After 24 to 48 hours8-9 of significantly reduced cognitive and physical activity, it is usually safe for concussion patients to slowly resume daily routines as long as symptoms have improved.
Resuming Cognitive Activities
As recovery progresses and symptoms diminish, it is appropriate for a person recovering from concussion to slowly resume cognitive activities. Below are tips for deciding when and how to resume cognitive activities:
Consult a physician. Concussion patients may consult their primary doctor. Depending on the severity of the injury or other risk factors, a patient may be referred to a concussion specialist or center. Any of these physicians will be able to help the concussion patient gauge when it is time to return to regular daily activity.
Discuss work accommodations. Options might include returning for half days at first or a reduction or change in workload or type until fully recovered.
Increase cognitive engagement incrementally. People can start by reading, using the computer, or working for only small increments of time to ensure symptoms do not worsen. They can then begin gradually increasing the amount of time spent working.
People easing back into work and daily life are advised to scale back their activities and consult their doctor if symptoms reappear.
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Resuming Physical Activities
Once athletes feel essentially back to themselves and their symptoms have basically returned to baseline, they may begin a step-wise, graduated program of increasing activity levels.
The Centers for Disease Control and Prevention (CDC) recommends a 6-step approach to help athletes and hobbyists return to physical activities after a concussion10:
Step 1: Back to regular activities. Returning to school, work, or other daily responsibilities is the first important step in concussion recovery.
Step 2: Light aerobic exercise. Patients may participate in stationary biking, walking, light jogging, and other similar activities. Patients are typically safe to continue these activities for 5 to 10 minutes at a time.
Step 3: Moderate exercise. More rigorous activities may be resumed (e.g. jogging, weightlifting, etc.), but not at the rate prior to the concussive event.
Step 4: Heavy, non-contact exercise. Athletes may resume sport-related drills, but should abstain from practice and competitive play. Casual athletes should increase their levels of exertion and the amount of time spent being active.
Step 5: Practice, including contact. Athletes may resume full-contact practice with their teams. Athletes who do solitary physical activities may use this step to increase their levels of physical exertion.
Step 6: Play. A return to full-contact competitive play or vigorous solitary activities can be made.
This kind of progression is typically done under the supervision of a health care professional and not undertaken independently by the patient. It is especially important for contact-sport athletes to follow a regimented return to play progression under the supervision of a health care professional, such as a physical therapist or concussion specialist.
Self-awareness is critical while increasing cognitive and physical activities after a concussion. Keeping track of sustained, emerging, or worsening symptoms is important, and concussion patients should check in with their physicians if symptoms worsen or unexpected symptoms occur.
Be Patient and Stay Vigilant Post-Concussion
Recovery from a concussion takes time. Patients who rush the recovery process or “power through” their symptoms may find it takes longer to comfortably resume their daily routine. Being patient with the recovery process, keeping track of symptoms, and consulting with a physician if symptoms worsen can help ease the recovery process.
- Ferry B, DeCastro A. Concussion. 2019 Jan 25. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK537017/ PubMed PMID: 30725702.
- McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 Jun;51(11):838-847. doi: 10.1136/bjsports-2017-097699. Epub 2017 Apr 26. PubMed PMID: 28446457.
- Centers for Disease Control and Prevention. Managing to return to activities. CDC. https://www.cdc.gov/headsup/providers/return_to_activities.html Accessed February 19, 2019. Page last updated November 18, 2018.