Parents and coaches should not allow a child to return to physical activity until he or she is completely free of concussion symptoms.
The CDC prescribes a 5-step approach to help athletes both young and experienced return to play after a concussive event,1 adapted from the International Concussion Consensus Guidelines. Outlined below, this approach details how athletes can gradually resume workouts or strenuous activities, ramping up exercise routines over time while monitoring for symptoms.
Step 1: Light aerobic exercise. An athlete may participate in light aerobic activity if:
- The athlete is evaluated by a doctor and has a normal physical exam
- The athlete has not experienced concussion symptoms for at least 24 hours1
At this stage, activities such as stationary biking, walking, or light jogging are safe to participate in for 5 to 10 minutes at a time.
Step 2: Moderate exercise. Exercises from Step 1 can be continued with increased intensity. Jogging and weightlifting (for teens) may be reintroduced. The time spent exercising during Step 2 should still be less than during the child’s previous routine.
Step 3: Non-contact exercise. Regular non-competitive, non-contact activities can be resumed. If the child is on an athletic team, they may add cognitive components or sport-related drills to their exercise routines.
Step 4: Practice. If the child is an athlete, they can resume full-contact practice with their team.
Step 5: Play. The child may return to competitive play.
It is important to note that the CDC baseline for returning to play is that the child has completed physical and cognitive rest and has not experienced concussion symptoms for 24 hours. If exercise results in worsening symptoms, then the workout should stop immediately and the child should get additional rest.
Once the child has not experienced symptoms for 24 hours, they can resume the step during which they previously experienced symptoms.