Return to activity considerations

Sound icon Driving

There are no legal requirements regarding returning to driving following a concussion or mild head injury, as the expectation is that the majority of people will return to all previous activities with little to no changes in performance within a week or a few weeks. If you have presented to ED or your GP, they may recommend a limited time of not driving based on the symptoms you present with.

These symptoms may include:

  • Reduced concentration
  • Reduced rate of thinking and responding
  • Headaches and fatigue
  • Dizziness
  • Overstimulation from fast moving environment
  • Poor visual tracking
  • Intolerance to noise and light

Some people post-concussion report a loss of confidence and capacity to manage driving safely at night, in busy/fast environments, when under time pressures, when reversing and when fatigued.

 

It is important to maintain safe driving practices such as:

  • Choosing not to drive at night
  • Practice skills in quieter environments initially
  • Starting with short/local trips
  • Initially returning to driving with someone else in the car
  • Reduce any additional demands or distractions when driving (eg. passengers don’t talk, music is off)
  • No time pressures
  • Plan ahead (ie. Time it will take you at the time of day to get to your appointment and add on more time than necessary, visualize the route in your head or on your phone prior to the trip)

If you do present with persisting symptoms your Doctor may recommend for you to have an on-road Occupational Therapy driving assessment prior to commencing driving.

Sound icon Return to study protocol

Allow 24 hours as a minimum between stages 1 – 3 and 1 - 2 weeks as a minimum between stages 4 – 6, if symptom free. Go back one step if symptoms resume.

Stage Functional exercise Objective
1. No activity Complete cognitive rest Recovery
2. Minor cognitive activity at home Short periods (5-15min) of cognitive activity (homework) Gradual, closely monitored increase in sub symptom threshold activities
3. Moderate cognitive activity at home Longer periods (20-30mins) of cognitive activity (homework) Increase cognitive stamina, self paced activity
4. Partial school entry Part day of school attendance, plus 1-2 cumulative hours of homework Re-entry into school with accommodation to maintain cognitive load below symptom threshold
5. Gradual reintegration to school Gradual increase to full day of school attendance Increase cognitive stamina, gradual decrease of accommodations
6. Full cognitive workload resumed Catch up on essential missed work, re-introduce testing and assessments Full return to school, recommended to commence RTP protocol

Return to study for school administrators

Return to study fact sheet (PDF) 

Sound icon Return to work protocol

Allow 24 hours as a minimum between stages 1 – 3 and 1 - 2 weeks as a minimum between stages 4 – 6, if symptom free.

Stage Functional exercise Objective
1. No activity Complete cognitive rest (Maximum of 1-2 days). Recovery
2. Minor cognitive activity & light aerobic exercise in/around home Short periods (5-15min) of cognitive activity (texting/computer) and going for walks up to 10-15 minutes, simple chores. Gradual, closely monitored increase in sub symptom threshold activities
3. Moderate cognitive/physical activity in/around home Longer periods (20-30mins) of cognitive activity (social media/TV) or housekeeping tasks. Increase cognitive/physical stamina, self paced activity
4. Part time work Part day in work environment, consider 3 mornings a week (ie. Monday, Wednesday, Friday) for 3 - 4 hours. Ensure one task at a time. Re-entry into work environment with accommodation to maintain cognitive load below symptom threshold, commence GRTWP
5. Gradual reintegration to work Gradual increase to full work days (ie. Monday, Wednesday, Friday), then onto a full working week with reduced responsibilities, time pressures and restricted duties. Increase cognitive stamina, gradual decrease of accommodations, progress GRTWP
6. Full time work and duties Catch up on essential missed work, and plan out priorities. Full return to work

Sound icon Return to sport protocol

Allow 24 hours as a minimum between each stage, if symptom free. Go back one step if symptoms resume.

Stage Functional exercise Objective
1. No activity Complete physical and cognitive rest. Recovery
2. Light aerobic exercise Walking, swimming or stationary cycling for 10 - 15 minutes, keeping intensity <70% maximum permitted heart rate. Avoid resistance training and other heavy lifting. Increase heart rate
3. Sport specific exercise Running and throwing drills. Avoid body contact, resistance training, heavy lifting and other jarring motions. Add movement
4. Non contact training drills Progression to more complex training eg. passing/press drills. Start progressive resistance exercises but avoid impact activities. Exercise, coordination and cognitive load
5. Full contact practice Following medical clearance, return to normal training activities. Restore confidence and assess functional skills
6. Return to play Normal game play. Full return to pre-concussion activities

Return to work considerations

Open return to work considerations page.

