When can I go back to playing sports after a concussion?

Before an athlete can return to play, he or she must be totally symptom-free and return to his or her baseline (pre-concussion) scores. Once the athlete has returned to baseline, he or she should start a five-day program in which he or she increases activities while any symptoms are monitored. If any symptoms return, the athlete should return to the previous level of asymptomatic activity. 

While recovering from a concussion, it is important to avoid anything that could cause another jolt or blow to the head or body. Once you have a concussion, you are at three to five times greater risk for later concussions.  A repeat concussion that occurs before the brain has recovered from a first one can slow permanent recovery and increase the chances for long-lasting problems. These problems include difficulties with concentration and memory, headaches, and sometimes physical skills such as keeping one’s balance.
UCLA Health

After a diagnosis with a sports-related concussion, the athlete should avoid not only physical activity but also any mental tasks that exacerbate their post-concussive symptoms. Most concussive symptoms resolve on their own over 7-14 days. When athletes have no symptoms at rest, they can begin a graded return to activity/play. This is a step-wise plan that advances the complexity of their physical activity while monitoring closely for any return of symptoms. It is best for this return to play to be supervised by a doctor or athletic trainer.

If an athlete has had a prior concussion, more caution should be taken in clearing them to return. Athletes who have had one concussion are up to three times more likely to sustain another and to have a more prolonged recovery from any subsequent concussions. Of particular concern are concussions that recur within the same season, often a sign that the athlete was cleared to return too soon. Studies have found that more than 80% of same-season concussions occur within 10 days of the first one, when the athlete is most vulnerable. Particularly concerning are the potential long-term neurological effects of multiple concussions, which include a greater risk for cognitive impairment and chronic headaches.

Christopher C. Bell, MD
Sports Medicine

This can be a complicated issue because it depends on your sport, the duration of symptoms of your concussion, and your personal concussion history. It is best to see a physician who is well trained in sports-related concussion to answer this question on an individual basis.

However, assuming this is your first concussion and your symptoms resolve within one week, there have been published recommendations by an expert panel that outlines a graded return to play based on symptoms. The important concept here is making sure that your concussion has completely resolved prior to returning to play. This ensures that you will not worsen your current concussion and also prevent what has been called "second impact syndrome", where a second, lesser concussion leads to generalized brain swelling and death. The protocol below is in place because while your symptoms may be gone while at rest, they may resurface with physical activity. It works like this:

Step 1: Wait for symptoms to totally resolve. This means total rest from physical and mental activity (sometimes we'll have kids stay home from school during this period if their schoolwork is affected and they have symptoms during class or while doing homework).

Step 2: After 24 hours of being symptom-free, you can try light aerobic exercise (jogging, stationary bike).

Step 3: On day 2, you can try sport-specific exercise, such as running drills in soccer, football, or basketball, or skating drills in hockey. No head contact.

Step 4: On day 3, perform non-contact training drills at higher intensity and complexity, such as running patterns in football, dribbling and passing drills in soccer and basketball. Again, no head contact.

Step 5: On day 4, you can participate in full contact practice.

Step 6: On day 5, you can go back to full contact game.

This progression should be supervised by someone fully versed in this protocol and knowledgeable in sports concussion. Most state high school athletic associations as well as the NCAA have adopted this program and also require medical clearance by a physician before progressing to step 5. If at any time you have symptoms of your concussion during this progression, you should go back to the previous step.

If your symptoms last longer than one week, or this is the second concussion within 3 months, or you have had more than 3 concussions within a year, you should definitely see a physician with special training in concussion management.

Dawn Marcus
If you participate in sports, you should not participate in your sport until you have been symptom-free for 1-2 weeks after your concussion. Symptom-free means no residual headache, dizziness, confusion, etc. So joining back in the game that same day or even several days later shouldn’t be permitted.

Continue Learning about Head Injuries

Head Injuries

Head Injuries

Some of the primary causes of head injuries are motor vehicle, bicycle, and motorcycle accidents and can result in concussions and contusions. Usually, people with serious head injuries lose consciousness. You may notice swelling ...

or broken bones in the skull. However, not all head injuries are obvious at first. Learn more about head injuries from our experts.

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.