Exercise guide
A concussion is a brain injury that briefly changes how your brain works, after a blow to the head or a jolt to the body. Most symptoms settle within 2 to 4 weeks. If in doubt, sit them out: anyone who might have a concussion stops at once, doesn't play, train or do PE (physical education) for at least 24 hours, and is assessed within 24 hours by a healthcare professional or through NHS 111, the National Health Service's urgent advice line.
Rest for the first day or two, but strict rest after that doesn't help. Light activity, such as walking or a static bike at an easy pace, is safe, and in trials of teenagers and young athletes, starting it early helped them recover a few days sooner. The UK concussion guidelines for grassroots sport set out six stages back to sport, and an international consensus sets out the steps back to school and work.
This guide covers the first 48 hours, how hard to exercise and when to stop, the six stages, school and work, children, symptoms that last and the warning signs that need 999, with a 20-minute light exercise session to follow.
Anyone who might have a concussion stops at once and doesn't play, train or do PE again for at least 24 hours. Get them assessed within 24 hours by a healthcare professional or NHS 111, and call 999 for red flags such as getting drowsier, repeated vomiting, a fit or a worsening headache (the full list is below). Fewer than 1 in 10 concussions involve being knocked out.
Rest and sleep as you need to, but easy daily activities, reading and short walks are fine, and keep screens to a minimum for 48 hours. Someone should stay with you for the first 24 hours, with no driving and no alcohol.
A mild, brief rise in symptoms during activity is fine: the international consensus defines it as no more than 2 points on a 0 to 10 scale, settling within an hour. If symptoms rise more than that, stop, rest and try again the next day at an easier level.
Experts agree that resting strictly until every symptom has gone isn't helpful, and in one trial young people told to rest strictly for 5 days reported more symptoms. In trials, mostly in teenagers and young athletes, people who started light exercise early recovered a few days sooner. The UK guidelines' light exercise stage is 10 to 15 minutes of walking or a static bike, at a pace where you can easily talk in short sentences.
Go back to school, college or work step by step, with shorter days at first: the international consensus accepts a mild, brief rise in symptoms along the way. Be back at school or work full time before you go back to full sport.
Training for your sport starts once you're free of symptoms at rest, with no risk of a knock to the head. Anything with a risk of a head impact waits until you've had 14 days with no symptoms at rest, which is day 15 at the earliest, and there's no competition before day 21, counting the day of the injury as day 0. Call NHS 111 if you're getting worse or not improving by 14 days, and see a GP (general practitioner) if symptoms last more than 28 days.
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The UK guidelines call these red flags. They need urgent assessment, by ambulance if necessary. If a neck injury is suspected, only a trained healthcare professional should move the person.
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The UK guidelines describe concussion as a traumatic brain injury that disturbs how the brain works: it affects how you think, feel and remember things. It can follow a direct blow to the head, or a knock elsewhere that jolts the head, as in a whiplash-type injury. Being knocked out happens in fewer than 10% of concussions and isn't needed for a diagnosis, but anyone knocked out by a head injury has had a concussion.
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Standard brain scans, such as computed tomography (CT) or magnetic resonance imaging (MRI), show nothing abnormal in concussion: they aren't powerful enough to pick up damage at a microscopic level. A clear scan doesn't mean you didn't have a concussion; your symptoms are the better guide.
Physical (headaches, dizziness, vision changes), mood (short tempered, sad or emotional), thinking (not thinking clearly, feeling slowed down or "in a fog") and sleep (too little or too much). Symptoms usually start straight away or within minutes but can appear over the first 24 to 48 hours, and mood, sleep and concentration problems can show over the next few days.
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Playing on with concussion symptoms can make them worse and significantly delay recovery, and a second head injury before you've recovered can cause a more severe injury and, rarely, death (second impact syndrome). Across 278 studies, people who kept playing after the injury took longer to recover.
Each year over 1 million people go to emergency departments in England and Wales with a head injury, and a third to a half of them are children under 15. Most recover without any specialist treatment.
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Most symptoms settle within 2 to 4 weeks, and about two-thirds of people are back to full sport by 28 days; children, teenagers and young adults may take longer. In studies of mostly North American athletes, symptoms lasted 14 days on average. People seen in emergency departments after any kind of head injury recover more slowly: about 3 in 10 children and 3 in 10 adults still had marked symptoms after 4 weeks.
Symptoms often settle before the brain has fully recovered, which is why the sport stages have minimum times.
