Concussion Recovery for Athletes: What the Evidence Says About Return to Sport
You get a hit in the third period. You feel off. Someone asks if you are okay and you say yes because you always say yes. You finish the game, drive home, and wake up the next day with a headache you cannot shake. Or maybe it happens at training. A fall. A collision. Nothing dramatic. But something has shifted and it does not go away.
Concussion management has changed more in the last ten years than in the previous fifty. The old advice — go home, rest in a dark room, avoid all screens and activity until you feel better — is no longer what the evidence supports. In many cases it actually makes recovery slower.
This post explains what we now know about concussion recovery, what a proper return to sport protocol actually looks like, and why getting the right assessment early makes a meaningful difference in how quickly and safely you get back to your sport.
Written by Dr. Steph Bonneau, chiropractor and concussion specialist at Highlands Wellness in Kanata.
What Actually Happens in a Concussion
A concussion is a functional brain injury, not a structural one. That is why it does not show up on a standard MRI or CT scan. What happens is a neurometabolic disruption: the brain is shaken inside the skull, causing a cascade of chemical and cellular changes that affect how neurons communicate and how the brain regulates energy.
This is why concussion symptoms are so varied. Headaches, dizziness, brain fog, sensitivity to light and noise, sleep disruption, mood changes, difficulty concentrating — these are all expressions of a brain that is working harder than usual to perform tasks that used to be automatic.
What is also important to understand is that a concussion almost always involves more than just the brain. The cervical spine is injured in the majority of concussions because the same mechanism that shakes the brain also loads the neck significantly. This is one of the most commonly missed contributors to prolonged symptoms, including headaches and dizziness, and it is a major reason why proper assessment goes well beyond symptom checklists.
The Biggest Myth: Complete Rest Until You Feel Better
This one is worth addressing directly because it is still the most common advice athletes receive.
Complete, prolonged rest after a concussion is no longer the standard of care. The research over the last decade has consistently shown that complete rest beyond the first 24 to 48 hours is associated with worse outcomes, not better ones. It contributes to deconditioning, increases anxiety and catastrophising about symptoms, and can actually slow neurological recovery.
The current consensus, reflected in the 2023 Amsterdam Concussion Consensus Statement — which is the international benchmark for concussion management — recommends a period of relative rest lasting one to two days, followed by gradual reintroduction of activity that stays below the threshold at which symptoms worsen.
The goal is not to avoid all activity. It is to find the level of activity you can sustain without provoking symptoms and progressively build from there.
This is a fundamentally different approach and it requires clinical guidance to do safely. The threshold varies from person to person, changes throughout recovery, and needs to be monitored by someone who knows what they are looking for.
What a Proper Concussion Assessment Covers
Most concussion assessments focus on symptom scores and basic cognitive testing. These are useful but they do not give a complete picture. A thorough concussion assessment should include:
Symptom inventory and detailed injury history, including any previous concussions and how they resolved
Cognitive screening for memory, processing speed, and concentration
Neurological screening to identify any impairments
Balance and vestibular testing to identify inner ear involvement, which is common and often missed
Oculomotor screening for eye tracking and convergence problems that contribute to headaches, fatigue and difficulty reading
Cervical spine assessment to identify joint and muscle involvement in the neck
Graded aerobic exercise tolerance testing to establish a safe activity threshold
Each of these systems can be a source of ongoing symptoms after concussion. Treating only the brain while ignoring the neck, the vestibular system, and the visual system is one of the primary reasons concussions become prolonged and complicated.
The Return to Sport Protocol: Step by Step
Return to contact sport after a concussion follows a graduated, step-by-step process. A similar process is implemented for return to work and return to school. Each step introduces a higher level of physical and cognitive demand. You must be symptom-free at rest and able to complete each stage without symptom provocation before progressing to the next.
The standard protocol has six stages:
Stage 1: Symptom-limited activity — Typically the first 24–48 hours
Light daily activities such as walking and light stretching that do not provoke symptoms. No exertion. The goal is to establish a baseline and begin reintroducing activity without stress to the recovering brain.
Stage 2: Light aerobic exercise
Walking, swimming, or stationary cycling at low intensity. No resistance training. No sport-specific movements. The purpose is to establish your aerobic exercise tolerance threshold and begin building cardiovascular capacity safely.
Stage 3: Sport-specific exercise
Sport-specific movement patterns without contact or collision risk. Running drills for team sport athletes. Skating for hockey players. No head impact exposure. Adds complexity and sport-specific load.
Stage 4: Non-contact training drills
More complex drills with teammates. Resistance training can be reintroduced. No contact. This stage tests cognitive load alongside physical load, which is important because dual-task demands are often where residual deficits become apparent.
Stage 5: Full contact practice
Return to full contact training after medical clearance. This is a significant step and should only happen once stages 1 through 4 have been completed without symptom provocation. Medical clearance means a clinical assessment confirming complete symptom resolution and normal neurological function.
Stage 6: Return to competition
Full return to game and competition. Not a step to rush. The stakes of a second concussion before full recovery are significantly higher than the cost of a few extra days or weeks of patience.
The 24-hour rule: if symptoms return at any stage, drop back to the previous stage and allow 24 hours of symptom-free rest before attempting to progress again.
How Long Does It Actually Take?
This is the question every athlete and parent wants answered immediately. The honest answer is that it depends, but here is what the evidence shows for typical presentations:
Most straightforward concussions in healthy adults resolve within 2 to 4 weeks with proper management
Youth athletes typically take longer than adults, often 4 to 6 weeks or more
Athletes with a history of previous concussions, or those who did not manage the initial injury well, tend to have longer recovery timelines
Post-concussion syndrome, defined as symptoms persisting beyond the expected recovery window, occurs in roughly 15 to 20 percent of cases and requires more targeted management
Two things consistently predict a longer recovery: complete rest in the early stages, and returning to activity too quickly before symptoms have resolved. Both are avoidable with the right guidance from the beginning.
Why Early Assessment Makes Such a Difference
The window between injury and first assessment matters. Athletes who are assessed properly within the first 72 hours and given a clear, evidence-based management plan consistently recover faster than those who wait, rest at home, and come in only when symptoms persist.
Early assessment allows us to establish a baseline, identify contributing factors like cervical spine involvement, begin sub-threshold activity at the appropriate level, and catch any red flags that warrant urgent medical referral.
It also removes a significant source of anxiety. One of the things that prolongs concussion recovery is fear of symptoms. When athletes understand what is happening and why, what is safe to do and what to monitor for, they recover with more confidence and less catastrophising.
Book a Concussion Assessment at Highlands Wellness
Dr. Steph Bonneau at Highlands Wellness in Kanata provides comprehensive concussion assessment and return-to-sport management for athletes at all levels. Whether you are dealing with a recent concussion or symptoms that have lingered longer than expected, a proper assessment is the right first step.
We work with youth and adult athletes in Kanata, Stittsville, and across west Ottawa. We communicate directly with coaches, athletic therapists, parents, and physicians as needed.
Book online here!
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