A concussion is a mild traumatic brain injury caused by a blow or jolt to the head or body that causes the brain to move rapidly inside the skull. This sudden movement disrupts normal brain function, leading to symptoms like headache, dizziness, and confusion. Swimming is strictly prohibited during the initial recovery period. Returning to any physical activity must be delayed until a healthcare provider experienced in concussion management provides medical clearance. This cautious approach is necessary because the brain is in a vulnerable state and requires time to heal.
Why Swimming Poses Unique Dangers During Recovery
Swimming and pool environments introduce specific risks that go beyond the general dangers of physical exertion after a brain injury. A concussed brain affects balance, coordination, and judgment, which are necessary for safely navigating a pool area. Slipping on wet deck surfaces or around starting blocks is a common hazard, and a fall could result in a second, more severe head injury.
The danger of Second Impact Syndrome (SIS) is a primary concern. SIS occurs when a person sustains a second concussion before the brain has fully recovered from the first. This second impact can trigger rapid and catastrophic brain swelling, carrying the risk of severe neurological damage or even death. Returning to the water too soon increases the risk of accidental impact, such as hitting the wall during a flip turn or colliding with another swimmer, which could lead to SIS.
The environment of an indoor pool can also exacerbate common concussion symptoms. Many people with a concussion experience light sensitivity (photophobia) and noise sensitivity (phonophobia). Bright overhead lighting, the reflective surface of the water, and the loud echoes of a natatorium can intensify these symptoms, causing an immediate spike in pain or discomfort. Furthermore, swimming requires concentration and coordination, which are impaired by the injury, increasing the risk of drowning or a near-drowning incident.
The Necessity of Physical and Cognitive Rest
The foundation of early concussion treatment is rest: physical and cognitive. Physical rest involves avoiding activities that substantially increase heart rate and blood pressure, including any form of exercise. The injured brain requires extra metabolic energy to repair damaged cells, and exertion diverts this limited energy supply away from the healing process.
This diversion can prolong recovery or worsen existing symptoms. Cognitive rest means limiting activities that demand intense concentration or mental processing. This includes avoiding excessive screen time, complex reading, or prolonged schoolwork.
Early rest minimizes the demands on the brain during this vulnerable period. After the initial 24 to 48 hours, a gradual reintroduction of mild activity is often recommended, but only if it does not provoke symptoms. Symptoms like persistent headache, nausea, or feeling “foggy” are the primary guide for how long rest must continue. If a specific activity causes symptoms to return or intensify, the activity should be reduced or stopped.
Safely Returning to the Water: A Step-by-Step Approach
The process for safely returning to the water is governed by a medically supervised protocol known as the Graduated Return to Activity Protocol (GRTP). This structured plan ensures the athlete’s brain has adequate time to heal before being subjected to the physical and cognitive demands of swimming. The swimmer must be completely symptom-free at rest before a healthcare provider approves the start of the first stage.
The GRTP is a series of stages that an athlete must complete successfully. Each stage requires at least 24 hours of being symptom-free before advancing to the next level. The first stage involves symptom-limited activity, meaning daily activities that do not provoke symptoms, along with a gradual reintroduction of school or work.
The next stage involves light aerobic exercise, which is usually land-based, such as walking or riding a stationary bike for a short period at a low heart rate. For a swimmer, the initial water-based activity, often considered part of the third stage, involves light, non-strenuous movement. This might begin with easy kicking drills using a kickboard or water walking, maintaining a low heart rate.
Subsequent stages progress to sport-specific exercise, which involves adding limited head movement and all four strokes, but still avoiding high-risk actions like flip turns. Full practice, including complex intervals and dryland training, and finally a return to full competition, are the final steps in the protocol. If any concussion symptoms return during or after an activity in any stage, the athlete must regress to the previous symptom-free stage and remain there for another 24 hours.