Concussion Recovery: A Safe Return to Play Guide

A concussion can happen in an instant, but recovery takes time. While many people recover well, returning to sport or activity too soon can place them at risk of prolonged symptoms, further injury, or delayed recovery. Whether you’re a player, parent, coach, trainer, or supporter, knowing how concussion should be managed is critical.

70% of people will usually recover by 21 days when following the appropriate management, which includes a gradual progression of returning to life activities such as learning and work, with returning to sport being the last step.

Here’s what you need to know.

What happens immediately after a suspected concussion? 

Stage 1: First 24-72 hours

If concussion is suspected, the person should be removed from play immediately and should not return to any activity with risks of head contact, fall or collision. Even if symptoms seem mild, or the person says they’re “fine”, continuing can be dangerous.

Once red flags have been excluded, the person should be referred to a healthcare practitioner and see them within 72 hours of head knock.

If you are curious about what the red flags after a concussion are, head to the blog post at https://www.goodcountryphysio.com.au/blog to find out. 

• The person should not be left alone for the first 3 hours and should be monitored regularly by a responsible adult over the first 12 hours for any worsening or new symptoms. 

• Prioritise relative rest by limiting screen time, reading or anything requiring concentration. 

• Driving should be avoided until cleared by a healthcare professional. 

• Alcohol and non-prescription drugs should also be avoided, as they may interfere with recovery or mask worsening symptoms. 

• The person needs to be seen within 72 hours of incident to complete a concussion assessment and discuss a recovery plan including graded return to learning, work and sport. 

Stage 2: Gradual Return to Activity 

Recovery should be gradual and stepwise. Progress only if symptoms have resolved or do not worsen with activity. If symptoms flare: Stop → Rest → Return to the previous step.

• The first goal is to return to normal daily activities without symptom worsening. Once this is achieved, a gradual return to school or work can begin, with modifications to hours or tasks if needed under guidance from a healthcare professional. 

• When the person can tolerate normal learning or work activities without modifications or worsening symptoms, they can progress to sport-specific activity. 

• Start with stationary skills and minimal head movement before gradually increasing to movement-based drills, moderate aerobic exercise, and then higher intensity training.

• Contact and other high-risk activities should still be avoided at this stage.

Stage 3: Return to Contact training 

Once the person has remained symptom-free for a minimum of 14 days, successfully completed the earlier recovery stages, and been reviewed by a healthcare professional, they may begin supervised contact training and game simulation. This stage helps ensure they can safely tolerate the physical demands and unpredictability of their sport before returning to competition.

Stage 4: Return to Play

 Return to competition should only occur once the person has completed all recovery stages without symptom recurrence, remained symptom free for a minimum of 14 days, passed 21 days since the initial injury and been medically cleared to play with a signed medical clearance form. 

Importantly, the 21-day timeframe is a minimum not a target, and some people may require longer depending on their symptoms, recovery progress, age, and concussion history.

Because of this, the period after a concussion should focus on ensuring the brain has fully recovered, rather than returning to sport as the priority. Every concussion is different, so recovery timelines will vary, and progression should always be guided by symptoms and healthcare advice rather than the calendar. When in doubt, prioritise safety because no game is worth risking long-term health.

Chloe & Brook, 4th Year Physiotherapy Students

4th Year Physiotherapy Students at Adelaide University

Supervised by Angela Willsmore