Des Moines University Clinic, Physical Therapy and Concussion Management and Rehabilitation

Returning to Physical Activity After a Concussion

While concussions are often considered a sports injury, they can occur any time a force acts upon the head. Avoiding physical or mental exertion has historically been the prescribed treatment plan for individuals recovering from a concussion, but research has shown that complete rest following a concussion can lead to more symptoms up to a month after receiving a concussion. National guidelines that clinics follow recommend a graded return-to-activity program when recovering from a concussion. Today, we’ll go over a return-to-activity program for non-athletes, in addition to the return-to-play protocol for athletes.


Returning to Activity for Non-Athletes

Initial Rest

Early on, relative rest is the most important thing to focus on—with the key word being relative. During this time, anything that triggers symptoms should be avoided, but what triggers symptoms can vary from person to person. This includes mental and physical activity triggers. Some examples of mental triggers are listening to music and anything that involves a screen (video games, tv, phone, etc.). Physical triggers include common daily activities such as doing household chores. Initial rest includes staying home from work or school and typically lasts 24-48 hours.

Light Activity

This phase involves slow progression and incorporation of more physical and mental activities. In this phase, activities that bring on symptoms should be minimized. However, individuals can do activities that require some mental exertion until symptoms are brought on. For example, if someone can read for 15 minutes before their symptoms are brought on, they can still read but should take a break once they reach their limit. In this phase, light physical activity can be incorporated using the same approach of letting symptoms guide the duration of activity. A modified work or school schedule can also be incorporated, such as taking more frequent breaks or shortened days.  

Moderate Activity

During this phase, symptoms should be nearly gone but could still occur. Therefore, it is important to continue to let symptoms guide the duration of activities and to not push through them. Activities can be added gradually towards a normal school or work schedule as the individual is able to tolerate them.  

Full Activity

At this final stage, individuals will be able to return to a full day of school or work without experiencing symptoms. While most people fully recover in two or three weeks, reaching this stage could take a few months for some individuals. Baseline testing is advised to assess your child’s balance, memory, concentration, coordination, reaction time, and more moving forward after a concussion.


Returning to Sports and Physical Activities

For a student who wants to return to playing sports, the state of Iowa has specific instructions that must be followed to ensure the student’s safety. This protocol involves following a six-step process with possible activities at each stage, outlined below:

  • Stage 1: Symptom-limited activity (daily activity)
  • Stage 2: Light aerobic exercise (walking, cycling)
  • Stage 3: Sport-specific exercise (running drills)
  • Stage 4: Non-contact drills (more advanced skills, such as throwing, kicking, resistance training)
  • Stage 5: Full contact practice (full practice, not yet cleared for competition)
  • Stage 6: Return to play (full clearance)

With Stages 1-5 students must be symptom-free for 24 hours after participating in activities that correspond with the stage before moving to the next stage. If they have any symptoms, they return to the previous stage. For example, if a student-athlete experiences symptoms with running drills in Stage 3, then they would return and complete Stage 2 again. If they do not have symptoms for 24 hours after completing running drills, they can progress to Stage 4. A licensed health care provider with concussion management training can help make sure a student safely completes the protocol, and written clearance is required before the student can return to play. Our experts at the DMU Clinic and the MidAmerican Energy RecPlex will guide you through this process and provide exceptional care.


The physical therapists at the Des Moines University Clinic have been trained in concussion management, sports and vestibular therapy. They collaborate with other health care providers in the Des Moines area for concussion management. The DMU Clinic can help make sure a student safely completes the protocol and provide written clearance so the student can return to play. We are currently offering in-clinic and virtual appointments for patients. Visit the DMU Clinic website or call 515-271-1717 to learn more.

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