Preventing Second Impact Syndrome: What You Need to Know

Second Impact Syndrome (SIS) is a rare but potentially fatal condition that can occur if an individual sustains a second concussion before the symptoms from an initial concussion have fully resolved. The risk of SIS underscores the critical importance of properly managing concussions and ensuring a complete recovery before returning to any activities that could result in another head injury. At Revivo, our Toronto-based physiotherapy and neurology clinic, we prioritize education on concussion management, including the prevention of SIS, to protect our patients and community. This post will delve into key information about preventing Second Impact Syndrome and highlight essential precautions for individuals recovering from a concussion.

Understanding Second Impact Syndrome

SIS involves rapid and severe brain swelling after a person sustains a second head injury, even if it’s minor, before fully recovering from a previous concussion. This condition can lead to devastating neurological outcomes and is more common in younger athletes, though it can occur at any age.

Signs and Symptoms of Second Impact Syndrome

The symptoms of a second concussion can be similar to those of the first but often manifest more rapidly and severely. They may include:

  • Severe headache
  • Loss of consciousness
  • Rapidly worsening neurological function
  • Dilated pupils or unequal pupil size
  • Respiratory failure

Strategies for Preventing Second Impact Syndrome

1. Complete Rest and Recovery: The cornerstone of preventing SIS is ensuring complete recovery from the initial concussion before resuming activities that pose a risk of head injury. This involves both physical and cognitive rest until symptoms have fully resolved.

2. Gradual Return to Play Protocols: Athletes should follow a stepwise return-to-play protocol under the guidance of a healthcare professional. Each step should be completed without symptoms before progressing to the next level of activity.

3. Education and Awareness: Athletes, coaches, parents, and educators should be educated about the signs and symptoms of concussions, the risks associated with premature return to activity, and the importance of reporting and managing concussions properly.

4. Implementing Protective Measures: Wearing appropriate headgear and enforcing sports rules designed to minimize head impacts can reduce the risk of concussions.

5. Monitoring and Reporting: Individuals recovering from a concussion should be closely monitored for symptoms and must report any new or worsening symptoms to a healthcare professional immediately.

The Importance of Medical Clearance

Returning to sports or activities that could result in head impacts without medical clearance poses a significant risk. Healthcare professionals can assess whether an individual has fully recovered from a concussion and provide guidance on safely resuming activities.

Creating a Culture of Safety

Promoting a culture of safety and support around concussion management can help prevent SIS. This involves prioritizing health and safety over competition, encouraging open communication about symptoms, and ensuring that everyone involved in sports and physical activities is informed about the risks of concussions and Second Impact Syndrome.


Second Impact Syndrome is a preventable condition that requires awareness, proper concussion management, and adherence to safety protocols. At Revivo, we are dedicated to providing our community with the knowledge and resources needed to prevent concussions and protect against the risks associated with Second Impact Syndrome. By taking these precautions seriously, individuals can enjoy sports and physical activities while minimizing the risk of long-term neurological consequences.

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