Concussion Diagnosis Is Clinical, Not Radiological A concussion does not show up on standard brain imaging. CT scans and MRIs look normal after concussion because the injury is functional (how the brain works) not structural (brain tissue damage visible on imaging). Diagnosis depends on a trained clinician recognizing the pattern of symptoms, cognitive changes, and physical findings that define concussion (McCrory et al., 2017). The diagnostic process involves multiple assessment components because no single test confirms concussion. A clinician integrates information from symptom reporting, cognitive screening, balance testing, neurological examination, and injury mechanism to arrive at a diagnosis. This multi-component approach reduces missed diagnoses and false positives. The gold standard assessment tool is the Sport Concussion Assessment Tool (SCAT5), which combines all major assessment components into a standardized protocol. The SCAT5 takes 15-20 minutes and provides a structured framework that improves diagnostic accuracy across different clinician experience levels. The Diagnostic Components Symptom assessment. The clinician evaluates 22 common concussion symptoms rated on a severity scale of 0-6. Symptoms include headache, pressure in the head, neck pain, nausea, dizziness, blurred vision, balance problems, sensitivity to light, sensitivity to noise, feeling slowed down, feeling "in a fog," difficulty concentrating, difficulty remembering, fatigue, confusion, drowsiness, emotional changes, irritability, sadness, nervousness, and trouble falling asleep. The total symptom score and severity score provide quantified baselines for tracking recovery. Cognitive screening. Orientation questions (month, date, day of week, year, time) test basic awareness. Immediate memory testing (five-word list recall over three trials) assesses encoding. Concentration testing (reverse digit span and month-in-reverse-order) evaluates attention and working memory. Delayed recall (recalling the five-word list after several minutes) tests short-term memory consolidation. Balance evaluation. The modified Balance Error Scoring System (mBESS) tests three stances: double leg, single leg, and tandem (heel-to-toe), each held for 20 seconds with eyes closed on a firm surface. Errors (opening eyes, lifting hands from hips, stepping, stumbling, falling, moving hips beyond 30 degrees, lifting toes or heels, remaining out of position for more than 5 seconds) are counted. Concussion typically increases balance errors compared to baseline or normative values. Neurological examination. Cranial nerve testing, pupil reactivity assessment, coordination testing (finger-to-nose), cervical spine evaluation, and gait assessment identify neurological deficits. Red flags (worsening headache, repeated vomiting, seizure, increasing confusion, weakness or numbness, neck tenderness, double vision) indicate potential structural injury requiring immediate imaging. Mechanism of injury review. The force, direction, and nature of the impact provide context. Direct head impact, whiplash mechanism, blast exposure, and rotational forces each carry different injury profiles. The mechanism helps the clinician interpret borderline findings. What the Assessment Looks Like in Practice Sideline assessment (sport). Immediate evaluation uses the SCAT5 or Concussion Recognition Tool (CRT5). The athlete is removed from play and assessed in a quiet area. Assessment focuses on observable signs (loss of consciousness, amnesia, disorientation, blank stare, balance problems) and rapid symptom screening. Any positive finding means the athlete does not return to play that day. Emergency department. ED evaluation focuses on ruling out structural injury (bleeding, fracture) through neurological examination and, when indicated, CT imaging. Concussion diagnosis in the ED often relies on symptom assessment and brief cognitive screening rather than the full SCAT5 protocol. ED discharge instructions should include follow-up with a concussion specialist within 48-72 hours. Clinic-based assessment. The most comprehensive evaluation occurs in a clinical setting 24-72 hours after injury. Full SCAT5 administration, detailed symptom history, vestibular and oculomotor screening (VOMS), cervical examination, and comparison to baseline testing (when available) provide the most accurate diagnostic picture. Vestibular/Ocular Motor Screening (VOMS). This tests smooth pursuits, saccades, near point of convergence, horizontal and vertical vestibular-ocular reflex, and visual motion sensitivity. Each component is rated for symptom provocation. VOMS