What is the recommended return to work plan for a 25-year-old female with a concussion (mild traumatic brain injury) 6 weeks post-injury, assuming no significant medical history and asymptomatic at rest and with exertion?

Return to Work After Concussion at 6 Weeks

A 25-year-old female who is asymptomatic at rest and with exertion at 6 weeks post-concussion should be cleared to return to full work duties immediately, following the same graduated return-to-activity protocol used for sports. 1

Immediate Clearance Criteria

Since this patient is asymptomatic at both rest and with exertion at 6 weeks post-injury, she has already met the fundamental requirements for return to activity:

• No symptoms at rest for at least 24 hours is the prerequisite for beginning any graduated return protocol 2, 1
• No symptoms with exertion indicates successful completion of the physiological recovery phase 2, 1
• At 6 weeks post-injury, she is well beyond the typical 7-10 day recovery window for most concussions 2, 1

Return-to-Work Protocol

Apply the same stepwise progression used for return-to-sport, adapted for workplace activities:

Stage 1 (Day 1): Light cognitive work at home for 2-4 hours—emails, reading, light computer tasks at reduced intensity 1

Stage 2 (Day 2): Moderate cognitive work—full work tasks at home for 6-8 hours if Stage 1 completed without symptoms 1

Stage 3 (Day 3): Return to workplace part-time (4-6 hours) with full duties if Stage 2 completed without symptoms 1

Stage 4 (Day 4): Full return to work with all regular duties and hours if Stage 3 completed without symptoms 1

• Each stage must last at least 24 hours before progression 2, 1
• If any symptoms return at any stage, she must stop immediately, rest for 24 hours after symptoms resolve, then restart at the previous asymptomatic stage 2, 1

Critical Management Points

She should NOT be taking any medications to mask concussion symptoms during this return-to-work process, as medications can hide worsening symptoms and lead to premature return 2, 1

Given she is already asymptomatic with exertion at 6 weeks, she has likely already completed the equivalent of the physical exertion testing (light aerobic activity, moderate exercise) that would normally precede clearance 1

Medical clearance from a healthcare professional experienced in concussion management should be obtained before beginning the return-to-work protocol 1

Why Prolonged Rest Beyond 6 Weeks Is Harmful

Advising rest beyond 2 days when asymptomatic is associated with delayed return to productivity and worse outcomes 3

• Patients advised to rest for more than 2 days were significantly less likely to have returned to work/school at 1-2 months post-injury (64.5% still on leave vs. 40% in those not given prolonged rest advice) 3
• Prolonged activity restriction itself contributes to persistent symptoms through physical deconditioning, removal from validating life activities, and development of depression and anxiety 4
• Excessive rest and prolonged avoidance of exercise have negative consequences at both physical and psychological levels 5

Red Flags Requiring Specialist Referral

If symptoms had persisted beyond 10 days (which they have not in this case), multidisciplinary management would be indicated 2, 1. However, at 6 weeks asymptomatic, this patient does not require specialist care unless:

• Symptoms recur during the graduated return-to-work protocol 1
• Psychological distress or anxiety about returning to work is present, as these are negative predictors for successful return to work 6
• History of multiple prior concussions, which would warrant more conservative management 2, 1

Evidence-Based Interventions if Return-to-Work Difficulties Arise

Should she experience difficulty during the return-to-work process, evidence supports:

• Interdisciplinary coordinated rehabilitative treatment (combining at least 2 interventions from different disciplines) shows positive effects on symptom burden and return to daily activities 2
• Psychological treatment (if emotional symptoms emerge) administered minimally 1 hour/week for at least 4 weeks 2
• Action planning, instruction on how to perform behaviors, and problem-solving strategies are the most effective behavior change techniques for return to work after concussion 7

Common Pitfall to Avoid

The most critical error would be continuing to advise rest at this point. At 6 weeks post-injury with complete symptom resolution, continued activity restriction will worsen outcomes through deconditioning, social isolation, and development of secondary psychological symptoms 3, 4. The current evidence-based approach emphasizes gradual return to activity after 1-2 days of rest, not prolonged avoidance of work 3.