Concussion Recovery: A Step-by-Step Return to School and Sport
A hit in football practice, a header in soccer, a fall on the ice. Concussions happen at every age and in every sport, and the advice about recovery has changed a lot in recent years.
The old approach was to rest in a dark room until every symptom disappeared. Current international guidance recommends a short period of relative rest followed by a gradual return to light activity, school and sport (Amsterdam 2022 Consensus on Concussion in Sport). Here's what that looks like.
This guide is general information, not a substitute for a medical evaluation. Anyone with a suspected concussion should be checked by a health care provider.
Get emergency care right away for these signs
A headache that's severe or getting worse
Repeated vomiting
Seizure, or loss of consciousness
Increasing confusion, agitation or unusual behavior
Slurred speech, weakness or numbness
Very drowsy or hard to wake up
Neck pain or tenderness after a hard hit
Washington's rule for youth athletes
Under Washington's Lystedt Law, a youth athlete suspected of having a concussion must be removed from play right away. They can't return until a licensed health care provider trained in concussion evaluation and management gives written clearance (RCW 28A.600.190). "When in doubt, sit them out."
The first 24 to 48 hours
Use relative rest. That means:
Normal daily activities like walking around the house, eating meals and short conversations are fine
Limit screens, especially in the first 48 hours
Avoid anything with a risk of another hit, and avoid hard exercise
Get plenty of sleep
Complete rest in a dark room for days isn't recommended anymore. It can make symptoms last longer.
Return to learn comes first
Getting back to school or work comes before full return to sport. The usual steps:
Relative rest for the first 24 to 48 hours.
Light thinking tasks at home, like short reading sessions, with breaks.
Part-time school or work, with accommodations like extra breaks, reduced screen time, and extra time for tests and assignments.
Full-time school or work without accommodations.
It's normal for symptoms to bump up a little with activity. Slow down only if they get more than mildly and briefly worse.
Return to sport: step by step
Relative rest for 24 to 48 hours.
Light, then moderate aerobic exercise like walking or a stationary bike. This can start early, while still having mild symptoms.
Individual sport-specific drills, like running or shooting, with no risk of head impact.
Non-contact practice with harder drills.
Full-contact practice after medical clearance.
Return to games.
Steps 4 through 6 should start only after the athlete is fully back at school. The whole process usually takes at least a week, and most athletes are back to full sport within about a month. Every athlete is different, and progress should be guided by a health care provider.
When symptoms don't go away
Most people feel back to normal within a few weeks. Some keep having dizziness, headaches, neck pain, trouble focusing their eyes, or a foggy, off-balance feeling.
The consensus statement recommends targeted rehab, specifically cervical and vestibular rehabilitation, when dizziness, neck pain or headaches last more than 10 days. Symptoms beyond four weeks call for a broader team evaluation.
That's where a physical therapist helps. Post-concussion rehab can include:
Gaze stabilization and balance exercises to retrain the vestibular system
Treatment for the neck, since the same hit that causes a concussion often strains the neck and can drive headaches
Graded aerobic exercise on a bike or treadmill, set at a heart rate that doesn't flare symptoms
Sport-specific progressions so the return to play is planned, not guessed
Concussion rehab at BYLT
Lauren Wagner, PT, DPT, specializes in post-concussion and vestibular rehab. We work alongside your physician or athletic trainer, who handles medical clearance, and focus on getting you through the steps safely. We also treat the headaches and neck pain that often come with concussion. Every visit is 60 minutes, one-on-one.
Frequently asked questions
Should someone with a concussion stay awake all night?
No. Sleep helps recovery. If emergency warning signs are present, get medical care right away.
Can I exercise with concussion symptoms?
Light aerobic activity like walking or an easy stationary bike is recommended after the first 24 to 48 hours, as long as symptoms only get mildly and briefly worse.
How long does a concussion take to heal?
Most athletes return to full sport within about a month. Some people need longer, especially if symptoms last beyond the first few weeks.
Who can clear a youth athlete to return in Washington?
A licensed health care provider trained in concussion evaluation and management, who must give written clearance.
Still dizzy, foggy or getting headaches after a concussion? Book an evaluation with Lauren or call or text 509-540-3286.
