Physical Activity and Sports

Key Points:

  • Physical activity is safe and beneficial after 24-48 hours.
  • Returning to physical activity is important and not the same as returning to competition/sports which requires medical clearance.
  • Physical activity helps concussion recovery.
  • Start exercising gradually and follow the Return to Activity Stages [PDF].

Returning to Physical Activity

All youth are participants in some type of physical activity, such as: gym classes, team sports, clubs, or other activities such as walking. When you first suspect you have had a concussion, you need to be removed from play immediately and monitored by a responsible adult (see Concussion Recognition Tool [PDF]). However, after this initial period of rest, you can start getting back to your activities and normal routines.

Here are 3 important things to remember:

1. Take care of your brain

Taking care of your brain from another concussion or injury is very important. You will need to be medically cleared to return to PE class, any organized sport, or high risk activity.

2. Return to activity is a step by step process

You cannot immediately return to your sport or prior activity level after a concussion. You need to go through a graduated return to activity program.

3. Prolonged rest is not the best

Complete rest has been shown to prolong recovery, so 24-48 hours after your concussion, start getting physically active with walks, household activities, or other light exercises. Gradually build up your tolerance and endurance.

Why is physical activity and exercise important?

Physical activity has many benefits that help improve your:

  • Energy and strength
  • Sleep
  • Memory and concentration
  • Mood

How do you return to physical activity?

After a concussion, you will likely face unique challenges when returning to activity. For example, you may not be able to exercise because of headaches, while others may get dizzy or nausea📝Upset stomachted. Here are some strategies to help guide you back safely:

1. Adapt activities to your symptoms

Try different activities and see if some are better tolerated than others. For example, many people find jogging difficult because of dizziness, neck pain, or headaches. A stationary bike may be easier to tolerate.

2. Choose safe activities

We want to try and limit the risk of injury while you are still recovering. This means not participating in contact sports/team sports or participating in risky activities such as skiing or mountain biking. Choose concussion safe activities such as walking, jogging, hiking, rowing, pilates, yoga, riding a stationary bike, tennis, or badminton. You can still have fun and participate in activities safely without playing your sport.

3. Start slowly and set realistic goals

A gradual steady increase in activities has been shown to be the best, safest, fastest, and most effective way to recover. This can be super frustrating, but try to stick with it. This is the time to set realistic goals you can achieve without causing more symptoms. Start slowly and go steady.

4. Adjust exercise duration and intensity to symptoms

Find the level of exercise that does not provoke more or worse symptoms. This means you may start with 5 minutes of light aerobic exercise while monitoring your symptoms. For example: if your headache is a 2/10 when you start, you likely should stop when it goes beyond a 3/10 to 4/10.

5. Rest breaks

In case of a change in your symptoms, it is often helpful to schedule in a rest break after you exercise.

6. Stick to a schedule

You likely will get the best results if you make a weekly schedule of what, when, for how long, and what intensity you will exercise. Try to stick to your schedule but modify intensity as needed (guided by symptoms).

7. Be kind to yourself

Don't get frustrated with yourself, it is normal to have good and bad days.

Getting Help

A physiotherapist, kinesiologist, or coach can help you with your specific return to activity plan. Your doctor can also help guide your activity and manage your symptoms. As you learned in other sections, you want to choose a therapist who has knowledge and experience with concussion rehabilitation and your sport.

Returning to Your Favourite Sport or Activity

Experts recommend you follow the Return to Activity Stages [PDF]. If you are not progressing steadily and get stuck because of symptoms, talk to your doctor for help.

Follow sport-specific return to activity guidelines for basketball, soccer, figure skating and many more, which may be more relevant to you. Many can be found on sport organization websites. Share these with your coach/trainer, so they can help you follow the guide.

Stage 1: Symptom-Limited Activity

Activity: Daily activities that do not provoke symptoms.

Goal: Gradual reintroduction of work/school activities.

Stage 2: Light Aerobic Exercise

Activity: Walking or stationary cycling at slow to medium pace.

Goal: No resistance training Increase heart rate.

Stage 3: Sport-Specific Exercise

Activity: Running or skating drills. No head impact activities.

Goal: Add movement.

Stage 4: Non-Contact Training Drills

Activity: Harder training drills, eg. passing drills, may start progressive resistance training.

Goal: Exercise, coordination and increased thinking.

Stage 5: Full Contact Practice

Activity: Following medical clearance, participate in normal training activities.

Goal: Restore confidence and assess functional skills by coaching staff.

Stage 6: Return to Sport

Activity: Normal game play

NOTE: An initial period of 24–48 hours of both relative physical rest and cognitive rest is recommended before beginning the RTS progression.

There should be at least 24 hours (or longer) for each step of the progression. If any symptoms worsen during exercise, the athlete should go back to the previous step.

Resistance training should be added only in the later stages (stage 3 or 4 at the earliest). If symptoms are persistent (eg, more than 10–14 days in adults or more than 1 month in children), the athlete should be referred to a healthcare professional who is an expert in the management of concussion.

Are You Ready to Return to Sports?

After you have progressed through the Return to Activity Stages and think you’re ready to play a game, ask yourself the following questions:

  1. Do you have medical clearance to return to play?
    *You need a written note from a doctor before returning to an organized sport.
  2. Are you “symptom free”? If so, for how long?
  3. Have you tried more vigorous activities such as sprinting or jumping?
  4. Have you tried sport-specific drills or balance exercises?
  5. Have you attended non-contact practice successfully?
  6. Is your fitness level back to where it was before your injury?
  7. Have you returned to other activities in your life that are important to you?
    *Remember: return to school before returning to sports
  8. Do you feel ready? If not, why

If your answer is no to any of the above, you may not be ready - it is important to speak with your healthcare team.

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