When can I safely return to sports or the gym after a concussion?

Return to Sports or Gym After Concussion

You must never return to sports or the gym on the same day as your concussion, and you must complete a minimum 5-day graduated protocol after becoming completely symptom-free at rest and with exertion before returning to full competition. 1, 2, 3

Absolute Contraindications Before Starting Any Return-to-Play Protocol

You cannot begin the graduated return protocol until ALL of the following are met:

• Complete resolution of all symptoms at rest (no headache, dizziness, nausea, cognitive difficulties, balance problems) 2, 3
• Complete resolution of symptoms with physical exertion (walking, climbing stairs, light activity) 1, 3
• Normal neurological examination 3
• Normal cognitive evaluation 3
• Medical clearance from a licensed healthcare provider trained in concussion management 1, 2, 3

Critical timing consideration: Most concussion symptoms resolve within 7-10 days, but pediatric and adolescent athletes require longer cognitive recovery periods than adults—often extending beyond symptom resolution—making a conservative approach essential. 1, 2, 3

The 6-Stage Graduated Return-to-Play Protocol

Each stage must last a minimum of 24 hours, meaning the fastest possible return to competition is 5 days after becoming asymptomatic. 1, 2, 3

Stage 1: Complete Rest

• Complete physical and cognitive rest until asymptomatic at rest 1, 2
• No school work, screen time, or activities that exacerbate symptoms 2
• Remain at this stage until you have zero symptoms at rest 1

Stage 2: Light Aerobic Activity

• Walking, swimming, or stationary cycling at ≤70% maximum heart rate 1, 2, 3
• No resistance exercises permitted 1, 2
• Duration: minimum 24 hours if asymptomatic 1, 2

Stage 3: Sport-Specific Exercise

• Sport-specific drills (running patterns, ball work) but no head impact activities 1, 2
• For soccer: no heading; for football: no contact 3
• Duration: minimum 24 hours if asymptomatic 1, 2

Stage 4: Non-Contact Training Drills

• More complex training drills with progression of exercise 1, 2, 3
• Light resistance training may begin at this stage 1, 2
• Still no contact or collision activities 3
• Duration: minimum 24 hours if asymptomatic 1, 2

Stage 5: Full-Contact Practice

• Return to normal training activities only after written medical clearance from a licensed healthcare provider trained in concussion management 1, 2, 3
• Participation in all typical practice drills including contact 2, 3
• Duration: minimum 24 hours if asymptomatic 1, 2

Stage 6: Return to Game Play

• Unrestricted participation in competition 1, 2, 3

Critical Management Rules for Symptom Recurrence

If ANY symptoms return at ANY stage:

• Immediately stop all activity 1, 2, 3
• Rest for at least 24 hours until completely asymptomatic again 1, 2, 3
• Drop back to the previous asymptomatic stage and remain there for another 24 hours before attempting to progress 1, 2, 3
• Contact your healthcare provider if symptoms recur during the protocol 1, 2

Research shows that approximately 12% of athletes experience symptom recurrence when resuming exercise after being symptom-free at rest, with higher risk among those who had previously undiagnosed concussions or longer symptom duration. 4

Special Populations Requiring Extended Protocols

You need a longer, individualized rehabilitation program if you have: 1, 2

• Multiple concussions (especially 3 or more in one season) 1, 2
• Postconcussive symptoms lasting more than 3 months 1, 2
• History of previously undiagnosed concussions 4
• Pre-existing mood disorders, learning disorders, ADHD, or migraine headaches 5
• Age under 18 years (pediatric athletes demonstrate longer cognitive recovery periods) 1, 2, 3

These cases require management by a physician experienced in concussion management and may necessitate prolonged time away from sports or even retirement from contact/collision sports. 1, 2

Common Pitfalls to Avoid

"When in doubt, sit them out" is the paramount principle in concussion management. 2

• Never attempt same-day return to play, even if symptoms completely resolve within minutes or hours of injury 1, 2, 3, 5
• Do not skip stages or progress faster than 24 hours per stage, even if you feel completely normal 1, 2, 3
• Do not ignore cognitive symptoms (difficulty concentrating, memory problems, feeling "foggy") while focusing only on physical symptoms like headache 1, 2
• Do not resume full academic workload before beginning the return-to-play protocol—cognitive rest is as important as physical rest 1, 2
• Do not rely solely on symptom resolution as the indicator for return to play; medical clearance is mandatory 1, 2, 3

The longer cognitive recovery period in children and adolescents compared to adults makes conservative management essential for preventing long-term complications, including increased risk of repeat concussion and prolonged dysfunction. 1, 2, 5

Academic Accommodations During Recovery

Teachers and school administrators must modify workloads to avoid symptom exacerbation during cognitive recovery, including: 2, 5

• Reduced workload 2
• Extended time for tests 5
• Breaks during the school day 5
• Delayed return to full academic activities 2