How Many Concussions Are Too Many?

Article by Moody Neuro

When you hit your head, fall or get tackled to the ground, your brain can bounce and move against the skull’s bony structure. This results in a concussion or a mild traumatic brain injury (TBI) and brings symptoms of varying severity.

Some events that cause concussions include falls, car accidents and physical assaults, but athletes involved in contact sports are also vulnerable to TBIs. In fact, at least 1.6 million sports-related concussions are estimated each year in the United States.

Mild concussions may cause short-term symptoms that typically resolve within a week or two, but some patients experience symptoms that linger longer, even with time and rest.

Moreover, athletes engaged in contact sports like soccer, rugby, ice hockey and boxing are at risk of repetitive concussions and their long-term consequences. At what point do multiple TBIs become problematic? How many concussions are too many? Let’s dig deeper into these fundamental topics on concussions in the following sections.

How Many Concussions Can You Have?

If you are an athlete or a parent of an athlete, you may have heard of the three-strike rule. This was developed 60 years ago and essentially said that an athlete who has suffered three concussions in a season will have to sit out for the rest of that season. However, this rule is not based on scientific data.

Rather than the number, more relevant factors to consider when an athlete should stop or return to the game include the severity and recentness of the last concussion. Suffering three TBIs in a single year differs from suffering the same number of concussions over three years.

An individual’s response to brain injuries also influences how many concussions are too many for that person. For example, those predisposed to certain problems can experience worsened dizziness or balance issues after a single head injury.

How Many Concussions Are Too Many for an Active Athlete?

As every person is different, there’s no definite number of how many head injuries a person can sustain before permanent damage occurs. After all, some experience long-term complications after a single concussion, while others seem fine after multiple injuries. Still, the more traumas you’ve had, the greater the chances of permanent damage.

It’s also worth stressing that how many concussions you can have isn’t the best question to ask, as it encourages an unhealthy understanding of how TBIs can cause damage. Following the three-concussion rule or setting a specific limit can discourage athletes from reporting symptoms so that they can continue playing.

As individuals experience head injuries differently, discussing your vulnerability and injury history is a better approach. The timing between the injuries matters as athletes who continue to play with a healing concussion can develop worse symptoms, double their recovery time and suffer more significant impairment. There’s also the risk of suffering second impact syndrome, which happens when an already-damaged brain swells up rapidly after getting hit again.

The Second Impact Syndrome

This is a rare but potentially fatal phenomenon in individuals sustaining a TBI while recovering from a recent concussion. Also known as repetitive head injury syndrome, this is when the brain dramatically swells after a second concussion before symptoms from an earlier injury have resolved.

Second-impact syndromes are often fatal, and the few who survive usually become severely disabled.

Common Short-Term and Long-Term Symptoms of Concussion

Athletes and non-athletes who suffered a blow to the head may experience physical, emotional and psychological symptoms. They may experience a headache, nausea or vomiting, double vision, confusion, fatigue or sensitivity to light, among many others. Other symptoms include losing consciousness or not recalling getting injured. Some also report feeling sluggish or hazy.

Meanwhile, persistent symptoms post-concussion include but are not limited to irritability, loss of concentration and memory, sleep disturbances, smell and taste dysfunction and anxiety.

Consequences of Repetitive Head Impacts and Multiple Concussions

The recovery time for a single concussion is typically short. Symptoms usually disappear within ten days, but they can also last up to three months in some cases. Fortunately, once they are resolved and the brain has healed, there are usually no further complications.

However, it’s a different story when there are multiple concussions involved. The brain needs time to recover from an injury, so permanent damage can happen when it is overwhelmed by several injuries.

After too much trauma, blood flow and oxygenation in the brain are negatively impacted. This makes it hard for the brain cells to do their job, consequently hampering an individual’s ability to think, concentrate and even move. Ultimately, repetitive brain injuries can lead to chronic traumatic encephalopathy, a progressive degenerative disease.

