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Concussion Management

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

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

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

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

More severe forms of brain injury may be mistaken for concussion. If ANY of the following symptoms are observed or reported within 48 hours of an injury, then you should be taken for urgent medical assessment at the nearest hospital. Call 911. Activate your emergency action plan.

  • Severe neck pain
  • Deteriorating consciousness (more drowsy)
  • Increasing confusion or irritability
  • Severe or increasing headache
  • Repeated vomiting
  • Unusual behaviour change (persistent irritability in younger children; increased agitation in teens)
  • Seizure
  • Double vision
  • Weakness or tingling / burning in arms or legs

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.

Anyone with a suspected concussion should NOT:

  • Be left alone in the first 24 hours
  • Consume alcohol in the first 24 hours, and thereafter should avoid alcohol until free of all concussion symptoms
  • Drive a motor vehicle and should not return to driving until provided with medical or healthcare professional clearance

Once safely removed from play the player must not be returned to activity that day.
(Canada Soccer Concussion Guidelines, page 8)

More severe forms of brain injury may be mistaken for concussion. If ANY of the following symptoms are observed or reported within 48 hours of an injury, then you should be taken for urgent medical assessment at the nearest hospital. Call 911. Activate your emergency action plan.
  • Severe neck pain
  • Deteriorating consciousness (more drowsy)
  • Increasing confusion or irritability
  • Severe or increasing headache
  • Repeated vomiting
  • Unusual behaviour change (persistent irritability in younger children; increased agitation in teens)
  • Seizure
  • Double vision
  • Weakness or tingling / burning in arms or legs

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.

Anyone with a suspected concussion should NOT:

  • Be left alone in the first 24 hours
  • Consume alcohol in the first 24 hours, and thereafter should avoid alcohol until free of all concussion symptoms
  • Drive a motor vehicle and should not return to driving until provided with medical or healthcare professional clearance

Once safely removed from play the player must not be returned to activity that day.
(Canada Soccer Concussion Guidelines, page 8)

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 or nurse practitioner
◦  Specialized sports medicine or concussion clinic
◦  Multidisciplinary rehabilitation service


There are smartphone apps available to help with concussion management, including symptom monitoring and return to activity, such as:
Concussion Ed App (iOS and Android) >

The First Week – Concussion 101 Primer

(click to view full infographic)

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

TOO SLOW GETTING BACK TO SCHOOL

  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • 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

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

TOO SLOW GETTING BACK TO SCHOOL

  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • 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/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.

Holland Bloorview Kid’s Rehabilitation Hospital
The Ontario Neurotrauma Foundation

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:

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

Parachute Canada
Concussion Awareness Training Tool

Parachute Canada guidelines provide steps to return to school, physical activity and sports following concussion. If you are having ongoing symptoms, consult your doctor before starting these steps:

The Concussion Awareness Training Tool (CATT) provides resources to guide return to school and return to sport and physical activity:

Resources for Children/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.

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

The Ontario Neurotrauma Foundation Guidelines for Diagnosing and Managing Pediatric concussion also provides comprehensive guidelines that are particularly useful for health professionals:
Living Guideline for diagnosing and managing pediatric concussion – Section B: Managing Concussion Symptoms >

Parachute Canada

Parachute Canada guidelines provide steps to return to school, physical activity and sports following concussion. If you are having ongoing symptoms, consult your doctor before starting these steps:
Parachute Return to School >
Parachute Return to Sport Strategy >

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

TOO SLOW GETTING BACK TO WORK

  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • Risk of social isolation
  • May reduce confidence
  • Second guessing/dwelling on symptoms
  • Financial worries
  • Stress, anxiety and mood problems may increase

For adults who are stay at home parents or retired, a gradual return to normal activities and housework is best.

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

TOO SLOW GETTING BACK TO WORK

  • Symptoms may get worse
  • Rate of recovery may slow
  • May be overwhelmed
  • Stress, anxiety and mood problems may increase
  • Risk of social isolation
  • May reduce confidence
  • Second guessing/dwelling on symptoms
  • Financial worries
  • Stress, anxiety and mood problems may increase

For adults who are stay at home parents or retired, a gradual return to normal activities and housework is best.

Resources for Adults

Concussion Awareness Training Tool
The Ontario Neurotrauma Foundation
Acute Concussion Evaluation

Guideline for concussion/mild traumatic brain injury and prolonged symptoms 3rd edition for adults over 18 years of age:

The ACE form provides information about return to work and play for adults. The ACE Care Plan is for health professionals to give to adults after a concussion has been identified:

Resources for Adults

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 Awareness Training Tool
The Ontario Neurotrauma Foundation

Guideline for concussion/mild traumatic brain injury and prolonged symptoms 3rd edition for adults over 18 years of age: Acute Concussion Evaluation (ACE) Care Plan >

Acute Concussion Evaluation

The ACE form provides information about return to work and play for adults. The ACE Care Plan is for health professionals to give to adults after a concussion has been identified: Patient Version >