General Concussion Guidelines

To help you make the best and fastest recovery, follow these general concussion management guidelines.

Most people who have a mild concussion who have proper rest and management will start to feel better in a few days, and be “back to normal” in 3-5 weeks. A small percentage of people will have long lasting symptoms. No two concussions are alike!

Those who may take longer to recover include:

  • Children and teens
  • Older individuals
  • People who have had prior concussions
  • People with prior ADHD and/or learning problems
  • People with prior mental or physical health problems

First Steps

After you have had a concussion, you need to rest your body (physical rest) and your brain (mental rest). Rest helps your brain heal so you can return to the activities you want and need to do.

In the first 24-48 hours,

  • Take a few days off work or school
  • Get plenty of rest and sleep
  • Avoid activities that involve thinking and/or screen use (e.g., texting, cell phone, computer, TV, reading)
  • Avoid activities that are physically demanding (e.g., jogging, working out, playing with friends)
  • Do not drink alcohol
  • Do not drive

If your symptoms are improving after 24-48 hours, you can gradually increase your thinking and physical activity level. Do what you can, but if your symptoms get worse, stop.

“The therapeutic goal during concussion recovery is to find an appropriate level of cognitive exertion that does not exacerbate symptoms or cause the re-emergence of previously resolved symptoms.”
(Sady, M., Vaughan, C., and Gioia, G. (2011). School and the concussed youth: Recommendations for Concussion Education and Management, Phy Med Rehabil Clin N Am, 22, 701-719)

If your symptoms are not getting better after 24-48 hours, and you have not yet seen a health professional, you should do so. Health professionals that can be helpful in concussion management include:

  • Your family doctor
  • Specialized sports medicine or concussion clinic
  • Multidisciplinary rehabilitation service

The First Week – Concussion 101 Primer

There are a number of apps available to help with concussion management, including symptom monitoring and return to activity. An example is:

Concussion Recognition & Response: Coach & Parent Version by PAR
Parachute Canada – What To Do

Information for Children/Teens

Return To School

Children and teens should not return to sports until they have made a successful return to school and social activities. Successful return means they do not have symptoms, and are going to school full time with no adaptations.

You can start back to school part time when you can focus and do school work for short periods of time at home (e.g., an hour or two) without making symptoms worse.

When starting back to school, you may need some help or adaptations to do your work. You and your parents should let your teacher, principal /VP, or guidance counselor know about your concussion and work with them to plan your return to school.

It is important to start going to school at least part-time as soon as you are able to. However, finding the balance in returning to school is important.

  • Too much school too early:
  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • Too slow getting back to school:
  • Risk of social isolation
  • May reduce confidence
  • Second guessing/dwelling on symptoms
  • Worry about losing credits/school year
  • Stress, anxiety and mood problems may increase

Resources For Children And Teens

The following resources provide more information helpful to children and teens, and their families, schools and coaches for return to school, social activities and sports.

Concussion and You: A Handbook for Parents and Kids by Holland Bloorview Kid’s Rehabilitation Hospital

This handbook provides easy to read information for parents and kids about topics such as energy conservation, sleep, nutrition, relaxation, return to school and return to physical activity.

Concussion and You Handbook

The Ontario Neurotrauma Foundation Guidelines for Diagnosing and Managing Pediatric Concussion

The Ontario Neurotrauma Foundation Guidelines for Diagnosing and Managing Pediatric concussion also provides comprehensive guidelines that are particularly useful for health professionals.

ONF Guidelines for Pediatric Concussion

The Nationwide Children’s Hospital Educator’s Guide to Concussions in the Classroom 2nd Edition

This Guide provides return to school guidelines for teachers and school administrators. It also includes a Classroom Concussion Assessment Form that can be used by teachers to discuss symptoms with students and plan adaptations.

The Nationwide Children’s Hospital Educator’s Guide to Concussions in the Classroom 2nd Edition

Parachute Canada Return to Play Guidelines

Parachute Canada guidelines provide 6 steps to return to physical activity and sports following concussion. This information is particularly useful for athletes and coaches. If you are having ongoing symptoms, consult your doctor before starting these steps.

Parachute Canada- Concussion Guidelines for Parents and Caregivers

Return to Cognitive Activity and Return to Play from NB

These Return to Cognitive Exertion and Return to Physical Activity Protocols from the NB Trauma Program’s Concussion Awareness Kit provides 6 steps for return to school and physical activity. They are useful tools for families, healthcare professionals, coaches and teachers, and are available in French and English.

Return to Cognitive and Physical Exertion Protocols – English
Return to Cognitive and Physical Exertion Protocols – French

Information For Adults

Return To Work

If you feel 100% after resting for 24 to 48 hours you can try going back to work. You should let your manager/occupational health know about your concussion and work with them to plan your return to work. If your symptoms increase when you go back to work, you may need to modify your work and/or cut back on your hours. Otherwise, you may take longer to get better. If work modifications are necessary,
contact your family doctor.

If you are not feeling 100% after 24-48 hours you may still be able to start back to work gradually depending on the nature of your job. You should not do physical activities at work or at home that would place you at risk of a second concussion. If symptoms become worse, reduce physical and mental activity again and see your doctor for advice.

If you are not able to return to work, an occupational therapist or other rehabilitation specialist may be helpful to assess workplace demands (physical, thinking, environment) to see if further adjustments can be made. Other rehabilitation services may be needed to treat your symptoms to help you get ready to return to work.

It is important to start going to work at least part-time as soon as you are able to. However, finding the balance in returning to work is important.

  • Too much work too early:
  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • Too slow getting back to work:
  • Risk of social isolation
  • May reduce confidence
  • Second guessing/dwelling on symptoms
  • Financial worries
  • Stress, anxiety and mood problems may increase

Parachute Canada guidelines provide 6 steps to return to play once symptoms are gone and you are back at work full time. If you are having ongoing symptoms, consult your doctor before starting these steps.

Resources For Adults

The ACE form provides information about return to work and play for adults:

The ACE Physician Clinician Office Version is a shorter assessment tool for health professionals

The ACE Care Plan is for health professionals to give to adults after a concussion has been identified.

Concussion the first week

The Ontario Neurotrauma Foundation Guidelines for Concussion/mTBI for Persistent Symptoms

The Second Edition (2013) has many resources for individuals with concussion, and for Health Professionals.

ONF Guidelines for Concussion/Mild TBI