Returning to sport after a concussion follows a stepwise protocol, not a calendar. Push it and you risk a second injury that takes far longer to heal.
Direct answer: The concussion return-to-sport protocol is a six-stage progression — from rest through to full contact — and each stage has to be symptom-free before you move up. Under the published guidelines the minimum is roughly one week, but most athletes I see realistically need two to four. A physiotherapist checks your readiness at every stage and adjusts the plan around the symptoms you still have.
What is the return-to-sport protocol and where does it come from?
The protocol most physiotherapists work from comes out of the Concussion in Sport Group (CISG) consensus statement, last updated in 2023. It splits recovery into six stages, from symptom-limited rest up to full unrestricted play.
Here is the reason it is built that way. After a concussion the brain goes through a window of metabolic vulnerability. Loading it poorly without a plan — physically or cognitively — before that window closes can worsen symptoms, drag out recovery, and in rare cases set up second-impact syndrome, where a second concussion lands before the first has cleared. That second hit can be catastrophic. It is the whole reason the stages exist.
Working through that progression with someone watching your symptoms is the point of a proper concussion management programme, and it is what we do at our South Granville and False Creek clinics.
Every athlete who comes through our doors receives a comprehensive assessment and education on a safe return to sport, work, and school. We guide you through a gradual, symptom-limited progression, starting with simple daily activities and slowly increasing your level of activity as your recovery allows. When you’re ready, we’ll perform a treadmill test to assess your tolerance for more vigorous exercise and help determine your readiness to progress. Each stage of your return to activity, work, and school is guided by your symptoms, ensuring you can safely advance without exacerbating your concussion symptoms.
What are the six stages?
Stage 1 — Symptom-limited activity. Rest until symptoms settle toward baseline. That is not weeks of lying in a dark room. The current evidence backs light physical and cognitive activity as long as it does not provoke symptoms. You are settling things down, not shutting down.
Stage 2 — Light aerobic exercise. Walking, swimming, or a stationary bike at low intensity. No resistance work yet. Heart rate stays well under the level that brings symptoms on. Keep it short — 10 to 15 minutes is plenty to start.
Stage 3 — Sport-specific exercise. Running drills, skating patterns, ball handling — movement that looks like your sport, with no contact or collision risk. Coordination and effort go up; the chance of a head impact stays at zero.
Stage 4 — Non-contact training drills. Harder drills, full practice minus the body contact, resistance training back in. The cognitive load jumps here, and this is often where an athlete who felt fine finds out they are not.
Stage 5 — Full-contact practice. Medical clearance comes before this stage, not after. The athlete goes back to normal training with contact. This is the real test: can they play at their level with no symptoms creeping back?
Stage 6 — Return to competition. Normal game play.
Each stage needs at least 24 hours of symptom-free activity before you move up. If symptoms come back, you drop a level and wait another 24 hours before trying again.
Clinical example: We recently worked with an athlete who progressed through the first three stages without any issues and felt ready to return to full team practice. During Stage 4, which involved more complex drills and higher cognitive demands, they developed a mild headache and noticed increased mental fatigue later that evening. Rather than pushing through, we had them return to Stage 3 for another 24 hours before gradually progressing again. The second time through, they completed each stage without symptoms and returned to full competition the following week. This is a common part of concussion recovery — it doesn’t mean you’ve gone backwards or failed. Instead, it’s valuable information that tells us your brain needed a little more time before it was ready to tolerate the next level of physical and cognitive demand.
How long does return-to-sport actually take?
No one can give you an honest number without assessing you first.
Where the symptoms clear in the first day or two, the guidelines put the protocol minimum at about six days — one day per stage. That is the floor, not the average. In practice most adult recreational athletes I work with land in the two-to-three-week range. Athletes under 18 generally take longer and need more conservative handling.
A few things reliably slow it down: a history of prior concussions, pre-existing migraine or anxiety, sitting on the injury before resting it, and loading too hard too soon while symptoms were still active.
In our experience at the clinic, most adults with uncomplicated concussions are able to return to full sport within three to four weeks when they begin appropriate management early and follow a structured, symptom-guided progression. We also see athletes who recover much more quickly, as well as those whose symptoms persist for several weeks or months. Recovery timelines vary considerably, which is why we focus on treating the individual rather than trying to fit everyone into the same schedule. Where symptoms are still driving dizziness or balance trouble, vestibular rehabilitation often runs alongside the return-to-sport stages.
Does a physiotherapist clear you for return-to-sport, or does a doctor?
In BC it can be either, depending on the situation. For most recreational athletes, a physiotherapist with concussion training can run the whole protocol and sign off on return-to-sport. For youth in organised sport, a lot of associations and school boards also want a physician or nurse practitioner to put their name on the clearance.
If your concussion came from a motor vehicle accident and you are claiming through ICBC, the paperwork is different — a physician is usually on the care team from day one.
At our clinic, we are able to assess your recovery, guide you through the return-to-sport protocol, and provide clearance to return to activity in most cases. If your family physician, sports medicine physician, or another member of your healthcare team has requested that they provide the final clearance, we coordinate with them throughout your recovery. Some sports organizations, leagues, or governing bodies — such as Hockey Canada — also require medical clearance from a physician before an athlete can return to full contact or competition. For youth athletes, we work closely with families to ensure all medical and organizational clearance requirements are met before returning to play.