People who've had a concussion before, children and teenagers, and possibly women and girls, though the evidence there is limited. Disabled people, for example with cerebral palsy or after a stroke or a previous brain injury, may need a longer rest at first. Poor sleep in the first 10 days goes with slower recovery.
This guide is about concussion. A longer loss of consciousness, or a scan that shows bleeding or damage, means a more serious brain injury that needs specialist care and rehabilitation. NICE (the National Institute for Health and Care Excellence) asks that people whose problems persist are referred to specialists trained in brain injury.
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Rest and sleep as you need to for the first 24 to 48 hours, which helps recovery. Easy daily activities, reading and short walks are fine, in slots of 10 to 15 minutes, as long as they don't make your symptoms more than mildly worse. Avoid hard exercise, demanding work and sport. The international consensus is clear that complete rest and isolation aren't recommended, even in these first days.
Keep smartphone, screen and computer use to a minimum for at least the first 48 hours. In a trial of 125 young people, those asked to avoid screens for 48 hours got better sooner (the evidence section has the numbers).
Don't be left alone for the first 24 hours, and don't drive or drink alcohol in that time. The NHS adds that you don't need to stay awake if you're tired; hold an ice pack wrapped in a tea towel to any swelling for short periods; paracetamol can help a headache; don't drink alcohol until you're feeling better; and don't take sleeping pills unless a doctor advises you to.
Sleep as much as you need early on. Sleep problems in the first 10 days go with a higher risk of symptoms lasting, so tell a GP if poor sleep isn't settling.
Most trials are small, and most were in teenagers and young athletes seen in specialist clinics after a sport-related concussion, so the results may not apply to everyone.
The 2022 international consensus says recommending strict rest until all symptoms have gone is not beneficial. In a trial of 88 young people aged 11 to 22 seen in an emergency department, those told to rest strictly for 5 days reported more symptoms over the next 10 days than those who rested for 1 to 2 days and then went back to activity step by step. In 107 adults after a mild brain injury, 6 days of bed rest did no better than none. The evidence that strict rest does harm comes from the one small trial.
In trials, mostly in teenagers and young athletes, people who started light activity or aerobic exercise early recovered a few days sooner than comparison groups who rested, stretched or had usual care: about 4 to 5 days sooner on average in one review of 7 studies. That review covered sport-related concussion only, and we read its published summary (the abstract), not the full paper. The consensus concludes that light activity in the first 2 days and aerobic exercise from day 2 to day 14 are safe and help recovery. Whether the same applies to adults injured outside sport is less clear.
In 103 teenagers aged 13 to 18 seen within 10 days of a concussion, 20 minutes a day on a bike or treadmill, kept below the heart rate that brought on symptoms in a treadmill test, led to recovery in a median of 13 days, against 17 with stretching. In a second trial of 118 teenagers, the same approach about halved the risk of symptoms lasting beyond 4 weeks. A small trial in 39 people aged 13 to 25 used a simple heart rate target with no treadmill test and also found faster recovery. No one was harmed by the exercise in any of them.
In 2,413 children aged 5 to 18 seen in emergency departments, those who were active in the first week were less likely to still have symptoms at 4 weeks (25% against 44%), though children who felt better may have been more active for that reason. In a trial of 456 children aged 10 to 17, going back to activity after 72 hours, even with symptoms, was safe but didn't clearly reduce symptoms at 2 weeks overall; many children didn't follow their plan, and those who did had fewer symptoms.
The evidence in adults is thinner. Bed rest didn't help in one trial, and in 118 adults seen in an emergency department, written advice on rest and a graduated return made no difference to symptoms at 2 or 4 weeks compared with usual advice; about 3 in 10 still had marked symptoms at 4 weeks. Nothing suggests adults should rest for longer than teenagers (our reading).
In a trial of 125 people aged 12 to 25, those asked to avoid screens for 48 hours had symptoms for a median of 3.5 days, against 8 days for those allowed screens. The consensus says cutting screen use in the first 48 hours is reasonable, but it may not help after that.
A 2025 review of 9 small trials with 346 people concluded that aerobic exercise may improve concussion symptoms, especially when started early.
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If dizziness, neck pain or headaches last more than 10 days, the consensus recommends physiotherapy for the neck and the balance system (cervicovestibular rehabilitation). In small trials it shortened the time to get back to sport, and balance (vestibular) rehabilitation helped teenagers with dizziness.
Most people recover with time and a gradual return to activity, without specialist treatment. For symptoms that last, the evidence is for rehabilitation: physiotherapy for neck and balance problems, prescribed exercise, and referral to brain injury specialists, as NICE recommends.
