A concussion is a mild traumatic brain injury caused by a jolt, bump, or blow to the head or body that causes the brain to move rapidly inside the skull. This movement temporarily alters normal brain function, resulting in a range of physical, cognitive, and emotional symptoms. Recovery is highly individualized and demands careful management, especially regarding the return to physical activity. Understanding the structured progression for resuming activity is necessary to prevent prolonged recovery times and the risk of further injury.
Initial Recovery and Symptom Baseline
The immediate period following a concussion requires a brief phase of physical and cognitive rest. Current clinical guidelines recommend a period of relative rest lasting approximately 24 to 48 hours after the injury. This approach allows the brain to begin the initial healing process without exacerbating symptoms through demanding activities. During this time, activities of daily living that do not provoke symptoms, such as light walking or quiet socialization, are generally acceptable.
After this initial rest period, the focus shifts to ensuring that the individual is symptom-free before beginning a formal exercise protocol. Symptoms like headache, dizziness, nausea, light sensitivity, or difficulty concentrating must have resolved at rest for at least 24 hours. Engaging in strenuous activity while still experiencing symptoms can delay recovery and potentially increase the brain’s vulnerability to a second injury. The absence of symptoms at rest establishes the necessary baseline for initiating the structured return to physical activity.
The Phased Return to Physical Activity
The path back to full activity follows a medically recognized, standardized protocol known as the Graduated Return to Sport (GRTS) strategy. This progression is divided into six distinct steps, each requiring a minimum of 24 hours before the individual can advance to the next level. The goal of this phase is to gradually increase heart rate, physical exertion, and cognitive load without provoking a return of concussion symptoms.
Step 1: Symptom-Limited Activity
This initial step focuses on daily tasks that do not worsen existing symptoms. This includes a full return to school or work, ensuring all cognitive demands can be tolerated without difficulty. Physical exertion is limited to activities like walking or very light household chores.
Step 2: Light Aerobic Exercise
This step introduces light aerobic exercise designed to slightly increase the heart rate. Activities are limited to low-impact movements, such as a brisk walk, stationary cycling, or light jogging for 10 to 15 minutes. Intensity must remain low, and resistance training or weight lifting is strictly avoided.
Step 3: Sport-Specific Exercise
This step incorporates sport-specific exercise, focusing on movements commonly performed in the individual’s sport. Examples include short sprints for a runner or skating drills without contact for a skater. These exercises introduce more complex motor patterns and movements but remain non-contact.
Step 4: Non-Contact Training Drills
This step increases intensity and complexity by adding non-contact training drills and controlled resistance training. This stage includes heavy aerobic activity, such as high-intensity interval training or regular weightlifting. The individual performs challenging coordination drills that mimic game-time situations in a controlled, non-contact environment.
Step 5: Full Contact Practice
This step transitions to full contact practice, attempted only after medical clearance from a healthcare professional experienced in concussion management. It allows participation in normal training activities, including simulated game situations and controlled contact drills. The goal is to restore confidence and assess the ability to tolerate the highest physical and cognitive demands of the sport.
Step 6: Return to Play
This final step is the full return to play or unrestricted physical activity. It is achieved only after successfully completing all previous steps without any return of symptoms and receiving final medical approval. The entire structured progression, assuming no setbacks, typically takes a minimum of six days to complete.
Recognizing Setbacks and When to Consult a Professional
The process of returning to activity is governed by a strict symptom-monitoring rule. A setback is defined as the return of any concussion symptom, such as a headache, increased confusion, or balance issues, either during exercise or in the subsequent 24 hours. The recurrence of symptoms signals that the brain has been pushed past its current tolerance threshold. If a setback occurs, the individual must immediately stop the activity and revert to the previous step of the protocol that was completed without symptoms.
If symptoms return during a light jogging session (Step 2), for example, the individual must revert to symptom-limited activity (Step 1) for a minimum of 24 hours. They can only attempt to re-start the failed step after a full day without symptoms. While the phased protocol is a self-management guide, professional medical consultation is necessary if symptoms worsen or persist for an extended period, generally exceeding 10 to 14 days. Furthermore, medical clearance is required before progressing to the full contact practice phase (Step 5) and ultimately returning to full competition.