identifies vestibular and oculomotor deficits that predict prolonged recovery and guide targeted treatment. Cervical Assessment in Concussion Evaluation The cervical spine is injured by the same mechanism that causes concussion. Cervical evaluation is essential because neck dysfunction produces symptoms (headache, dizziness, difficulty concentrating, nausea) that overlap with concussion symptoms. Missing cervical involvement leads to incomplete treatment and prolonged recovery. Cervical mobility exercises support the assessment and recovery process: JME 1 Cervical rotation assessment and mobility. Asymmetric rotation range or pain with rotation indicates cervical involvement that requires targeted treatment alongside concussion management. JME 14 Chin tucks assess and strengthen deep cervical flexors. Weakness or pain with chin tucks indicates cervical motor control deficits common after concussion mechanism injuries. JME 6 Cervical flexion range and strength assessment. Limitations in flexion suggest anterior cervical dysfunction contributing to post-concussion headache patterns. JME 5 Cervical extension evaluates posterior neck function. Extension limitations correlate with tension-type headache patterns frequently attributed solely to concussion. Start your 14-day free trial for cervical mobility programming that supports concussion recovery. Complementary Upper Body Assessment JME 3 Lateral flexion identifies asymmetric cervical function that contributes to post-concussion symptom persistence. JME 42 Shoulder mobility assessment reveals upper quarter tension patterns that contribute to cervicogenic headache after concussion. JME 150 Thoracic rotation assessment identifies mid-back stiffness that increases cervical strain and perpetuates post-concussion symptoms. JME 152 Upper back extension evaluation reveals thoracic kyphosis patterns that contribute to forward head posture and cervical symptom persistence. Common Diagnostic Challenges Delayed symptom onset. Symptoms sometimes develop hours after the injury, not immediately. Athletes or individuals assessed at the scene of injury and initially cleared sometimes develop symptoms later. Educating patients to monitor for delayed symptom onset and return for evaluation if symptoms emerge is essential. Symptom overlap. Headache, fatigue, difficulty concentrating, and mood changes occur with dehydration, heat illness, sleep deprivation, stress, and cervical injury. The clinician must differentiate concussion from these conditions. History, mechanism, and the specific pattern of symptoms guide differential diagnosis. Underreporting. Approximately 50% of concussions go unreported. Athletes underreport to avoid removal from play. Employees underreport to avoid lost work time. Children underreport because they don't recognize symptoms. Creating cultures that normalize reporting and remove penalties for disclosure improves detection rates. Support your recovery with simplmobility's structured mobility programming. How long does concussion assessment take? A comprehensive SCAT5 assessment takes 15-20 minutes. Sideline screening takes 5-10 minutes. A full clinic-based evaluation including VOMS, cervical examination, and neuropsychological screening takes 45-60 minutes. The initial assessment establishes baseline measurements that track recovery progress over subsequent visits. Do I need to see a specialist for concussion diagnosis? Primary care physicians, emergency medicine physicians, and athletic trainers trained in concussion assessment diagnose concussions effectively. Specialist referral (sports medicine, neurology, or concussion clinic) is appropriate for symptoms lasting beyond 10-14 days, complex presentations, history of multiple concussions, or when return-to-activity decisions require specialized guidance. What if my assessment is normal but I still feel off? Normal cognitive scores with persistent symptoms still indicate concussion. Some individuals maintain cognitive function through compensatory effort while experiencing significant symptoms. Symptom reporting carries equal diagnostic weight as objective testing. If you have symptoms consistent with concussion after a plausible mechanism, you have a concussion regardless of cognitive screening performance. References McCrory, P., et al. (2017). Consensus statement on concussion in sport: the 5th international conference on concussion in sport. British Journal of Sports Medicine, 51(11), 838-847. PubMed Mucha, A., et al. (2014). A brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions. American Journal of Sports Medicine, 42(10), 2479-2486. PubMed