Before you start, score your worst symptom from 0 (none) to 10 (the worst you can imagine): this is our practical version of the consensus scale. A rise of no more than 2 points that settles within an hour of stopping is fine. If it rises more than that, or a new symptom appears, stop, rest and try again the next day at an easier level. The UK guidelines say a mild worsening is acceptable if it's brief, ideally under an hour but sometimes up to a few hours, and that flare-ups with exercise are generally safe, brief and settle on their own.
In the light exercise stage, start at an intensity where you can easily speak in short sentences, and increase how long and how hard you go as you can tolerate it.
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The consensus suggests light exercise up to about 55% of your maximum heart rate, then moderate exercise up to about 70%, taking your maximum as 220 minus your age. A trial without a treadmill test built up from 60% to 75% over 11 days. Our heart rate zone calculator works out the numbers.
Start with 10 to 15 minutes, as the UK guidelines suggest, and build up as you tolerate it. The trials worked up to about 20 minutes a day.
Walking or a static bike. One trial chose cycling to limit head movement. Avoid anything with a risk of a fall, a collision or a knock to the head, such as contact sport, road cycling, skiing or climbing, until the stages allow it.
From the UK concussion guidelines for grassroots (non-elite) sport. The day of the injury is day 0, and no stage should last less than a day. Children and adults follow the same stages.
Rest and sleep as needed, with easy daily activities, short walks and screens kept to a minimum. You can still have symptoms.
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Daily activities outside school or work, such as easy reading, limited screen time, moving around the house, simple chores and short walks. Rest briefly if symptoms rise more than mildly.
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Walking or a static bike for 10 to 15 minutes, at a pace where you can easily speak in short sentences, building up as you tolerate it. Brisk walks and easy bodyweight exercises are fine, but no hard efforts or added weights. You can move through stages 1 to 3 with mild symptoms. Our 20-minute light exercise session is built for this stage.
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Only once you're free of symptoms at rest. Train for your sport with no risk of a knock to the head, and now increase the intensity of exercise and resistance training.
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Training with head impacts, or a risk of a head injury, only once you've had no symptoms at rest for 14 days: day 15 at the earliest. If symptoms come back after a knock in training, stop.
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Not before day 21, and only if you've been free of symptoms at rest for the previous 14 days and during training. If symptoms continue beyond 28 days, stay out of sport and see a GP.
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Injured on day 0, with a headache and nausea until day 4 and no symptoms at rest from day 5: training with a risk of a knock to the head can start on day 19, after 14 symptom-free days, and competition on day 21 at the earliest. Someone whose symptoms get much worse with activity and are still stuck at day 14 should get medical advice, and can't return within 21 days.
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The UK guidelines no longer expect a review by a doctor or healthcare professional to move through the stages, including back to contact training and matches. Get NHS advice through 111 if symptoms get worse or haven't improved by 14 days, and see a GP if they last beyond 28 days. Some sports' governing bodies have their own rules (our sport pages give them), and elite players with specialist doctors may follow a different pathway.
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The UK guidelines say going back to education or work takes priority over going back to sport. The international consensus says students should be fully back to learning before they return to full sport, and that the two can run side by side: you can be back at school part time while working through the early sport stages.
The 2022 consensus sets out four steps for students. Move on when you can manage a step with no more than a mild, brief rise in symptoms: no more than 2 points out of 10, settling within an hour.
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The UK guidelines agree that going back to school or work part time, for example half days or with planned breaks, is fine even if you still have symptoms, as long as they aren't severe or much worse. In children and teenagers, going back too soon can make symptoms worse, so build up a step at a time.
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The UK guidelines' summary table puts part-time school or work in stage 4, alongside training for your sport, which waits until you're free of symptoms at rest. Their text and the consensus both allow part-time school or work with mild symptoms. Our reading: go back to school or work part time while you still have mild symptoms, keep sport to light exercise until you're free of symptoms at rest, and be back full time before training with any risk of a knock to the head.
The return to learn steps are written for students, and we apply the same approach to work (our reading): short blocks of work at home first, then reduced hours with breaks, then full time, with no more than a mild, brief rise in symptoms. The UK guidelines' stages describe the same build-up: 20 to 30 minute blocks of work at home with a rest after each, then part time while avoiding hard physical work, then a full return. After a mild brain injury from any cause, a little over half of people are back at work within a month and about 8 in 10 within 6 months, in 14 studies of variable quality.
