11 / Post-concussion & TBI

What to Expect During Structural Concussion Care: Safety, Protocols, and Recovery Timelines

Cranial Solutions17 December 20257 min read

Structural concussion care focuses on assessing and supporting mechanical function of the upper neck, sphenoid bone and skull sutures following head injury. Patient safety comes first. All care begins with thorough clinical screening - including cranial nerve testing, upper neck range of motion and vascular assessment - to rule out red flags. Gentle endonasal inflation (Nasal RX) is delivered as a structured series of sessions, and where there is significant cranial or facial distortion, care may extend over a longer, more widely spaced plan.

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The Biomechanical Problem: Navigating Safe Recovery After Head Injury

Recovering from a concussion benefits from a clear, evidence-informed plan that puts safety first while looking at the physical factors associated with lingering symptoms.

Because post-concussion symptoms involve delicate structures - the upper neck, sphenoid bone, brainstem, cranial nerves and dural membranes - care is delivered by registered health practitioners following clinical safety protocols.

The Structured Care Pathway

Step 1: Safety and red-flag screening - cranial nerves, vascular checks and range of motion.
Step 2: Standard Nasal RX series of 5 sessions, spaced 1 week (or less) apart.
Step 3: Extended plan for significant distortion (around 20% of cases), with later sessions spaced further apart.
Step 4: Outcome review and functional progress check.

Key phases of structured care include:

Safety triage and red-flag screening: identifying contraindications before any physical care begins.
Targeted structural care: gentle upper neck (C1/C2) care and mobilising restricted facial and cranial sutures.
Fluid dynamics support: supporting the body's natural cerebrospinal fluid (CSF) turnover, which occurs several times a day.

See how persistent symptoms are assessed on our Post-Concussion Symptoms & TBI page.

Comparison: Unstructured Care vs. a Structured Nasal RX Protocol

Safety screening

Unstructured approach: Brief verbal check only.
Structured Nasal RX protocol: Cranial nerve and vascular screening before care.

Treatment schedule

Unstructured approach: Open-ended visits.
Structured Nasal RX protocol: A defined series, extended only where assessment indicates.

Claims

Unstructured approach: Relies on testimonials.
Structured Nasal RX protocol: No guarantees; outcomes vary between individuals.

Assessment focus

Unstructured approach: Symptoms viewed in isolation.
Structured Nasal RX protocol: Dural tension and craniocervical junction assessed.

Technique

Unstructured approach: Higher-force, generalised adjustments.
Structured Nasal RX protocol: Low-force upper neck care and endonasal inflation.

Progress review

Unstructured approach: Subjective ratings only.
Structured Nasal RX protocol: Range of motion and functional measures reviewed.

Protocol feature	Unstructured approach	Structured Nasal RX protocol
Safety screening	Brief verbal check only.	Cranial nerve and vascular screening before care.
Treatment schedule	Open-ended visits.	A defined series, extended only where assessment indicates.
Claims	Relies on testimonials.	No guarantees; outcomes vary between individuals.
Assessment focus	Symptoms viewed in isolation.	Dural tension and craniocervical junction assessed.
Technique	Higher-force, generalised adjustments.	Low-force upper neck care and endonasal inflation.
Progress review	Subjective ratings only.	Range of motion and functional measures reviewed.

Safety Contraindications for Endonasal Inflation

For patient safety, Nasal RX is not performed where any of the following are present:

Active facial, nasal or skull base fractures.
Recent nasal, sinus or neurosurgical procedures.
Known intracranial aneurysms or vascular malformations.
Active, unmanaged nasal bleeding disorders or anticoagulant therapy.
Severe, unmanaged high blood pressure.

Anyone presenting with red-flag neurological signs - such as sudden muscle weakness, slurred speech, unmanaged seizures or progressive vision loss - is referred for urgent medical care.

