What are the return to work guidelines for a truck driver with a mild concussion?

Return to Work Guidelines for Truck Drivers with Mild Concussion

A truck driver with mild concussion should remain off work for a minimum of 2-3 days of strict rest, followed by a graduated return-to-work protocol that begins only when symptom-free at rest, typically achieving full duty within 2-4 weeks for uncomplicated cases. 1, 2

Initial Rest Period (Days 0-3)

• Mandatory work restriction for the first 2-3 days post-injury with both physical and cognitive rest to minimize symptom exacerbation 3, 1
• Complete avoidance of driving during this acute phase, as the safety-sensitive nature of commercial truck driving requires full cognitive function 1
• Prolonged rest beyond 3 days may actually worsen outcomes and delay recovery 1, 4

Graduated Return-to-Work Protocol (Days 4+)

Stage 1: Light Duty Activities (Days 4-7)

• Begin with non-driving tasks such as paperwork, vehicle inspections, or warehouse duties for 2-4 hours daily 3, 2
• Activities should not exacerbate symptoms; if symptoms worsen, return to previous activity level 3
• Monitor for headache, dizziness, concentration difficulties, and fatigue 1

Stage 2: Simulated Driving Tasks (Days 7-14)

• Progress to simulator training or short local routes (under 2 hours) in familiar areas if symptom-free at Stage 1 2
• Avoid highway driving, night driving, or complex traffic situations initially 1
• Continue monitoring symptom expression with each activity increase 3, 2

Stage 3: Progressive Return to Full Duty (Days 14-28)

• Gradually increase driving duration and complexity only if remaining symptom-free 3, 2
• Return to full commercial driving duties when symptom-free at rest and with increasing levels of physical and cognitive exertion 3, 2
• Most patients achieve full return to work within 2 months, with 70.6% returning by 4 weeks 5

High-Risk Factors Requiring Extended Work Restriction

Identify patients at higher risk for prolonged recovery who may need 3+ months before full duty:

• Age over 40 years 1
• Pre-existing mood disorders (depression, anxiety) 1, 6
• High initial symptom burden, particularly the triad of headache, nausea, and dizziness 1
• Multiple bodily injuries from the accident 5
• Intracranial abnormality on initial imaging 5
• Significant psychological distress or poor global functioning at 2 months 6

Active Rehabilitation After Initial Rest

• Begin sub-symptom threshold aerobic exercise after the first 2-3 days rather than continued strict rest 1
• Start with 15-20 minutes daily of light aerobic activity at 60-70% maximum heart rate, gradually increasing as tolerated 1
• Progressive reintroduction of non-contact aerobic activity that does not exacerbate symptoms 3, 2

Critical Safety Considerations for Commercial Drivers

The safety-sensitive nature of commercial truck driving requires complete symptom resolution before return to full duty:

• Cognitive symptoms (memory problems, difficulty concentrating, confusion) are particularly concerning for driving safety 1
• Dizziness and balance problems pose significant risk in operating heavy machinery 1
• Fatigue is common and affects work capacity for an average of 14 days 7
• 20% of patients still have symptoms at 90 days, mostly affecting memory, concentration, and work capacity 7

Medical Clearance Requirements

• Require formal medical clearance from a healthcare provider before return to commercial driving 1
• Document symptom-free status at rest and with exertion 3, 2
• Consider neurocognitive testing if symptoms persist beyond 4 weeks 3
• Patients developing persistent post-concussion syndrome (15-20% of cases) require specialist referral before return to safety-sensitive work 1

Common Pitfalls to Avoid

• Do not allow premature return to driving based solely on patient self-report of feeling "fine" - objective assessment is required 1
• Avoid prolonged complete rest beyond 3 days, which may worsen outcomes 1, 4
• Do not progress to the next activity stage if symptoms persist or worsen at the current level 3
• Recognize that 46% of workers cannot perform their job as well as usual for an average of 14 days despite returning to work 7