- Jeffrey Peng MD
- Mar 4
- 7 min read
By Dr. Jeffrey Peng, MD · Published March 5, 2026 · 8 min read
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Concussions are one of the most common injuries in sports, yet they remain surrounded by myths and misconceptions. Should you rest in a dark room for a week? When is it safe to look at your phone? Can you exercise, or will that make things worse? The answers to these questions have shifted dramatically based on recent research, and understanding the latest evidence can make a meaningful difference in your recovery.
In this guide, I break down the most important aspects of concussion management — from recognizing symptoms and identifying your clinical profile to practical strategies for activity, cognitive load, screen time, and sleep. Whether you are an athlete, a parent, or someone recovering from a recent head injury, this evidence-based approach can help you navigate your recovery with confidence.
What Is a Concussion?
A concussion falls under the category of mild traumatic brain injuries. It is defined as a trauma-induced temporary disruption of normal brain function. When a sudden impact occurs, the brain undergoes rapid acceleration followed by deceleration. Because the skull is a rigid structure, the brain can bounce around inside and become stretched or damaged. The end result is a complex cascade of metabolic changes that disrupt normal brain function. The 6th International Conference on Concussion in Sport held in Amsterdam in 2022 produced the most comprehensive and up-to-date consensus statement on sport-related concussion, emphasizing evidence-informed principles of prevention, assessment, and management.
What Are the Most Common Concussion Symptoms?
Researchers have compiled over twenty of the most common symptoms associated with concussions. These include headache, pressure in the head, neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light and noise, feeling slowed down or in a fog, difficulty concentrating and remembering, fatigue, confusion, drowsiness, increased emotionality, irritability, sadness, anxiety, and difficulty falling asleep.
Red flag symptoms that require immediate medical evaluation include loss of consciousness, a severe and worsening headache, persistent vomiting, and seizures. These can be indicative of more dangerous conditions such as intracranial hemorrhage, skull fracture, or serious neurological complications. Because there is considerable overlap between red flag symptoms and common concussion symptoms, concussion management should always be supervised by a qualified healthcare provider.
The Six Clinical Profiles of Concussion
The concussion symptoms listed above are part of the Sport Concussion Assessment Tool, a standardized form used by sports medicine physicians worldwide. After evaluating which symptoms are most severe, clinicians can categorize a concussion into six clinical profiles as outlined in the AMSSM position statement: cognitive, fatigue, anxiety and mood, headache and migraine, ocular, and vestibular.
There is significant overlap between these profiles, and most people with concussions will have symptoms spanning multiple categories. However, the most severe symptoms typically concentrate in one or two profiles, which helps guide targeted treatment.
Headache and Migraine Profile
In many cases, the force absorbed during an injury concentrates in the neck muscles, causing them to become extremely tight. This limits range of motion and triggers headaches and migraines. Treatment focuses on the neck muscles through stretches, self-massage, and soft tissue modalities to reduce tightness and improve range of motion.
Cognitive Profile
Those with cognitive involvement tend to have significant difficulties with concentration. These individuals usually need accommodations for school or work — often a letter from a healthcare provider is all that is needed. They also benefit from more frequent breaks and additional time to process information.
Vestibular and Ocular Profile
People with vestibular or ocular involvement experience difficulties with balance and reading. These patients can improve dramatically when given targeted balance exercises and eye training exercises prescribed by a specialist.
Anxiety and Mood Profile
Those with anxiety and mood symptoms benefit from maintaining social engagement and having extra support from friends and family. This is especially important for individuals who already experience anxiety or depression, as these symptoms tend to be magnified after a concussion. A strong social support system can help mitigate many of these symptoms.
Fatigue Profile
Individuals with the fatigue profile benefit from activity modification, stress reduction, and a slow graded exercise program. Prioritizing sleep and maintaining proper sleep hygiene is also essential for those with severe fatigue symptoms.
Grouping symptoms into clinical profiles allows clinicians to provide more individualized and targeted treatments, which can help reduce symptom severity and speed recovery.
Should You Rest or Exercise After a Concussion?