What to Expect During the Nasal RX Treatment Schedule

Once cleared for care, patients follow a structured, progressive plan tailored to their assessment findings.

Standard Protocol: 5 Sessions

For most patients with persistent post-concussion symptoms, Nasal RX is delivered as a structured series of 5 sessions, spaced 1 week (or less) apart:

Early sessions (assessment and initial care): baseline neurological and cranial checks, followed by gentle, directional endonasal inflations aimed at introducing suture movement.
Later sessions (progressive care): targeted upper neck care combined with multiple inflations within key inner nasal passageways, aimed at easing deeper dural membrane tension.

Extended Plan for Significant Cranial Distortion (Around 20% of Cases)

Where there is significant cranial or facial distortion - often after severe injury or long-standing asymmetry - care may take up to 12 sessions in total:

Initial phase: sessions delivered weekly (or closer together) to begin easing suture and membrane restriction.
Consolidation phase: later sessions spaced 1 to 3 weeks apart, allowing the dural membranes, facial bones and craniocervical junction time to adapt.

Recovery timelines vary with the degree of distortion and injury history. Some patients report gradual changes in brain fog, head pressure, visual fatigue and sleep over several weeks. Individual results vary.

Read more about care for lingering symptoms on our Post-Concussion Symptoms & TBI page, and see our

fees and care pathway.

Frequently Asked Questions

What safety checks are performed before structural concussion care begins?

Before care begins, practitioners carry out a safety evaluation including cranial nerve checks, upper neck range-of-motion tests and vascular screening. Care is not performed where contraindications such as recent fractures or bleeding risks are present. Learn more on our Post-Concussion Symptoms & TBI page.

How many Nasal RX sessions are needed and how often are they scheduled?

Nasal RX is typically delivered as a structured series of 5 sessions, spaced 1 week (or less) apart. In around 20% of cases with significant cranial or facial distortion, care may take up to 12 sessions, with later sessions spaced 1 to 3 weeks apart. Your practitioner discusses this after assessment.

Are there any guarantees that structural care will cure my concussion?

No. Health practitioners cannot guarantee outcomes or promise cures. Structural care is non-surgical and aims to support natural joint movement and fluid dynamics. Read Why Am I Still Having Concussion Symptoms Months Later?

How long does it take to notice changes in symptoms like brain fog?

Experiences vary. Some patients report changes in head pressure and nasal breathing after early sessions, while changes in brain fog, fatigue and eye strain, where they occur, tend to unfold over several weeks. Read Why Do I Have Brain Fog and Fatigue After a Concussion?

For the full overview, visit our Post-Concussion Symptoms & TBI page.

Read Why Am I Still Having Concussion Symptoms Months Later?

Also see Why Do I Have Brain Fog and Fatigue After a Concussion?

Learn about our clinical approach.

Browse the published studies on our Research page.

References

01Gard A, Vedung F, et al. (2023). Cerebrospinal fluid levels of neuroinflammatory biomarkers in athletes with persistent post-concussive symptoms. PubMed, 18(1): 45-52.
02Dura Mater & Migraines Synthesis Report (2025). Biomechanical stiffness (28-86 MPa) and dural mechanics.
03StatPearls: Post-Concussive Syndrome (2024). Pathophysiology and clinical evaluation. NCBI Bookshelf / NIH.
04Al-Khazali et al. (2022). Neck pain co-occurrence in concussion and migraine: a systematic review. Cephalalgia, 42(9): 910-921.
05Zheng N, Chung BS, Li YL, et al. (2023). The relationship between myodural bridge, suboccipital musculature, and cerebrospinal fluid dynamics. Scientific Reports, 13: 18882.
06AHPRA Advertising Guidelines (2026). Health Practitioner Regulation National Law (Section 133) Compliance Standard. Australian Health Practitioner Regulation Agency.

Learn how our non-surgical endonasal protocol is used to evaluate suitability for conservative management, and how cranial base structural mechanics guide an individual care plan.