Returning to Activity After a Concussion
Post-concussion symptoms can be frustrating to deal with and there's a lot of mixed information out there about how to navigate through the recovery process.
Should you be resting? Should you try and go back to your regular routine right away?
The truth is, recovery is not a straightforward process and everyone's trajectory will be different. The important thing is to listen to your body and let your symptoms be the guide on how quickly to return to your usual routine.
Let's outline the stages and go over some helpful tips to ensure a safe and effective return to your daily life, whether that be returning to school, work, or activity/sport.
Concussion Recovery and the Importance of a Graded Return
A concussion is a mild traumatic brain injury caused by an impact directly to the head or an indirect impact that causes the brain to bounce around in the skull.
This injury results in decreased blood flow and energy to the brain, causing symptoms such as headaches, dizziness, sensitivity to light and sound, fatigue etc. All these symptoms can make it difficult to enjoy your day to day activities.
Although rest is an important part of recovery, too much rest can be detrimental to the brain and will actually make it more difficult to return to activity.
If the brain gets used to not being stimulated, it will become even more sensitive when any sort of activity is attempted. On the flip side, ignoring and pushing through symptoms can lead to a crash later on. Not giving the brain enough time to recover by not resting enough will also prolong post-concussion symptoms.
In order to promote long-term recovery, the brain needs to be stimulated while still allowing periods of rest and recovery.
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A gradual return to activity is needed, allowing the brain time to heal and adapt. This takes patience, self awareness and making sure you are incorporating rest into your day while still challenging yourself an appropriate amount.
Finding balance between rest and activity can take some experimenting because what can be tolerated will be different for every person, and it will change as you heal.
This can be tricky because there’s not a clear cut answer, but there are great tools to help guide you and ultimately empower you!
Using zones of symptoms is one helpful tool you can use. 
There are three zones of symptoms, the green zone is minimal symptoms, the yellow zone is mild-moderate symptoms, and the red zone or danger zone means that symptoms are significant. This is the zone we want to avoid.
Staying mostly in the green zone and coming in the yellow zone briefly for periods of time can help the brain adjust to the new level of activity without becoming overly symptomatic and fatigued.
Over time, as symptoms subside, you will be able to do more without feeling symptomatic.
Stages of Return to Activity |
Whether you are returning to school, sport, or work, there are general guidelines to help guide a gradual and safe return.
These guidelines help you to avoid doing too much too quickly. Even if symptoms are mild, fully returning to work before you are ready can make your recovery take longer so it is important to follow these steps.
During the return to activity process, it is completely normal for symptoms to worsen mildly. Some days can be better than others and no two people’s recoveries will ever be the same.
It is normal to feel fatigued when first returning to activity but keep in mind you should still have enough energy at the end of the day for household tasks etc.
There are a few things for you to consider as you move through these stages:
- You should be symptom free for at least 24 hours before moving onto the next stage.
- Each stage should also last a minimum of 24 hours.
- If symptoms are worsening and this lasts for over an hour, you have probably done too much. Use further modifications or go back a step.
- Keep in mind that symptoms can also show themselves that next day or after an activity and not necessarily just during.
Stage 1: Rest
The rest phase usually lasts about 24-48 hours. Any longer than this can make it harder to get back into activity.
Rest does not mean sitting in a dark room, but means doing things that involve minimal cognitive strain, light physical activity, and things that do not trigger any concussion symptoms.
What to avoid:
- Screens
- Visual/cognitive tasks like reading
- Too much physical exertion
Ideas for rest:
- Podcasts or audiobooks
- Listening to a movie/TV show that you have already watched
- Walking or gentle yoga
- Hobbies like baking, arts and crafts, simple card games
Stage 2: Light Cognitive and Physical Activity
Begin to reintroduce light activities that don't provoke symptoms.
This would include some light resistance training, periods of screen time, reading or walking at a brisk pace.
For more information on returning safely to aerobic activities check out our blog on the importance of cardio in concussion recovery.
If returning to work/school, at this stage you can try some simple tasks that only require light cognitive activity and easy reading.
Stage 3: Returning to a light load on a part-time basis
The focus of this stage is to return to more specific work tasks and school tasks but on a part-time basis (3 half days/week for example).
At this stage, there should be concussion accommodations put in place, such as working in a quiet area with less distractions and more time given to complete tasks.
Consider using noise cancelling headphones and dimmed lighting.
Work/school tasks should be light and less demanding than usual. Symptoms should be monitored closely while slowly increasing work load as tolerated.
Frequent breaks should be taken, at least every 30-60 minutes at first. If returning to a sport, activities that are specific to the sport such as skating can be started in a low risk environment while monitoring symptoms.
Stage 4: Returning to a moderate load on a part-time basis
This stage is a progression of stage 3.
Work load can be gradually increased with more complex tasks as symptoms allow.
The number of hours and days being completed can also slowly be increased. Rest and concussion accommodations should continue to be used as needed for symptom management.
If returning to sport, training drills (that risk no contact or further head injury) can be resumed.
Stage 5: Return to Near-Normal Activity
In this next step, near normal work and school load are resumed.
Concussion accommodations should be weaned off slowly as symptoms allow.
If returning to sport, non-competition/ full impact activities and practices are allowed.
Stage 6: Full Return to Activity
All previous activities are resumed as well as full work/school/sport schedule.
Keep in mind that a child with a concussion should be completely back at school before returning to a full sports schedule.
Remember that recovery from any injury is not a straight line of improvement - there will be bumps, setbacks and frustration along the way.
Though returning to a previous stage may be frustrating and feel like it’s slowing your progress, in the long run, honouring where you’re at and what your symptoms are telling you will help you to further your recovery.
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You don’t have to navigate this alone.
It can be helpful to seek coaching and guidance from a Physiotherapist who has additional training in concussion recovery.
They can help you decipher symptoms, figure out when to move onto the next stage (and what that stage will include for you), and strategize and problem solve any bumps along the way so you can continue to move forward.
Important things to remember during concussion recovery:
- A concussion is an invisible injury. You might look ok on the outside, and people may not know you are struggling. Reach out to those around you like your family, teachers, employers, coaches etc., so that you get the help and support you need.
- Do not underestimate the importance of adequate sleep and rest throughout the day. This is very important to the brain's recovery. You should establish a regular sleep schedule and avoid frequent napping.
- Listen to your body! Pace yourself and do not try to do too much at once. If your symptoms are worsening significantly, this is your body's way of telling you that it is being overloaded. Stop and rest so that the symptoms can settle and then make modifications to the tasks so that it is more doable.
Recovery and returning to activity after a concussion requires a lot of patience and the ability to listen to your body.
If you are struggling with persistent post-concussion symptoms or returning to activity, book an appointment with one of our concussion trained physiotherapists - Ally Ferguson & Miriam Mulkewich.
They can help you develop a personalized plan to help guide you through a gradual return to activity so you can get back doing what you love!
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Ally Ferguson is a Registered Physiotherapist who has additional training in treating vestibular issues and concussion. She is passionate about exercise and helping her clients address pain and limitation so they can do the things they love! Looking for guidance and support as you return to activity after a concussion? Book with Ally! |