A concussion is a mild traumatic brain injury (mTBI) caused by a bump, blow, or jolt to the head that disrupts normal brain function. Standard medical advice previously involved strict, prolonged physical and cognitive rest, often called “cocooning.” The current consensus has shifted, recognizing that a gradual, monitored return to physical activity is beneficial for recovery. Exercise is now permitted after a concussion, provided the activity is controlled and individualized.
Understanding the Modern Approach to Concussion Recovery
The philosophy behind concussion management has evolved because prolonged inactivity often hinders recovery. Strict physical rest leads to physical deconditioning, causing patients to quickly lose cardiovascular fitness and muscle strength. This deconditioning can mimic or worsen concussion symptoms, such as fatigue and headache. Furthermore, complete isolation and removal from normal routines can negatively affect mental health, increasing anxiety, depression, and social withdrawal.
Active rehabilitation is the new standard of care, recognizing that controlled physical activity is therapeutic for the injured brain. Mild aerobic exercise helps regulate the brain’s blood flow, which is often disrupted following a concussion. This controlled movement encourages the return of normal physiological function and can accelerate symptom resolution. Studies demonstrate that patients who begin light, supervised aerobic activity soon after injury tend to recover faster than those adhering to long periods of rest.
Criteria for Initiating Physical Activity
Starting any form of exercise must be guided by a healthcare provider specializing in concussion management. The initial 24 to 48 hours following the injury usually require relative rest, focusing on limiting activities that significantly worsen symptoms. This initial period allows the brain to stabilize following the metabolic changes caused by the trauma.
Before attempting a structured exercise program, the patient should perform daily activities without a notable increase in symptoms. The individual’s baseline headache, dizziness, or fogginess should be stable or minimal during cognitive tasks like schoolwork or screen time. The goal is to start physical activity below the “symptom threshold,” which is the point of exertion where concussion symptoms significantly worsen. This threshold is unique to every person and is typically determined through a medically supervised test, such as a specialized treadmill test.
Once a safe starting point is established, the exercise regimen must be carefully managed to avoid exceeding this threshold. The severity of symptoms should not increase by more than two points on a zero-to-ten symptom scale during the activity. A controlled, progressive approach ensures the brain receives the benefits of increased blood flow without being overwhelmed by excessive physiological stress.
Recommended Low-Impact Activities
Initial post-concussion exercise should focus on light, non-contact aerobic activity that avoids sudden head movements or the risk of falling. The safest activities include walking at a moderate pace or using a stationary bicycle. These exercises allow for cardiovascular exertion without the high impact or rapid changes in head position associated with running or contact sports. Intensity is regulated primarily by monitoring the heart rate.
During early recovery, the heart rate should be kept well below maximum exertion to ensure the activity remains sub-symptom. A common recommendation is to start exercising at 70 to 80 percent of the heart rate that first triggered symptoms during testing. If formal testing has not been performed, a conservative starting point is around 50 percent of the age-predicted maximum heart rate (calculated as 220 minus the patient’s age). This low-intensity range promotes healing blood flow without overtaxing the recovering brain.
As tolerance improves, the duration of the activity can be increased before the intensity is gradually raised. The individual should aim for short, regular sessions, such as 15 to 20 minutes daily, focusing on maintaining a steady rhythm. Activities like using an elliptical machine or light swimming may be incorporated later, provided they do not introduce new symptoms or risks of head impact.
Monitoring Symptoms and Knowing When to Stop
Self-monitoring is a crucial component of safe post-concussion exercise, requiring the individual to be highly attuned to their body’s signals. Symptoms that signal an activity is too strenuous include a notable increase in headache intensity or pressure, dizziness, lightheadedness, or feelings of nausea. Other warning signs are heightened sensitivity to light or noise, confusion, or a general feeling of fogginess.
If any of these symptoms increase significantly—by more than two points on a ten-point scale compared to the baseline—the activity must be stopped immediately. This “stop and rest” rule prevents over-exertion and potential setbacks in recovery. If a symptom flare-up occurs, the individual should rest until symptoms return to the pre-exercise baseline. The next attempt at exercise should be at a reduced intensity or duration, stepping back to the previously tolerated level.
Symptom exacerbation that lasts for many hours after the activity, or into the next day, indicates the exercise session was too aggressive. Any sustained setbacks or new, concerning symptoms must be communicated promptly to the supervising medical professional. The goal is consistent, forward progression, not pushing through pain or discomfort.