Guidelines for Recovery

Concussion Alliance has created a framework of guidelines for recovery including evaluation, rest, return to activity, and rehabilitation/treatment for persistent symptoms.

This framework is based on the 5th international consensus on concussion in sport. Even if you did not get your concussion from sports, these guidelines are important as they reflect the international consensus on the best way to manage a concussion.

Evaluation: remove from sports or further harm, evaluate if an ER visit is necessary, see a medical professional within 2 days

Use arrows to click through the different guidelines; click on an image to download a pdf of the guideline.

Remove from the field of play (sports), or from further activity (non-sports).

If a medical professional is not available, use the Concussion Recognition Tool 5 to evaluate for a concussion.

Evaluate if a trip to the ER is necessary: use the Concussion Recognition Tool 5 or see our page Immediate Care. The CATT Concussion Pathway is a decision-tree chart for the evaluation and management of a concussion.

If a concussion is suspected, get a medical evaluation within two days. The medical assessment should include “a comprehensive history and detailed neurological examination including a thorough assessment of mental status, cognitive functioning, sleep/wake disturbance, ocular function, vestibular function, gait, and balance.”

The medical professional should inquire whether there has been improvement or deterioration since the time of injury.


Rest for 24-48 hours and then gradually become more active; activity level should not bring on or worsen symptoms.

Follow one of these guidelines concerning rest and step-by-step return to activity.

Use arrows to click through the different guidelines; click on an image to download a pdf of the guideline.

Many patients are still being told to effectively “cocoon,” meaning long-term rest and removal from all stimulation. Recent research shows that long-term rest (after the 48 hour initial rest-period) delays recovery and may contribute to persistent symptoms.


The current international consensus advises patients to rest for 24-48 hours following the initial injury, and then begin to gradually increase activity, making sure that the activity does not exacerbate symptoms.


We recommend the INESS document, which goes into detail about the initial rest period.

We have provided some of the best step-by-step guidelines for a gradual return to activity for different circumstances. Download a guideline on Return to Learn, Return to Sport, Return to Work, Return to Activity, and How to Manage Your Energy.


We highly recommend the Concussion Awareness Training Tool, which is a comprehensive website with in-depth concussion information for medical professionals, coaches, parents or caregivers, players or participants, and workers and workplaces.


Seek rehabilitation/treatment for persistent symptoms

The expected time frame for recovery is 10-14 days for adults, and 4 weeks for children. Seek treatment if symptoms persist past these time frames

There is not yet a consensus on the expected time for recovery for adolescents.

If you are seeing a medical professional that is telling you that you need long-term rest for persistent concussion symptoms, find a different doctor who is informed about the current concussion management consensus.

Assessment

The assessment is best performed by a medical professional well versed in concussion management. “A detailed multimodal clinical assessment is required to identify specific primary and secondary pathologies that may be contributing to persisting post-traumatic symptoms. At a minimum, the assessment should include a comprehensive history, focused physical examination, and special tests where indicated (e.g., graded aerobic exercise test).” A concussion clinic is a good place to get this assessment, see our page Concussion Clinics.

If you are seeing a medical professional who is telling you that you need long-term rest for persistent symptoms, find a different doctor who is informed about the current concussion management consensus.

Rehabilitation / treatment options for persistent concussion symptoms

It can be difficult to know where to start when addressing persistent concussion symptoms. Ideally, every patient could be assessed and treated at a top concussion clinic. However, many patients and their families end up being their own care coordinators. Below are some frameworks for thinking through treatment options.

Treatments Endorsed by the 5th International Consensus on Concussion

  1. An individualized aerobic exercise program (which limits for symptom aggravation) for patients whose persistent symptoms are associated with autonomic nervous system dysfunction. The autonomic nervous system regulates non-conscious bodily functions such as blood pressure and breathing. For information, see Physical Therapy.

  2. A targeted physical therapy program in patients with cervical spine (neck) or vestibular dysfunction. See Physical Therapy and Vestibular Therapy.

  3. Cognitive behavioral therapy (CBT) to deal with any persistent mood or behavioral issues.

Concerning medication, “Currently, there is limited evidence to support the use of pharmacotherapy. If pharmacotherapy is used, then an important consideration in return to sport is that concussed athletes should not only be free from concussion-related symptoms but also should not be taking any pharmacological agents/medications that may mask or modify the symptoms of SRC.”

Leading doctors in the field recommend that medication should not be prescribed in isolation, but with professional therapists (PT, OT) and lifestyle interventions. See Medication.


Vision Therapy is an important rehab to consider

A joint statement by the College of Optometrists in Vision Development (COVD) and the Neuro-Optometric Rehabilitation Association (NORA) recommends that concussion patients be given an optometric evaluation and vision rehab if necessary. "Vision-related problems are often overlooked" and can manifest in the form of "headaches, difficulty thinking, memory problems, attention deficits, mood swings, and frustration." For more information see our page on Vision Therapy.

Concussion Alliance knows numerous concussion patients with persistent symptoms who have recovered fully or improved significantly after doing vision therapy. A few concussion clinics offer vision therapy, but usually, you have to see attended a specialized vision therapy clinic.

Additional Therapies

Our website provides information about many additional treatments. A significant number of these have been the subject of limited research showing efficacy, but more research is needed. These treatments include hormone therapy, light therapy, and both CBD and medical cannabis. There has been very limited research on functional neurology, but many patients have found it to be effective. We’ve also heard from numerous people that craniosacral therapy is helpful. For further information, see our Treatments page.