Repeat injuries while recovering from a recent concussion can cause life-changing consequences. However, it’s important to note that it can also occur with less force, as the brain is at an increased risk while still healing.

Findings from Sports Studies

In boxing, attacking the head and face of the opponent is part of the game. While amateur boxers wear protective gear, the nature of the sport makes concussions and even severe brain injuries common among fighters.

A 1997 study examined boxers who played 12 or more professional bouts and, therefore, had higher exposure to head contact and compared their neurocognitive performance with those who played less than 12 professional bouts. The authors reported that the first group had lower cognitive function than the latter.

A high-resolution MRI study of 100 professional boxers in 2009 also showed a significant correlation between their years in the sport and diffuse axonal injury. It is a type of traumatic brain injury that occurs when axons in the brain become torn as the brain rapidly moves and rotates inside the skull. This movement typically results in the shearing of nerve fibers and usually leads to a coma.

Considering all these, it’s best to move beyond asking how many concussions are too many for an individual. Whether in a boxing ring or field, it’s best to sit out if you’re at risk for a repeat injury until you’ve healed. The brain is vulnerable after a trauma, and successive injuries will only increase the chances of permanent deficits.

When To Return to a Sport

Just like, “How many concussions can you have?” it’s difficult to give a definite answer for when it’s best for an individual to return to a sport. Return-to-play guidelines vary by the severity of the head injury.

With that said, the Centers for Disease Control and Prevention recommends a graduated return-to-play protocol for players who suffer concussion symptoms like confusion or loss of consciousness. Following these six gradual steps is a great starting point, but working closely with your physician is still paramount. Athletes who continue to play sports after concussions risk repeat injuries, more serious complications and a longer recovery time.

Managing Concussion Symptoms and Recovering from Traumatic Brain Injury

Most sports-related concussion symptoms resolve on their own within two weeks. Athletes can also return to their sports practices if they have the approval and supervision of their healthcare provider.

However, in cases where multiple or severe concussions resulted in mobility issues, speech and language impairment, or emotional and behavioral struggles, undergoing rehab is recommended. Rehabilitation programs can take many forms, including physical, occupational, speech and language therapy, as well as counseling and community integration. These are designed to help patients recover from the effects of their injury.

Ultimately, a proactive approach is the key to a speedy and successful recovery. Simply mitigating the symptoms with medication may increase your comfort, but it doesn’t address the underlying issue.

Start Your Recovery Journey with Moody Neurorehabilitation

At Moody Neurorehabilitation, we’re all about empowering patients to gain independence and return to the activities they love. With our world-class facilities, experienced staff and passion for improving the lives of our patients, we provide highly personalized care for adolescents and adults with acquired brain injury.

We serve several locations across Texas and are available to begin the admissions process for you. Upon admission, a comprehensive evaluation will be done to develop a rehabilitation regimen tailored to your cognitive and emotional status. Please don’t hesitate to contact us to schedule a tour or refer a patient.


Strokes are medical conditions that affect millions globally. In the United States, more than 795,000 people have a stroke each year, with about 610,000 cases being first or new strokes. 

These can lead to a wide range of physical and cognitive impairments. Speech and language disorders are among the most common and most challenging consequences of strokes, occurring in about a third of stroke survivors. 

Understanding Stroke-Induced Speech & Language Disorders

Stroke-induced speech and language disorders significantly impact communication abilities. Among these, aphasia, dysarthria, and apraxia of speech are prevalent. Understanding how they are diagnosed and their specific symptoms can aid in prompt and effective management.