Return-to-sport assessment is a standard part of how we manage concussions here — built into the care, not billed as an extra. It sits within our wider sports physiotherapy service.
What symptoms should stop a return-to-sport attempt?
If a symptom that showed up during the acute phase comes back during exertion, stop. The ones I see most often:
- Headache or head pressure that was not there before you started
- Nausea or dizziness
- Visual disturbances or light sensitivity
- Fog or trouble concentrating that gets worse as the session goes on
- Balance problems
Plain exercise fatigue — tired legs, heavy breathing, nothing neurological — is not the same thing and does not automatically mean stop. Telling the two apart is exactly the judgement a clinician is there to make with you. If you are not sure which symptoms belong to the injury in the first place, our guide to concussion symptoms walks through them.
If you are still experiencing symptoms at rest and wondering whether to push through, read when to see a physiotherapist after a concussion first — the timing of your initial assessment matters more than most athletes realise.
Does the protocol differ for youth athletes?
Yes. The CISG calls for a more conservative approach under 18. A developing brain takes longer to recover, and feeling symptom-free is not the same as being fully recovered neurologically. A lot of youth programmes in Vancouver now run return-to-learn alongside return-to-sport — get the academic accommodations sorted first, clear them for sport second.
At Envision, we regularly assess and treat youth athletes with concussions from a wide variety of sports. Our approach prioritizes a safe return to both school and sport, recognizing that academic demands are just as important as athletic ones during recovery. Our physios, Marcus, Taylor, and Erin have all completed their Complete Concussions Certification, providing advanced training in evidence-based concussion assessment and management. We tailor each athlete’s recovery plan to their age, symptoms, school demands, and sport, and work closely with families, schools, coaches, physicians, and other healthcare providers when needed to ensure a safe and successful return to normal activities.
Where a team or athlete wants pre-injury numbers on file before the season starts, that is what baseline concussion testing is for.
Frequently asked questions
Can I exercise at all after a concussion?
Yes. The current guidelines deliberately move away from total rest. Light, symptom-free activity in the first day or two is safe and may even help recovery. The word that matters is symptom-free — if something brings your symptoms on, ease off or stop.
What if my symptoms come back during the protocol?
Drop back a stage and wait at least 24 hours symptom-free before trying again. One setback does not send you back to Stage 1 unless the symptoms are significant or you are stacking up multiple setbacks close together. That call is one your physiotherapist makes with you.
Do I need a doctor’s note to start physiotherapy for a concussion?
No. In BC, physiotherapists are direct-access primary care providers, so you can book an assessment without a GP referral. If the concussion came from a motor vehicle accident and you are filing an ICBC claim, contact ICBC first so you understand your coverage and reporting requirements.
How is a concussion baseline test used in return-to-sport?
A baseline test, usually done pre-season, gives the clinician your pre-injury numbers for reaction time, balance, and cognitive function. Clearance then compares your post-concussion scores against your own baseline rather than a population average. At Envision, we offer pre-season baseline concussion testing for teams and athletes. Our physiotherapists use the Complete Concussions software as part of a comprehensive baseline assessment, which includes symptom evaluation, cognitive screening, balance testing, and neurological examination. If an athlete sustains a concussion during the season, these baseline results can provide valuable context alongside the clinical assessment to help guide recovery and return-to-sport decisions. While baseline testing is a useful tool, it is only one part of the overall assessment and should always be interpreted alongside the athlete’s symptoms and clinical presentation.
How long does the return-to-sport protocol take?
Where symptoms clear in the first day or two, the guidelines put the protocol minimum at about six days — one day per stage. That is the floor, not the average. In our experience most adults with uncomplicated concussions return to full sport within three to four weeks when they begin appropriate management early and follow a structured, symptom-guided progression. Athletes under 18 generally take longer and need more conservative handling.
About the author
Marcus Dusseault is a registered physiotherapist at Envision Physiotherapy in Vancouver with a special interest in sports injury rehabilitation, concussion management, and return-to-sport. He has provided on-site physiotherapy coverage at multiple tennis and squash tournaments at the Vancouver Lawn Tennis & Badminton Club, as well as basketball and volleyball events at KitsFest in Vancouver. Marcus has completed advanced training in concussion assessment and management through Complete Concussions and is certified in Intramuscular Stimulation (IMS) through Foundations Health Education. His treatment approach combines hands-on manual therapy, IMS, individualized exercise prescription, and evidence-based rehabilitation to help patients recover from injury and return to the activities they enjoy.
Concussion recovery is not a guessing game. Book a return-to-sport assessment and we will build the progression around your symptoms — not a calendar.
Both clinics — South Granville (604-737-7309) and False Creek / Olympic Village (604-876-2344) — see concussion patients weekly. No referral needed. If you are not sure which stage you are at, get in touch and ask.
This article is written for educational purposes and does not replace individual medical advice. If you suspect a serious head injury, go to the nearest emergency department.