Sports related concussion (SRC)

Sports related concussion is an area of study within the mild traumatic brain injury (mTBI) field and relates to the traumatic brain injury induced by biomechanical forces during sports.

SRC can be identified in the community by athletes, coaches, parents, teachers, trainers and officials as well as licenced healthcare professionals. However, a formal diagnosis and assessment should be made by a medical physician. SRC can be challenging to assess and recognise during play and can often be an evolving injury with delayed signs and symptoms. Therefore, repeated assessment may be required. Assessment tools look at recognising the injury, observable signs and symptoms, cognition (ie memory), neurological and balance assessments. If a concussion is suspected, without significant injury to the spine or head, athletes should be removed from play immediately and appropriate sideline assessment performed. For health care professionals, it is recommended to use Sport Concussion Assessment Tool (SCAT5) for athletes 13 years or older and the Child SCAT5 for those under 12. For non-medically trained individuals the Concussion Recognition Tool 5 (CRT5) is recommended. If there is any suspicion of concussion/mTBI further medical evaluation and assessment is required.

 

Those diagnosed with SRC should receive education from a health care professional in regards to the management of ongoing signs and symptoms as well as guidance on return to work, school and sport. Prior to returning to play they be reviewed by a medical professional and receive medical clearance.

For most people, symptoms improve within 1 to 4 weeks. If there have been multiple concussions, it may take longer to recover. If their symptoms do not settle within a reasonable timeframe (10-14 days for adults and 4 weeks for children), or you are concerned, you should recommend an assessment with a healthcare professional who is experienced in concussion management. For those with multiple concussions (>3) , unable to return to school or work full time, had subsequent concussions from lesser force, or increased duration of symptoms, consideration of retirement from play in consultation with an interdisciplinary healthcare team may be appropriate.

The information provided on this website is a general guide to return to activity not specific to sport related injury. For further information and guidance on acute and sub-acute assessment and management of SRC please refer to the latest Consensus Statement on concussion in sport: the Fifth International Conference on Concussion in Sport held in Berlin (PDF) or the recent Concussion in Sport Australia Position Statement (PDF)

Connectivity (external site) is a WA website about traumatic brain injury and has a health guidelines (external site) section that will also provide information on current best practice post-concussion in sports.

Most sporting organisations will also have specific recommendations unique to their sport that run parallel with existing guidelines including:

Community education and support

In Between The Ears are a WA support link that provides quality education and support regarding the effect’s concussion can have. They can provide an educational presentation to sporting clubs, schools and organisations where they speak about their personal experiences and struggles with concussion. They have linked with the leading concussion specialists, here in WA, to help provide the latest research and science. See Inbetween the ears (external site) for more information.

Sound icon Return to activity, fitness and sport

Immediately after a concussion, it can be helpful to rest for 24 – 48 hours. You then need to gradually and progressively become more active. Complete rest for longer than 3 – 4 days may slow recovery.

A gradual return to activity will improve your recovery and also reduce the risk of:

  • ongoing symptoms
  • poor mental performance
  • other injuries and long-term consequences of ongoing concussion.

People who were active prior to their concussion can experience physical deconditioning within 1 – 2 weeks of inactivity. This loss of fitness can prolong symptoms such as fatigue, irritability and sleep disturbance.

The aim of a gradual return to activity is to progressively increase your activity level without significantly increasing your symptoms. See return to sport protocol.

 

For most people, symptoms improve within 1-4 weeks. If you have had a concussion before, especially if you have not fully recovered, you may take longer to recover. If your symptoms do not settle within a reasonable timeframe, or you are concerned, you should seek an assessment with a healthcare professional who is experienced in concussion management. A reasonable timeframe is 10-14 days for adults and 4 weeks for children.

Exercise intolerance and persistence of symptoms with activity may be a sign of ongoing concussion. If you find this is an issue for you, you may benefit from visiting a physiotherapist with training in concussion to assess your exercise tolerance. A Buffalo Concussion Treadmill Test (BCTT) might be done. The BCTT test looks at your physiological response to increased work load. The results of the BCTT can be used to prescribe an appropriate aerobic exercise program. This program may include specific targets for heart rate, how hard you need to work and how long you should exercise for. A safe and effective exercise program that is tailored specifically for you can help your recovery.

A BCTT can also be helpful for people who are planning to return to activities with a high level of exertion (e.g. sports, military duty, manual labour), as it can help determine their readiness to restart their chosen activity.

Last Updated: 20/05/2022