Aphasia is a common outcome of stroke, manifesting as difficulty in speaking, understanding, reading, and writing. There are many different types of aphasia, depending on the affected brain area, and are categorized based on the symptoms present:

  • Expressive Aphasia (Broca’s Aphasia): Characterized by broken speech, limited vocabulary, and difficulty forming complete sentences. Patients often understand what is being said to them but struggle to verbalize responses.
  • Receptive Aphasia (Wernicke’s Aphasia): Patients can produce fluent speech but may lack meaning or include nonsensical words. They often have significant difficulty understanding spoken language.
  • Global Aphasia: A severe form of aphasia where individuals have extensive difficulties with both speech production and comprehension.
  • Anomic Aphasia: Individuals have difficulty finding words, particularly nouns and verbs, making their speech sound vague.


Dysarthria is a speech disorder that affects 20-30% of stroke survivors. It occurs when stroke impacts the muscles responsible for speech, leading to slurred or slow speech that can be hard to understand. It is typically diagnosed through a physical examination and a series of speech evaluations conducted by a speech-language pathologist (SLP). 

It is characterized by the following symptoms:

  • Slurred or slow speech that can be difficult to understand
  • Monotone or robotic-sounding speech
  • Difficulty controlling the volume of speech, which may be too loud or too soft
  • Challenges with the rhythm and flow of speech, including rapid speech that’s hard to interrupt or slow, drawn-out speech
  • Respiratory issues affecting the ability to speak loudly or for extended periods

Apraxia of Speech (AOS)

Apraxia of speech is a neurological disorder characterized by difficulty sequencing the movements needed for speech. This is caused by the impact of the stroke on the brain’s pathways involved in producing speech. 

Patients with AOS know what they want to say but struggle to coordinate the muscle movements to articulate words correctly. This results in distorted speech, difficulty initiating speech, or the inability to accurately produce speech sounds or sequences of sounds. 

How Long Is the Stroke Speech & Language Recovery Time?

According to one study on post-stroke speech and language therapy, approximately one-third of stroke patients experience speech problems after a stroke. Many of these individuals begin to recover within a few months, with significant progress typically observed within three to six months.

In another study, 62% of subjects had speech challenges after suffering from a stroke. By six months post-stroke, 74% were able to completely recover their communication abilities. 

However, the figures above provide a general timeline for post-stroke speech and language recovery. Stroke speech recovery time is highly individualized and can vary depending on several factors. These can include the following:

  • Severity of the Stroke: More severe strokes often lead to extensive brain damage, resulting in longer and more challenging recovery periods for speech.
  • Location of the Brain Injury: The brain’s specific regions control different speech and language functions; damage to these areas directly impacts recovery complexity and duration.
  • Age and Overall Health of the Patient: Generally, younger patients with better overall health before the stroke tend to experience faster and more complete recoveries.
  • Pre-existing Conditions and Comorbidities: Conditions such as diabetes or hypertension can slow down recovery by complicating the overall health scenario and rehabilitation process.
  • Individual Variability and Resilience: Personal resilience, the support system’s strength, and the individual’s motivation significantly influence the pace and success of speech recovery efforts.

The first three months after a stroke is a crucial period for recovery, as a majority of stroke patients see the most significant improvement during this period. However, it’s also important to note that, although at a slower pace, recovery can continue well past the 6-month mark with continued therapy and practice. 

This underpins the importance of early intervention and ongoing rehabilitation efforts, including speech therapy, to maximize each patient’s recovery potential. 

What Does the Stroke Speech & Language Recovery Process Look Like?

The journey to regain speech and language after a stroke is multifaceted and varies significantly from one individual to another. Understanding the structured phases of recovery can provide insight into what patients and their families can expect during this challenging time. 

Here’s a closer examination of each phase in the stroke speech recovery process.

Initial Assessment and Diagnosis

Before recovery can begin, a thorough evaluation is conducted by a team of healthcare professionals led by an SLP. This assessment aims to identify the type and severity of the speech and language disorder, be it aphasia, dysarthria, or AOS. The evaluation may include cognitive-linguistic assessments, comprehension tests, speech production analysis, and functional communication measures. 

Based on this assessment, a personalized therapy plan is crafted to address the patient’s specific needs.

