Post-Concussion Exercises: Safe Recovery After Head Injury

Recovery from a concussion requires a careful, graduated approach to physical activity. Returning too quickly can prolong symptoms, while excessive rest can delay healing. These exercises follow evidence-based protocols for safe return to activity after concussion.

Understanding Concussion Recovery

What is a concussion:

• Mild traumatic brain injury (mTBI)
• Caused by blow to head or rapid acceleration/deceleration
• Temporary disruption of brain function
• Usually no structural damage visible on imaging

Common symptoms:

• Headache
• Dizziness
• Fatigue
• Difficulty concentrating
• Memory problems
• Light and noise sensitivity
• Sleep disturbances
• Mood changes

Recovery timeline:

• Most recover within 10-14 days
• Some take weeks to months
• 10-30% develop persistent symptoms (post-concussion syndrome)

Important Principles

1. Medical clearance first

• See a healthcare provider after any concussion
• Follow their guidance
• Don't return to sport or high-risk activity without clearance

2. Symptom-limited activity

• Activity should not significantly worsen symptoms
• Mild, brief increase acceptable (returns to baseline within 1 hour)
• If symptoms significantly worsen, stop and rest

3. Gradual progression

• Start with light activity
• Progress through stages
• Each stage takes minimum 24 hours
• Return to previous stage if symptoms worsen

4. Complete rest is NOT recommended

• Brief initial rest (24-48 hours)
• Then gradual return to activity
• Prolonged rest can delay recovery

Stage 1: Symptom-Limited Activity (Days 1-2)

After brief initial rest, begin light activity.

Light Walking

Protocol:

• 5-10 minutes
• Slow, comfortable pace
• Indoor or flat outdoor area
• Stop if symptoms significantly worsen

Gentle Stretching

Neck stretches (if no neck injury):

1. Slowly tilt ear toward shoulder
2. Hold 15-20 seconds
3. Repeat other side
4. Slow head turns side to side
5. 5 repetitions each direction

Shoulder rolls:

1. Roll shoulders forward 10 times
2. Roll backward 10 times
3. Slow, gentle movements

Deep Breathing

Diaphragmatic breathing:

1. Sit or lie comfortably
2. Hand on belly
3. Breathe in slowly, belly rises
4. Exhale slowly, belly falls
5. 5-10 minutes
6. Helps with relaxation and focus

Stage 2: Light Aerobic Exercise

Begin when tolerated with minimal symptom increase.

Stationary Bike

Protocol:

• 10-15 minutes
• Low resistance
• Easy pace (60-70% max heart rate)
• No symptom worsening

Walking (Increased)

Protocol:

• 15-20 minutes
• Moderate pace
• Flat terrain
• Monitor symptoms

Swimming (Light)

Protocol:

• Easy laps or water walking
• 10-15 minutes
• No diving or underwater activity
• Avoid bright pool lighting if sensitive

Elliptical

Protocol:

• 10-15 minutes
• Low resistance
• Moderate pace

Target heart rate: 70% of maximum (220 - age × 0.7)

Progress when:

• Complete 20-30 minutes without symptom increase
• Symptoms at baseline next day

Stage 3: Sport-Specific Exercise

After tolerating Stage 2 for 24+ hours without symptoms.

Increased Intensity

• Jogging
• Moderate resistance training (no heavy lifting)
• Sport-specific drills (no contact or risk)

Running

Protocol:

• Start with jog/walk intervals
• Progress to continuous jogging
• 15-20 minutes
• Increase speed gradually

Body Weight Strength

Exercises:

• Squats
• Lunges
• Push-ups
• Planks
• Core exercises

Guidelines:

• No heavy weights yet
• Focus on form
• Stop if symptoms increase

Coordination Drills

• Agility ladder
• Cone drills (slow)
• Ball handling (if applicable)
• Sport-specific movement patterns

Stage 4: Non-Contact Training

After tolerating Stage 3 for 24+ hours.

