I'm still
not right.

Post-concussion syndrome, now more accurately referred to as persistent post-concussion symptoms, is when the effects of a concussion continue well beyond the expected recovery window. Most concussions resolve within two to four weeks. When symptoms are still present beyond that point, it signals that one or more systems in the brain and body have not fully recalibrated. This could be the vestibular system, the oculomotor system, the cervical spine, the autonomic nervous system, or a combination of all of them. It is not a sign that something is permanently wrong, and it is not in your head. It is a real, treatable condition, and at Akeso we have a clear clinical framework for identifying exactly what is driving your symptoms.

This is one of the most common questions we hear, and it usually comes from people who were told to rest, felt like they were improving, and then hit a wall. Persistent symptoms are almost always the result of one or more specific subsystems that were never properly assessed or rehabilitated. The vestibular system, visual system, cervical spine, and autonomic nervous system each require targeted treatment. General rest does not fix a vestibular problem or retrain gaze stability. At Akeso, we run a full multimodal assessment using tools including VOMS, BESS, and ImPACT to identify exactly which systems are involved, because treating the right thing makes all the difference.

There is no fixed timeline, and that is one of the most frustrating parts of this condition. Some people recover within a few weeks of specialist input. Others have been symptomatic for months or even years before finding the right help. What the evidence does tell us clearly is that the longer symptoms go unaddressed, the more entrenched certain patterns can become. The good news is that persistent post-concussion symptoms are treatable at any stage. At Akeso we regularly see patients who have been struggling for a year or more and who make significant progress once the right systems are properly assessed and treated.

For the vast majority of people, yes. Permanent post-concussion syndrome is rare. What typically prevents full recovery is not the injury itself but the absence of the right, targeted rehabilitation. The brain has a remarkable capacity to adapt and recover, particularly with the right clinical input. At Akeso, our approach is built on identifying the specific drivers of your symptoms and addressing them directly. Whether your primary issue is dizziness, headache, cognitive fog, visual disturbance, or sensitivity to movement, there is a clear evidence-based pathway forward.

Yes, and more commonly than most people realise. The brain regions involved in concussion also regulate mood, emotional processing, and sleep. It is very common for people with persistent post-concussion symptoms to also experience irritability, heightened anxiety, low mood, and disrupted sleep, not as a psychological reaction to their injury, but as a direct physiological consequence of it. These are recognised features of the condition and factor into how we assess and manage patients at Akeso. Identifying whether these symptoms have a neurological basis changes how we treat them.

This is something we hear often, and it is a fair question. Most physiotherapists are excellent generalists, but persistent post-concussion symptoms require a very specific skill set. Without training in vestibular rehabilitation, oculomotor assessment, autonomic dysfunction, and concussion-specific exercise protocols, even a thorough physio assessment can miss the systems that are actually driving your symptoms. At Akeso, concussion and vestibular rehabilitation is our clinical speciality. Kosta holds a postgraduate Masters from UCL, a vestibular rehabilitation certification from Duke University, and a FIFA Diploma in Football Medicine. This is not general physio. It is a different level of assessment and treatment.

Yes, when it is done correctly and guided by the right person. This is one of the most important shifts in post-concussion care over the last decade. Avoiding all exercise is no longer recommended and can actually make symptoms worse over time through deconditioning. Graded aerobic exercise, progressed carefully based on your individual symptom threshold, is now one of the most evidence-supported treatments for persistent post-concussion symptoms. At Akeso we use the Buffalo Concussion Treadmill Test to establish exactly where your safe exertion threshold sits, and we build a structured, personalised plan around it so you are always progressing without pushing into a setback.

This is a very understandable concern, particularly if you have had previous experiences where activity made things worse. The short answer is no, not with the right approach. At Akeso, every treatment decision is based on your individual symptom threshold. We never push you beyond what your system can handle. Flare-ups during recovery are usually temporary and informative rather than harmful, and we guide you through how to interpret and respond to them. Understanding why symptoms fluctuate is itself a powerful part of recovery, and building that confidence is something we work on from your very first appointment.

Yes. We see this regularly at Akeso. There is no point at which persistent post-concussion symptoms become untreatable. The nervous system retains its capacity to adapt and rehabilitate regardless of how long symptoms have been present. Some of the most meaningful recoveries we see are in patients who sustained their injury years ago and had simply never received an assessment that looked at the right systems. If you are still experiencing symptoms and have been told there is nothing more that can be done, we would encourage you to come in for a full specialist assessment. There is almost always more that can be done.

Yes, and it is a significant part of what we do at Akeso. Returning a professional athlete to high performance after persistent post-concussion symptoms requires more than symptom resolution. It requires the vestibular and oculomotor systems to be performing under load, with the gaze stability, reaction time, and spatial awareness that elite sport demands. Kosta has worked with athletes across football, rugby, diving, and snowboard at an elite level, including through the Chelsea FC Academy and GB Olympic programmes. If you are a professional or high-level athlete navigating post-concussion recovery, you are in the right place.