Acute Phase

The acute phase typically occurs within the first days to weeks following a stroke. During this period, medical stabilization is the primary focus, with healthcare teams working to manage the immediate effects of the stroke. 

Speech therapy may begin with simple exercises or assessments to gauge the patient’s abilities. However, intensive therapy usually does not start until the patient is medically stable. During the acute phase, the goal is to support overall recovery and prevent complications immediately after the stroke.

Subacute Phase

The subacute phase generally spans from two weeks to three months post-stroke and is characterized by more intensive speech therapy interventions. As the patient’s medical condition stabilizes, the focus shifts to active rehabilitation. Therapy during this phase is tailored to the individual’s specific speech and language deficits and may include:

  • Exercises to improve articulation, fluency, and voice control for those with dysarthria.
  • Language therapy to enhance understanding, speaking, reading, and writing skills in patients with aphasia.
  • Motor speech exercises and strategies to improve speech planning and production in apraxia of speech.

The subacute phase is crucial for taking advantage of the brain’s natural recovery processes and neuroplasticity, where the brain begins reorganizing and adapting to the loss of function.

Chronic Phase

The chronic phase of recovery extends from several months to years after the stroke. It focuses on long-term rehabilitation and adjustment to any residual speech deficits. During this time, patients may continue to see gradual improvements in their speech and language abilities, although the rate of recovery may slow. Therapy in the chronic phase often includes:

  • Advanced communication strategies to cope with ongoing challenges in daily life.
  • Maintenance exercises to preserve and enhance speech gains achieved in earlier phases.
  • Supportive technologies and aids, such as communication devices, to assist in effective communication.
  • Community reintegration activities to help patients return to as normal a life as possible, engaging in social, vocational, or recreational activities.

What Is the Role of Neuroplasticity in Speech & Language Recovery?

Neuroplasticity refers to the brain’s fundamental property to change and adapt its responses to new experiences, learning, and environmental changes. This adaptive capacity enables the brain to reorganize itself by forming new neural connections.

When the brain, or a part of the brain, is damaged after a stroke, neuroplasticity is what allows the other parts of the brain to take over the functions of the damaged area. Through targeted rehabilitation and therapy, such as speech therapy for stroke survivors, patients can retrain other brain areas to perform the lost functions and facilitate recovery.

Enhancing Stroke Speech & Language Recovery Time

Adopting a comprehensive approach involving several key strategies is vital to enhance the stroke speech and language recovery time. This multifaceted approach can maximize the chances of regaining speech and communication abilities.

This comprehensive approach must incorporate the following strategies:

  • Early intervention to leverage the brain’s highest potential for neuroplasticity in the initial period following a stroke, significantly improving the chances for recovery.
  • Alternative communication strategies, such as gestures, writing, and visual aids, to help maintain communication during the recovery process. 
  • Adopting technology, including speech-generating devices and software applications designed for speech rehabilitation, for personalized exercises and continuous practice, which is vital for progress.
  • Providing continuous support from psychologists, support groups, and therapy to help manage feelings of frustration, depression, and anxiety, fostering a positive mindset essential for rehabilitation.
  • A healthy diet and lifestyle to supply essential nutrients that support brain function, along with regular physical activity, adequate sleep, and management of medical conditions.

Begin Your Post-Stroke Recovery Journey With Moody Neurorehabilitation

Moody Neurorehabilitation understands the complexities and challenges that come with post-stroke rehabilitation. We are dedicated to supporting patients and their families through this critical time with specialized care and personalized treatment plans.

Since our inception in 1982, Moody Neurorehabilitation has been a leader in brain injury rehabilitation. Our approach centers on providing comprehensive care tailored to each patient’s needs and goals. We believe in treating the whole person, not just the symptoms, to improve overall quality of life.

We invite you to start your recovery journey with us. Contact Moody Neurorehabilitation today to schedule a consultation with our experts. Let us help you navigate the path to recovery with care, compassion, and expertise.