A new chapter in concussion care
For years, the standard advice after a concussion was strict rest.
No light, no screens, no thinking, no movement — just lying still in a dark room until all symptoms disappeared.
But over the last decade, that view has changed. And for good reason.
What the research shows
Strict, prolonged rest doesn’t speed up recovery — in many cases, it makes things worse.
Extended inactivity can lead to:
- Physical deconditioning
- Increased anxiety or low mood
- Social isolation and loss of structure
- Greater sensitivity to everyday stimulation
A new approach: guided activity from the start
Today, concussion guidelines recommend:
- A short rest period (24–48 hours)
No intense thinking or movement — just a calm, quiet environment. - Gradual reintroduction of light activity
Personal care, short walks, conversations — adjusted to what you can tolerate
What is sub-symptom threshold activity?
It means doing gentle activity below the level that significantly worsens your symptoms.
Light movement (like walking or gentle cycling) may help recovery by:
- Improving blood flow to the brain
- Rebalancing the autonomic nervous system
- Reducing inflammation
- Supporting the brain’s natural repair mechanisms
- Preventing the negative effects of inactivity
A mild increase in symptoms may be okay — as long as it fades within 30–60 minutes and doesn’t cause a major setback.
The evidence is strong
Several major studies support this active recovery model:
- Researchers at the University at Buffalo showed that adolescents who began light aerobic activity within a few days of their injury recovered faster and were less likely to develop persistent symptoms
- One trial found a 4-day shorter recovery time (median) for those who exercised compared to those who only stretched
- The risk of persistent symptoms was reduced by 43%.
- Meta-analyses confirm that early, guided physical activity is safe and effective.
- The Buffalo Protocol is now a well-known tool for finding each person’s safe exercise threshold
The sources can be found below in [3][4][5][6]
What about screens?
While screen time was once completely banned, it is now suggested that you introduce light, controlled screen use even within the first few days — especially if it doesn’t worsen symptoms.
The key is to go slow and take frequent breaks.
A shift in mindset
This change marks a fundamental shift in how we view recovery.
Exercise is no longer something to wait for — it’s a part of the treatment. Also in the early stages.
Instead of passively waiting for the brain to heal, controlled physical activity supports the healing process.
How Heads can help
The Heads app supports this new, active approach to recovery.
With Heads, you can:
- Track how symptoms change with rest and activity
- Follow a plan based on symptom tolerance
- Use audio guides when reading feels too hard
- Log activity levels and build insight into your limits
- Get personalized structure — without overdoing it
Whether you’re just getting started or recovering from persistent symptoms, Heads helps you stay on track — at your own pace.
Final thought
Strict rest is no longer the gold standard.
Recovery today is about balance, structure, and guided action.
And that’s good news.
It means you don’t have to wait passively.
You can start supporting your brain — one small step at a time.
References
- Patricios, J. S., Schneider, K. J., Dvorak, J., et al. (2023)
Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport – Amsterdam, October 2022.
British Journal of Sports Medicine, 57(11), 695–716.
https://bjsm.bmj.com/content/57/11/695
→ The most recent international consensus on concussion. Highlights the shift from strict rest to gradual activity, symptom-guided recovery, and the need for individualized care. - Leddy, J. J., Haider, M. N., Ellis, M. J., & Willer, B. S. (2018)
Exercise is Medicine for Concussion.
Current Sports Medicine Reports, 17(8), 262–270.
https://doi.org/10.1249/JSR.0000000000000505
→ Emphasizes the benefits of sub-symptom threshold physical activity and its positive effects on brain physiology and recovery. - Leddy, J. J., Haider, M. N., Noble, J., et al. (2019)
Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial.
JAMA Pediatrics, 173(4), 319–325.
https://doi.org/10.1001/jamapediatrics.2018.4397
→ This study reported a median recovery time difference of 4 days (13 days for the exercise group vs. 17 days for controls). - Grool, A. M., Aglipay, M., Momoli, F., et al. (2016)
Association Between Early Participation in Physical Activity and Persistent Postconcussive Symptoms.
JAMA, 316(23), 2504–2514.
https://doi.org/10.1001/jama.2016.17396
→ This study showed a significant reduction in the risk of persistent post-concussion symptoms (PPCS) by day 28. The abstract reports an absolute risk reduction of 18.9 percentage points (from 43.5% to 24.6%), equivalent to a relative risk reduction of 43.4%. - Lankford, D. E., et al. (2020)
Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Systematic Review and Meta-analysis.
Clinical Journal of Sport Medicine, 30(4), 385–394.
→ A meta-analysis confirming that early physical activity is both safe and effective for concussion recovery. - Leddy, J. J., & Willer, B. (2013)
Use of graded exercise testing in concussion and return-to-activity management.
Current Sports Medicine Reports, 12(6), 370–376.
→ This article describes the Buffalo Concussion Treadmill Test (BCTT), which forms the basis of the “Buffalo Protocol” — a key method for determining sub-symptom threshold exercise tolerance. - Silverberg, N. D., & Iverson, G. L. (2013)
Is rest after concussion “the best medicine?”
Journal of Head Trauma Rehabilitation, 28(4), 250–259.
→ A critical review of prolonged rest. Supports the argument that excessive inactivity may delay recovery and contribute to physical deconditioning, isolation, and psychological effects. - Danish Health Authority (Sundhedsstyrelsen) (2021)
National Clinical Guideline for Concussion (Commotio Cerebri).
https://www.sst.dk/da/udgivelser/2021/nkr-hjernerystelse
→ Denmark’s national guideline supporting gradual return to activity, early information, multidisciplinary care, and tailored rehabilitation.