Schools can allow shorter days, rest breaks, less screen time, extra time for homework and tests, and printed notes. Most students won't need them for long: across 278 studies of young athletes, 93% were fully back to learning within 10 days without extra support.
No PE for at least 24 hours after a suspected concussion. After that, avoid contact games, collisions and anything with a risk of falls until the sport stages allow them; walking and other activity without contact are fine.
Don't drive or ride a bike for at least 24 hours, and the NHS says don't drive until you feel fully recovered. Lorry, bus and other commercial drivers need a healthcare professional's review before driving again. You must tell the DVLA (Driver and Vehicle Licensing Agency) if you have a serious head injury; ask your doctor if you're not sure whether yours counts.
The NHS head injury page says not to go back to work or school until you're feeling better, and to see a GP if you're not sure it's safe to drive or go back to work, school or sport. The UK concussion guidelines and the international consensus give more detail and allow a gradual return with mild symptoms, so this guide follows them; the GP advice stands.
Take them out of play at once and get them assessed within 24 hours by a healthcare professional or NHS 111. For a child under 5, call 111 for advice, and for a baby under 1 with a bruise, swelling or large cut on the head, call 999. Don't leave them alone for the first 24 hours, and watch for any worsening over 24 to 48 hours.
Let them rest and sleep as they need to: they don't need to be kept awake if they're tired. Keep screens to a minimum for 48 hours, and the NHS says children should avoid rough play for a few days.
Children and teenagers may be more likely to get a concussion, take longer to recover, and can make symptoms worse by going back to school too soon. They're also more at risk of rare but dangerous complications, including death from a second knock before they've recovered. The day 21 minimum for competition applies to them too.
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Tell the school and any sports clubs, follow the return to learn steps above, and get back to full-time school before full sport.
Starting gentle activity after a few days was safe for children in a large trial, and in a large study, children who were active in the first week were less likely to have lasting symptoms. The aerobic exercise trials were in teenagers aged 13 to 18.
The UK guidelines cover all grassroots sport from primary school age upwards. Some governing bodies have their own rules; our sport pages give them.
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Call NHS 111 if symptoms get worse or haven't improved by 14 days. The NHS says see a GP if symptoms of a head injury last more than 2 weeks, and the UK guidelines say anyone with symptoms beyond 28 days should stay out of sport and see a GP, who may refer them to a specialist. NICE asks that people whose problems persist are referred to specialists trained in brain injury.
Headaches can persist for several months or more. They may look like migraine, and sometimes they come from a neck injury. Lasting symptoms are not usually a sign of a more severe brain injury, and if activity doesn't make your headaches worse, they shouldn't stop you going back to school, work and exercise. Our migraine and tension headache guides cover exercise for headaches.
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If dizziness, neck pain or headaches last more than 10 days, ask about physiotherapy for the neck and balance system. Our vertigo guide's balance exercises are for use once a GP or physiotherapist has checked your dizziness.
If exertion still brings on headaches or dizziness after a month, ask your GP about a referral. Specialist clinics can test how much exercise you tolerate and prescribe aerobic exercise below that level, which helps people whose symptoms have lasted beyond a month too.
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Concussion can make you short tempered, sad or emotional, and it can lead to depression and anxiety. Low mood, anxiety and poor sleep can also keep other symptoms going, so tell your GP if they aren't settling. Our depression, anxiety and sleep guides cover how exercise can help.
10 to 15 minutes of easy cycling or walking at a pace where you can talk in short sentences, then 1 or 2 rounds of 8 to 10 easy reps of each bodyweight move (our editorial starting point). Stop if your symptoms rise by more than 2 points out of 10.
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStanding marchBeginner · No equipment
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoGlute bridgeBeginner · No equipment
3D demoSlow calf raiseBeginner · A wallOnly once you're free of symptoms at rest, with no risk of a knock to the head. Start at about half your usual effort and build up through the stage (our editorial starting point).
For lasting neck stiffness or dizziness, only once a GP or physiotherapist has checked you and ruled out a serious neck injury. Stop if a move brings on dizziness, tingling down an arm or a headache, and hold a counter for the balance moves.
3D demoLying chin tuckBeginner · No equipment
3D demoChin tuckBeginner · No equipment
3D demoNeck CARs (controlled articular rotations)Beginner · No equipment
3D demoLevator scapulae stretchBeginner · No equipment
3D demoSemi-tandem stanceBeginner · A wall
3D demoTandem stance and heel-to-toe walkBeginner · A wall
3D demoSingle-leg standBeginner · A wallStage 3: the light exercise session or the 10-minute starter. Stage 4, once you're free of symptoms at rest: easy cardio, the interval walk, run-walk intervals and the dynamic warm-up (skip its head-down inchworm while that brings on dizziness). The vestibular, neck and breathing routines are for lasting symptoms, once checked.
