When to start exercise, school or work after a concussion?

Deciding when an athlete or player is ready to start exercise an art and not an exact science. Once an athlete or player is back to hours at school or work, start a balance and postural stability re-training programme. A progression to light aerobic exercise can follow the initial static balance and co-ordination re-training. 23–81% of persons report dizziness and balance problems in the first few days after concussion and 16–18% of concussed athletes may have ongoing dizziness for 3 months. Hence, the importance of balance training.

Balance training

Concussed athletes also have an increased risk of lower limb injury following concussion. This finding in recent studies is proposed to be caused by impaired body position sense and awareness. Balance drills should continue for months after the athlete or player is back at sport. Physical Therapists are in an excellent position to supervise, individualize and adapt this form of rehabilitation. Balance training programmes are effective at treating dizziness and improving balance after head injury.

Once symptoms of concussion have disappeared and the athlete or player is feeling their normal selves, coping at full work or school and has progressed through an element of balance training, start light non-impact loading aerobic exercise and progress through a number of stages, ending with high intensity sports specific exercise activity.

It is very important that an athlete or player be evaluated by a medical doctor and cleared before starting high risk or contact training activity, and not simply return on their own time.

When to start exercise?

When to start school or work?

Students or workers recovering from concussion can worsen their symptoms by attempting full school or work days, normal homework and testing too early in their recovery. A delay in testing, less school hours and frequent breaks between classes, would be appropriate. Wait until the learner has minimal symptoms and near normal concentration before increasing the load on the brain. Limiting the use of computers, mobile phones and television viewing soon after concussion, can allow recovery at a normal speed. A similar approach to managing the load on the brain in children can apply for adults returning to work after concussion. However, no studies have yet provided guidelines on a clear return to work progression for adults. Remember, it’s not possible to speed up brain cell recovery beyond the normal healing rate, but you can slow it down.


HeadSmart™ sports concussion tests can quickly and effectively detect concussion after an injury, allowing for immediate removal from play and referral to a medical doctor. For more information visit www.headsmart.me


Written by Dr Ryan Kohler • Sports Concussion Specialist • Director of HeadSmart™ Sports Concussion Programme • MBChB MPhil (Sports Med) FFIMS FACSM FFSEM (UK) FACSP.