A concussion is a mild traumatic brain injury resulting from a direct blow to the head or an indirect force that temporarily disrupts normal brain function. Common effects include headaches, dizziness, and difficulty with concentration, memory, or balance. Resuming physical activity too soon can increase the risk of prolonged recovery or a severe secondary injury. While recovery timelines are highly individualized, returning to exercise must follow a structured, gradual progression guided by symptoms and medical clearance.
The Mandatory Initial Rest Phase
Following a concussion, the initial treatment involves a period of relative rest, allowing the brain to stabilize. This phase typically lasts for the first 24 to 48 hours, though the duration depends on the individual’s symptoms. Physical rest means avoiding strenuous activities and anything that significantly increases the heart rate.
Cognitive rest is equally important and involves limiting activities that require high concentration, such as extensive screen time or complex tasks. Excessive mental exertion can worsen symptoms and delay healing. Current guidelines advocate for “relative rest,” meaning complete inactivity is not recommended. Activities of daily living and light physical movement, like short walks, are permitted as long as they do not significantly worsen symptoms.
Criteria for Beginning Physical Activity
The transition to beginning physical activity depends on the resolution of symptoms at rest, not a set number of days. Before starting the stepwise return to activity, the primary prerequisite is that the individual must be symptom-free for at least 24 hours. Symptoms that must have resolved include headache, dizziness, nausea, light sensitivity, and difficulty concentrating.
Medical clearance from a healthcare professional specializing in concussion management is non-negotiable before initiating the structured exercise protocol. This medical assessment confirms the brain has recovered sufficiently to tolerate the metabolic demands of exercise. Attempting to push past symptoms without this clearance risks delaying recovery. Once cleared, the goal of the subsequent stages is to ensure symptoms do not reappear with exertion.
The Stepwise Return to Activity Protocol
The return to physical activity is a structured, multi-stage process designed to gradually reintroduce exertion without provoking symptoms. This protocol, often consisting of six steps, should be followed sequentially, with each stage lasting a minimum of 24 hours. Progression is strictly symptom-driven; advance only if you remain symptom-free during and after the current stage.
The return to activity follows six sequential stages, each lasting a minimum of 24 hours:
- Stage 1: Light aerobic exercise (5 to 10 minutes of walking, swimming, or stationary cycling), keeping the heart rate below 70% of the maximum predicted rate. No resistance training is included.
- Stage 2: Moderate activity, such as moderate jogging, stationary biking, or light weightlifting with body or head movement, for a slightly longer duration.
- Stage 3: Sport-specific exercise, such as running drills or skating maneuvers, without any head impact.
- Stage 4: Non-contact training drills, which are more complex and may include passing or agility work, and allows for the reintroduction of a normal weightlifting routine.
- Stage 5: Full-contact practice or normal, heavy training activities. Medical clearance is required before beginning this stage.
- Stage 6: Full return to competition or normal, unrestricted game play.
Identifying and Managing Symptom Recurrence
Symptom recurrence, such as the onset of a headache, dizziness, or confusion during or after an activity, signals that the brain is being pushed too hard. Symptoms may not appear immediately but could be delayed until later that day or the next morning. Any return of symptoms, however mild, requires the individual to immediately stop the current activity.
The appropriate course of action is to regress to the previous stage of the protocol where the individual was able to complete the activity without experiencing any symptoms. They must remain at that symptom-free level until they are clear of symptoms for at least 24 hours before attempting to progress again. Pushing through symptoms risks prolonging recovery and increases the danger of a more serious injury, such as Second Impact Syndrome. If symptoms are severe, rapidly worsening, or concerning, seek immediate medical attention.