A 20-minute light session after a concussion: a symptom check, 10 to 15 minutes of easy cycling or walking, gentle bodyweight moves and a cool-down.
20 minBeginner8 movesCardio machine, A bench or boxA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 25-minute walk with short faster bouts: notice your heart and breathing speed up, then settle. A gentle way to get used to the feelings of effort.
25 minBeginner5 movesCardio machine, A wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallA 10-minute warm-up for any workout: raise your heart rate, move each joint through its range, rehearse the main movements, then ramp up to your first lift.
10 minBeginner12 movesA wall, A bandA 15-minute routine for lasting dizziness from an inner-ear problem: the vertigo guide's head and eye exercises, then balance at a counter and a short walk.
15 minBeginner7 movesA wall, Cardio machineEight gentle neck and shoulder stretches for desk stiffness, done standing or seated in ten minutes.
10 minBeginner8 movesA wallA 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentFor rebuilding your fitness once you're through the stages: the walking plan is the gentlest, and the couch to 5K plan's first weeks build up running slowly.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginnerEach sport page sets out its own concussion advice. Some governing bodies set longer minimums than the UK guidelines, some require medical clearance instead, and elite teams with specialist doctors follow their own protocols. Some governing bodies set later stages for riding (British Equestrian: riding not before day 21), and World Skate's competition rule allows a return after 14 days with medical clearance. GB Snowsport has its own protocol for its licensed athletes; other skiers and snowboarders follow the UK guidelines.
Rugby exercises with the evidence: the Activate warm-up as trialled, strength for tackling and sprinting, neck and shoulder work, and the concussion rules.
FootballFootball exercises with the evidence: FIFA's 11+ warm-up step by step, the Nordic and Copenhagen exercises that cut hamstring and groin injuries, and ACL tips.
BoxingBoxing training with the evidence: shadow and bag workouts, strength for punching power, hand and shoulder care, and the facts on sparring and concussion.
BasketballBasketball exercises with the evidence: a 10-minute warm-up linked with a third fewer ankle and knee injuries, ankle braces, ACL prevention and jump training.
CyclingStrength training for cyclists, with the evidence: heavy leg work that lifts power, jumps for bone density, bike fit and back pain, and mobility.
Skiing and snowboardingSki fitness with the evidence: a leg, balance and landing workout, a slope-top warm-up, how ACL tears happen, and the helmets and wrist guards that work.
American footballAmerican football workouts with the evidence: strength and speed, a warm-up, youth contact limits, heat acclimatisation, concussion rules and flag football.
Ice hockeyIce hockey training with the evidence: off-ice strength and jumps, a warm-up, body-checking ages, groin strains, neck guards, face shields and concussion rules.
Field hockeyField hockey workouts with the evidence: the tested Warming-up Hockey warm-up, a strength workout, hamstrings, ankles, backs, masks, goggles and concussion.
Horse ridingExercises for horse riders with the evidence: core and hip strength, back pain, falls, riding hats, body protectors, air jackets and concussion rules.
SkateboardingSkateboarding exercises with the evidence: helmets, wrist guards, how to fall, wrist and ankle injuries, a warm-up and a strength and landing workout.
SnowboardingSnowboarding exercises with the evidence: wrist guards and helmets, common injuries, a slope-top warm-up and a strength and landing workout for riders.
Mountain bikingMountain bike training with the evidence: strength, grip and interval workouts, crashes and broken collarbones, helmets, e-MTBs and concussion rules.
If you're told to go to A&E, don't drive yourself there after a head injury.
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Within 24 hours for any suspected concussion, and if, after a head injury, you:
Concussion can affect your mood. If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E. For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988. Headway, the brain injury charity, runs a nurse-led helpline on 0808 800 2244, Monday to Friday, 9am to 5pm.
Being knocked out happens in fewer than 1 in 10 concussions and isn't needed for a diagnosis. Watch for the other signs: a headache, dizziness, confusion, feeling "in a fog" or not feeling right.
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Experts agree that strict rest until all symptoms have gone isn't helpful. In one trial, young people told to rest strictly for 5 days reported more symptoms, and in adults 6 days of bed rest did no better than none. Rest for 24 to 48 hours, then build up: in trials of mostly teenagers and young athletes, light exercise helped people recover sooner.
