Sport-Related Concussion: Return-to-Learn and Return-to-Sport

Recognition and immediate safety

Concussion is a traumatic brain injury that may involve symptoms, balance or cognitive changes; symptoms can evolve and a normal brief screen does not exclude it.

Remove an athlete from play when concussion is suspected; there should be no same-day return to contact sport. Deteriorating consciousness, repeated vomiting, seizure, worsening severe headache, focal deficit or concerning neck symptoms require urgent emergency assessment.

Initial care and return-to-learn

• For the first 24–48 hours, use relative rest rather than strict isolation or prolonged complete inactivity. Light daily activity and gentle walking may begin as tolerated under clinical guidance.
• Support return-to-learn with temporary adjustments to screen time, workload, breaks and attendance, then gradually restore usual cognitive demands.
• Assess symptom trajectory, cervical/vestibular features, balance, exertional tolerance and neurological findings. Refer when recovery is atypical or the diagnosis is uncertain.

Graduated return-to-sport

• Progress through symptom-limited activity, light/moderate aerobic exercise, individual sport-specific exercise, non-contact drills, full-contact practice after medical authorization and return to competition.
• Each step generally takes at least 24 hours. If symptoms recur, stop, allow recovery and return to the previous tolerated level with clinical guidance.
• Before stages with head-impact risk, concussion-related symptoms, cognitive abnormalities and relevant clinical findings should have resolved, including no symptoms during or after exertion, and a qualified clinician must authorize progression.

Exercise, reassessment and errors

• Begin aerobic exercise at a tolerable intensity and progress duration before intensity when appropriate. A trained clinician may use supervised exertion testing in suitable patients.
• Track symptoms before, during and after exercise, perceived exertion, balance and function. Significant or prolonged worsening requires dose adjustment and reassessment.
• Persistent dizziness, neck pain, headache or visual-motion sensitivity may need targeted cervical or vestibular rehabilitation after assessment. Do not use days since injury alone as clearance; document stage, response and return-to-learn status.