabilitation, concussion symptoms can linger for weeks or months, leading to chronic headaches, brain fog, difficulty concentrating, and impaired sports performance.

"Our goal at CORE is to provide individualized treatment plans that help patients fully recover and safely return to their daily lives," Sterling said.

Take Action: Schedule a Concussion Evaluation at CORE

If you or someone you know has experienced a concussion, do not return to activity too soon. Protect your brain health by seeking expert care at Daviess Community Hospital’s CORE Center.

📍 CORE Center | 421 E. Van Trees Street, Washington, IN    

📍 CORE Center at North Daviess | 800 S. West Street, Odon, IN       

📞 Call (812) 254-8889 to schedule an evalution.

Your brain health matters—don’t take the risk.