A concussion can come from a hockey check, a slip on an icy Vaughan driveway, a rear-end collision or a cupboard door at the wrong height. However it happens, the days afterwards are usually confusing. You may feel foggy, headachy and tired, and the advice you find online contradicts itself: rest completely, or keep moving; avoid screens, or carry on as normal.
The good news is that the evidence has become much clearer over the last decade, and most people recover fully within a few weeks. This article sets out what is currently recommended, how to judge how much is too much, how a return to work, school and sport is structured, and what helps when symptoms linger.
What a concussion is
A concussion is a mild traumatic brain injury caused by a force to the head, or to the body that is transmitted to the head, which briefly disrupts how the brain functions. You do not have to be knocked out to have one; most concussions happen without any loss of consciousness.
The injury is functional rather than structural. Brain scans are usually normal because the problem is a temporary disturbance of how brain cells work and communicate, not visible damage. That is why concussion is diagnosed clinically, from the history and the symptoms, rather than from imaging. A CT scan is used when there are signs that something more serious, such as bleeding, might be present.
Common symptoms
Symptoms can appear immediately or develop over the first day or two. They vary widely from person to person, which is part of why concussion is easy to underestimate.
- Headache or a feeling of pressure in the head.
- Dizziness, balance problems or feeling off-kilter.
- Nausea, sometimes vomiting early on.
- Feeling foggy, slowed down or 'not right'.
- Difficulty concentrating or remembering.
- Sensitivity to light or noise.
- Fatigue, drowsiness or trouble sleeping.
- Irritability, anxiety or feeling more emotional than usual.
- Neck pain, which often accompanies the injury.
Red flags: go to emergency
Anyone with a suspected concussion should be watched closely for the first several hours. Call 911 or go to an emergency department straight away if any of the following appear. These can be signs of bleeding or swelling inside the skull, which needs immediate treatment.
- A headache that is severe or steadily worsening.
- Repeated vomiting.
- A seizure or convulsion.
- Increasing confusion, drowsiness or difficulty waking.
- Weakness, numbness or tingling in the arms or legs.
- Double vision or slurred speech.
- Severe neck pain or tenderness.
- Loss of consciousness, or unusual behaviour such as agitation or combativeness.
Why strict rest is out of date
For years, the standard advice was cocoon therapy: lie in a dark, quiet room with no screens, reading or activity until every symptom had gone. Research has since shown that this approach does not help and can actually prolong symptoms. Prolonged inactivity leads to deconditioning, poor sleep, low mood and social isolation, all of which make you feel worse.
Current international guidance recommends relative rest for the first 24 to 48 hours — reducing demanding activity and screen time, but not lying in bed all day — followed by a gradual return to normal life. Light physical activity such as walking or an easy stationary bike, at an intensity that does not make symptoms significantly worse, is now actively encouraged within the first few days. People who begin light aerobic activity early tend to recover faster than those who rest completely.
How to judge 'too much'
A useful rule of thumb is that a mild increase in symptoms during an activity is acceptable, as long as it is small and settles within about an hour. If you rate your symptoms out of ten, an increase of no more than two points that eases quickly suggests the level was about right.
If symptoms jump sharply, or are still worse the next morning, you did too much. That is not a disaster and does not mean you have set yourself back — it simply means scaling back to the previous level for a day or two before trying again. Recovery is rarely a straight line, and a bad day does not undo the progress.
| What happens | What it means | What to do |
|---|---|---|
| No change or a 1–2 point rise that settles within an hour | Level is tolerable | Continue, and progress gradually |
| Rise of more than 2 points during activity | Too demanding right now | Stop, rest, and retry at a lower level |
| Symptoms worse the next morning | Overloaded the day before | Drop back a step for 24–48 hours |
| Any red flag symptom | Possible serious injury | Seek emergency care |
Returning to work and school
Cognitive activity follows the same principle as physical activity: gradually increase it while keeping symptoms in check. Many people benefit from a short break from work or school, often a few days, followed by reduced hours or adjusted duties. Frequent breaks, larger font sizes, reduced screen brightness and a quieter workspace can all help in the early phase.
Children and teenagers should return to school before returning to full sport. Missing extended periods of school creates its own stress and isolation, and most students can return within a few days with temporary accommodations such as reduced workload, extra time for tests and rest breaks. Communication between parents, teachers and the treating clinician makes this much smoother.
Return to sport, step by step
Return to sport follows a staged plan, each stage lasting at least 24 hours, and moving on only if symptoms do not significantly worsen. In Ontario, Rowan's Law requires organised sports to have removal-from-sport and return-to-sport protocols, so that an athlete with a suspected concussion is taken out of play and does not return until it is safe.
Full contact practice and game play should only resume after medical clearance. Returning to contact too early risks a second concussion before the first has healed, which can mean a much longer recovery and, rarely, serious complications in younger athletes.
- Stage 1 — symptom-limited daily activity: normal daily life that does not provoke symptoms.
- Stage 2 — light aerobic exercise: walking or stationary cycling, building to moderate effort.
- Stage 3 — sport-specific exercise: running or skating drills, no head-impact activities.
- Stage 4 — non-contact training drills: harder drills, resistance training.
- Stage 5 — full contact practice, after medical clearance.
- Stage 6 — return to game play.
When symptoms last longer than a month
Around one in five to one in three people still have symptoms a month or more after a concussion. These persisting symptoms rarely mean ongoing brain damage. More often, they reflect one or more treatable systems that were disturbed by the injury and have not fully recovered.
The neck is a frequent contributor. The same force that causes a concussion often strains the neck, and a neck injury can produce headache, dizziness and difficulty concentrating that look very much like concussion symptoms. The vestibular system — the inner ear and the brain's balance processing — is another common source of ongoing dizziness, visual motion sensitivity and unsteadiness. Exercise intolerance, where your heart rate climbs and symptoms flare with modest exertion, is a third.
Sleep disturbance, anxiety and low mood are common after concussion and can sustain the other symptoms. These deserve attention in their own right, often in partnership with your physician.
What concussion rehabilitation involves
Physiotherapy for persistent concussion symptoms starts with an assessment that tries to identify which systems are involved. That usually includes a neck examination, balance and gait testing, eye movement and gaze stability tests, and sometimes a graded exercise test on a treadmill or bike to find the heart rate at which symptoms begin.
Treatment is then targeted. Neck-related symptoms are treated with manual therapy and neck exercise. Vestibular symptoms respond to vestibular rehabilitation, a structured set of eye, head and balance exercises that retrain the brain. Exercise intolerance is treated with a sub-symptom-threshold aerobic programme, where you exercise just below the heart rate that triggers symptoms and gradually push that threshold upward. Education and a structured plan for pacing daily life tie it together.
Concussion care in Woodbridge and Vaughan
At Med Wellness on Ansley Grove Road, our physiotherapists assess and treat concussion and the persistent symptoms that can follow it, including neck pain, dizziness and exercise intolerance. We screen first for anything that needs a physician, build a graded plan for returning to work, school and sport, and liaise with your doctor for clearance where it is needed.
No referral is needed to book physiotherapy in Ontario, and concussion rehabilitation is covered by most extended health plans and by auto insurance after a motor vehicle collision. Call +1 (905) 605-8889 to book, and if any emergency signs are present, go to the hospital first.
References
Written by Paramjeet Kaur Bassi, Registered Physiotherapist · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