One of the biggest shifts in concussion management has been the approach to rest and physical activity. The old recommendation — sometimes called "cocooning" — was to stay in a dark room and avoid all activity for a week. A systematic review and meta-analysis published in the British Journal of Sports Medicine found that this strict rest approach is not beneficial and can actually slow recovery. In clinical trials, athletes randomized to strict rest reported more daily concussion symptoms and slower symptom resolution.
The current recommendation is relative rest — not strict rest — for the first two days after injury. This means you can perform most activities of daily living including showering, managing household tasks, and preparing meals. The key is to avoid complete inactivity.
When Can You Start Exercising?
The latest research suggests that light-intensity physical activity such as walking or stationary cycling can be beneficial during the first 24 to 48 hours after a concussion. Light physical activity has been shown to enhance concussion recovery. After the first 48 hours, a slow and graded aerobic exercise program can further help recovery and reduce the risk of symptoms persisting beyond one month.
However, there is a critical distinction: moderate to high-intensity physical activity in the first three days after a concussion has been shown to exacerbate symptoms and delay return to normal activity. You need to start low and go slow.
A Practical Approach to Early Exercise
In my practice, I typically recommend starting with an easy walk for about 15 to 20 minutes on day one or two. Some symptoms may increase slightly, but as long as the increase is mild and tolerable, it is safe to continue. If symptoms get severely worse, stop and rest. Try again later or the next day. Record how long you were able to exercise, and aim to match or slightly exceed that duration the following day. The goal is to gradually increase to 30 minutes of light physical activity.
The evidence is clear that incorporating light aerobic exercise within the limits of what your symptoms allow results in a faster time to recovery and a reduction in overall symptom severity. After day two, you can slowly advance your physical activity back to your previous baseline, always progressing only as symptoms permit.
How Should You Manage School, Work, and Screen Time After a Concussion?
Similar to the approach with exercise, it is essential to avoid pushing cognitive activity too hard too soon. Gradual progression is key. In the first 48 hours, this might mean attending classes or going to work for a half day instead of a full day. As symptoms allow, you can slowly increase the cognitive load. Some individuals may return to regular cognitive activities within a few days, while others may need one to two weeks or longer.
Open communication with your school or employer about necessary accommodations is crucial during recovery. If you encounter difficulties, a letter of support from your doctor can help advocate for the time and flexibility you need.
What About Screen Time?
Research indicates that excessive screen time in the first 48 hours can slow concussion recovery. I recommend reducing usual screen time within the first 48 hours after injury. Once this initial period has passed, the evidence becomes much less definitive. Further restriction is only warranted if screen use provokes severe symptoms.
Why Is Sleep So Important After a Concussion?
There is a common misconception that you should stay awake for 24 hours after head trauma or have someone wake you every hour. Recent evidence suggests that sleep disturbance soon after injury can actually impair concussion recovery. Studies indicate that poor quality sleep and reduced total sleep time are associated with increased concussion symptoms the following day. Maintaining proper sleep hygiene and maximizing rest are essential components of concussion recovery.
When Is It Safe to Return to Sports After a Concussion?
Returning to sports before concussion resolution is dangerous. Research shows that athletes who return prematurely have a higher risk of repeat concussions and elevated rates of musculoskeletal injuries ranging from ankle sprains to meniscus tears and ACL tears. Every concussion is different, and a personalized treatment plan based on your concussion profile can help reduce symptom severity and expedite recovery. Talk to your healthcare provider about the best plan for your situation.
If you are dealing with a concussion or have concerns about a recent head injury, schedule a consultation to discuss a personalized recovery plan.
References
1. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695-711. doi:10.1136/bjsports-2023-106898
2. Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019;53(4):213-225. doi:10.1136/bjsports-2018-100338
3. Leddy JJ, Burma JS, Toomey CM, et al. Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. Br J Sports Med. 2023;57(12):762-770. doi:10.1136/bjsports-2022-106676
4. C Herman D, Zaremski JL, Vincent HK, Vincent KR. Effect of neurocognition and concussion on musculoskeletal injury risk. Curr Sports Med Rep. 2015;14(3):194-199. doi:10.1249/JSR.0000000000000157
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.