Full Training (No Contact)

Includes:

• Full practice participation
• No contact or collision
• More intense aerobic exercise
• Resistance training (progressive weights)

Sport Practice

• Team drills
• Scrimmage (non-contact only)
• Full intensity training
• No heading (soccer) or body contact

Strength Training

Progress to:

• Normal resistance training
• Progressive overload
• Monitor for symptom increase

Stage 5: Full Contact Practice

Requires medical clearance for return to sport.

Includes:

• Full contact practice
• Normal training
• Game-like scenarios

Only after:

• Medical clearance
• Completed all previous stages
• No symptoms at rest or with activity

Stage 6: Return to Play/Full Activity

Full clearance to:

• Competition
• Full sport participation
• Normal daily activities

Exercises for Persistent Symptoms

If symptoms persist beyond 2-4 weeks, targeted exercises may help.

For Headaches

Neck exercises (if cervicogenic component):

• Chin tucks
• Neck stretches
• Upper trap release

Breathing exercises:

• Diaphragmatic breathing
• Progressive relaxation

For Dizziness (Vestibular)

Gaze stabilization:

1. Hold finger in front of face
2. Move head side to side while keeping eyes on finger
3. 30 seconds, 2-3 times daily

Balance exercises:

1. Stand on one leg (near support)
2. Walk heel-to-toe
3. Stand with eyes closed
4. Progress difficulty gradually

For Exercise Intolerance

Sub-symptom threshold training:

1. Find heart rate that triggers symptoms
2. Exercise at 80% of that heart rate
3. Gradually increase intensity
4. Buffalo Concussion Treadmill Test can help establish threshold

For Cognitive Symptoms

Graded cognitive activity:

• Gradually increase mental tasks
• Take breaks before fatigue
• Use timers to limit screen time
• Increase duration gradually

Red Flags - Seek Immediate Help

Go to emergency room if:

• Severe or worsening headache
• Repeated vomiting
• Seizures
• Prolonged loss of consciousness
• One pupil larger than other
• Extreme drowsiness/can't be awakened
• Not recognizing people or places
• Increasing confusion
• Weakness or numbness
• Slurred speech
• Neck pain
• Blood or fluid from ears or nose

Activity Modifications

Screen time:

• Limit initially (may trigger symptoms)
• Take frequent breaks (20-20-20 rule)
• Reduce brightness
• Gradual return to normal use

School/work:

• May need accommodations initially
• Return gradually
• Breaks as needed
• Reduced workload if needed

Driving:

• Avoid until cleared by doctor
• Reaction time may be impaired
• Vision/concentration issues

Sleep:

• Maintain regular schedule
• Avoid screens before bed
• Rest when fatigued
• Brief naps OK if needed

Sample Recovery Timeline

Day 1-2:

• Brief rest
• Light activity as tolerated
• Stage 1 exercises

Day 3-5:

• Stage 2 (light aerobic)
• 20-30 minutes if tolerated
• Monitor symptoms

Day 5-7:

• Stage 3 (sport-specific)
• Increased intensity
• No contact

Day 7-10:

• Stage 4 (non-contact training)
• Full practice minus contact
• Progressive strength

Day 10-14:

• Medical clearance
• Stage 5 (contact practice)
• Return to full activity

Note: This is an ideal timeline. Many take longer. Do not rush.

Prevention

For athletes:

• Proper technique and form
• Neck strengthening
• Mouthguard use
• Rule enforcement
• Concussion education

For everyone:

• Seatbelts
• Helmets for cycling, skiing, etc.
• Fall prevention (especially elderly)
• Workplace safety

Key Takeaways

1. Brief rest, then gradual activity: Complete rest delays recovery
2. Symptom-limited: Activity should not significantly worsen symptoms
3. 24-hour stages: Minimum time at each level
4. Return to previous stage: If symptoms worsen
5. Medical clearance for contact: Required before full return
6. No rushing: Recovery takes time
7. Individual pace: Everyone recovers differently
8. Persistent symptoms need evaluation: See specialist if not improving

Most concussions recover fully with proper management. The key is a gradual, supervised return to activity while monitoring symptoms.