The NHS says you or your child don't need to stay awake if you're tired. An adult should stay with you for the first 24 hours, and someone who can't stay awake or keep their eyes open needs 999.
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A mild, brief rise in symptoms (no more than 2 points out of 10, settling within an hour) doesn't delay recovery, and flare-ups with exercise are generally safe and short-lived. A bigger rise means stop and try again tomorrow at an easier level.
Symptoms can settle before the brain has recovered. That's why training with a risk of a knock to the head waits until you've had 14 days without symptoms at rest, and matches until day 21 at the earliest.
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Standard CT and MRI scans are normal in concussion. Your symptoms are the guide, and anyone with a suspected concussion should be assessed.
Children and teenagers may take longer to recover than adults and are more at risk from a second knock before they've recovered. They follow the same stages, school first, with no competition before day 21.
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In grassroots sport, the UK guidelines no longer expect a review by a doctor or healthcare professional to move through the stages. Call NHS 111 if you're not improving by 14 days, and see a GP if symptoms last beyond 28 days. Some sports' governing bodies have their own rules.
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After 24 to 48 hours of relative rest, you can start light exercise such as walking or a static bike for 10 to 15 minutes, even if you still have mild symptoms. Build up as long as your symptoms rise by no more than 2 points out of 10 and settle within an hour. Harder training waits until you're free of symptoms at rest, and anything with a risk of a knock to the head waits until you've had 14 days with no symptoms at rest.
Yes, gentle exercise is fine in the early stages if your symptoms are stable and only rise mildly: no more than 2 points out of 10, settling within an hour. If they rise more, or a new symptom starts, stop, rest and try again the next day at an easier level. Harder training and anything with a risk of a knock to the head wait until you're free of symptoms at rest.
Rest for the first 24 to 48 hours, then start moving. Strict rest until every symptom has gone doesn't help, and in one trial young people told to rest strictly for 5 days reported more symptoms. In trials, mostly in teenagers and young athletes, people who started light exercise early recovered a few days sooner.
Start with walking or a static bike at a pace where you can easily talk in short sentences, plus easy bodyweight moves such as sit-to-stands, wall push-ups and bridges. Once you're free of symptoms at rest, you can train harder and lift weights, with no risk of a knock to the head. Leave contact, heading and anything you could fall from until the later stages.
Easy at first: you should be able to speak in short sentences. If you use a heart rate monitor, the international consensus suggests up to about 55% of your maximum heart rate (220 minus your age) at first, then up to about 70%. Let your symptoms set the pace.
Not on the day, and not in a match before day 21, counting the day of the injury as day 0. Training with any risk of a knock to the head waits until you've had no symptoms at rest for 14 days, which is day 15 at the earliest. Some sports' governing bodies set longer minimums, some require medical clearance instead, and elite players follow their own protocols.
Most symptoms settle within 2 to 4 weeks, and about two-thirds of people are back to full sport by 28 days. Children, teenagers and young adults may take longer. Call NHS 111 if you're getting worse or not better by 14 days, and see a GP if symptoms last more than 28 days.
Usually within days. Start with short spells of reading or homework at home, then shorter days or extra breaks, then full days; a mild, brief rise in symptoms along the way is fine. Most young athletes are fully back to learning within 10 days. Get back to full-time school before full sport, and leave PE contact games until the sport stages allow them.
Build up in the same way: short blocks of work at home, then reduced hours with breaks and no hard physical work, then full time. After a mild brain injury, a little over half of people are back at work within a month, and most within 6 months. If you're not sure it's safe to go back, see a GP.
Not for at least 24 hours, and the NHS says not until you feel fully recovered. Lorry, bus and other commercial drivers need a healthcare professional's review first. You must tell the DVLA if you have a serious head injury, so ask your doctor if you're not sure.
Call 999 for being knocked out, getting drowsier, memory loss, increasing confusion, a fit, new weakness, numbness, double vision or trouble speaking, a severe or worsening headache, repeated vomiting, severe neck pain or clear fluid from the ears or nose. People on blood thinners, with a bleeding disorder or past brain surgery, or who were drunk at the time need urgent assessment too. Call NHS 111 if you're being sick or dizzy after a head injury.
Take them out of play at once, get them assessed within 24 hours by a healthcare professional or NHS 111, and don't leave them alone for the first 24 hours. They can sleep if they're tired, should keep screens to a minimum for 48 hours, and should avoid rough play for a few days. Tell the school and clubs, and follow the graduated return, school first.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
