Published guidelines on return to play apply to simple concussions: (1) No return to play in the same 24-hour period as the concussion. (2) Graded, stepwise increases in activity guided by symptoms over approximately 6 to 10 days. (3) No difference in return to play for elite versus nonelite athletes. (4) Brief convulsions or posturing at the time of concussion does not indicate higher than normal risk of seizures and requires no specific management.
After 2 weeks in adults and 4 weeks in children, more rest is not likely to help. At that point, it is reasonable to start active interventions. For more complex concussions, discourage the patient from returning to contact sports until all of the following are true: The symptoms are all in the mild range or resolved, the collateral source verifies that the patient’s behavior is back to normal, the patient has been able to return to school or work (for nonprofessional athletes), balance is back to normal, and the patient passes a physical therapist-directed moderate exercise test. Many complex concussion patients will decide not to return to contact sports at all if their long-term well-being depends more on their work and interpersonal relationships than on their athletic performance.
Acute and recovery responses of serum IL-6 to one bout moderate exercise test in obese men