Concussion Rehab Is In, Rest Is Out

If you have been told to sit in a dark room until you feel normal, you are not alone. For years, complete rest was the default advice after concussion. The evidence has moved on. Today, the debate is really concussion rehab vs rest: brief rest when symptoms flare, then structured, symptom-limited activity under guidance. That is what we practise at Heads Up in Subiaco.

Rest is not the enemy. Unsupervised weeks of shutdown are. This article explains why, what safe activity looks like, and when to book so you are not guessing from week to week.

Why complete rest used to be standard

Concussion is a brain injury. It made sense to protect the brain by removing stimulation. Cocoon therapy (dark room, no screens, no exercise) was common. The problem is that many people were told to stay there for days or weeks without review, even when symptoms were stable.

We now know that prolonged isolation can increase anxiety, low mood, and fear of activity. Fitness and tolerance drop quickly. Returning to school, work, or sport becomes harder, not easier. Current Australian sport and community guidance supports graduated return once acute red flags are ruled out. See our first 48 hours guide for early self-care, then read on for what comes next.

When too much rest slows recovery

Complete rest beyond the first day or two is not recommended for most concussions unless your clinician advises it for a specific reason. Problems we see when rest is overdone include:

• Increased worry and symptom focus (sometimes called the nocebo effect: expecting to feel worse can make you feel worse)
• Low mood and social isolation, especially when sport, study, or work stops suddenly
• Deconditioning: heart rate, fitness, and confidence fall within days
• Harder return to exercise because the body is unaccustomed to load

None of this means you should push through sharp symptoms. It means there is a middle path between “ignore it” and “do nothing for a fortnight.”

What concussion rehabilitation actually means

Rehab is not “back to full training on day three.” It is a monitored plan that may include:

• Clinical assessment and symptom tracking
• Sub-symptom threshold aerobic exercise (walking, bike, or treadmill progressions)
• Neck treatment when whiplash or cervical drivers are present
• Vestibular rehabilitation for dizziness, balance, or visual symptoms
• Graduated return to study, work, and return to sport with clear criteria

We are a Complete Concussions certified clinic. Protocols align with international standards and the Australian Institute of Sport concussion guidelines for community and youth sport.

Research including Leddy et al. (2019, JAMA Pediatrics) supports early sub-symptom aerobic exercise in many sport-related concussions when supervised appropriately. Your plan still depends on your history, symptoms, and medical advice.

Can you exercise after a concussion?

Often, yes, and sooner than many people expect. Many can start light, symptom-limited activity within 24 to 48 hours if symptoms allow and red flags are absent. That might be a short indoor walk, not a gym session or contact training.

Rules that keep it safe:

• Stay below the level that clearly worsens your symptoms during or after activity
• No contact sport or risk of another head knock until cleared through a graduated protocol
• Increase load step by step with review, not all at once
• Stop and seek review if symptoms spike or new red flags appear

At concussion assessment, we set your starting point. Where appropriate, we use graded treadmill or bike testing (including Buffalo-style protocols) within the first week to find your exertion ceiling. If symptoms persist, we coordinate post-concussion syndrome rehabilitation rather than repeating “just rest more.”

How we guide rehab at Heads Up

Typical elements of care with us:

• Initial appointment ($139, in person or telehealth) to map symptoms and goals
• Relative rest only when symptoms demand it, not as a default week-long strategy
• Sub-symptom exercise prescription with clear stop rules
• Cervical and vestibular treatment within the first 1 to 2 weeks when indicated
• Return-to-learn and return-to-sport stages with criteria, not calendar clearance

Recovery is not identical for everyone. If your teammate was back in five days and you are not, that is a clinical signal, not a failure. See why personalised concussion recovery matters.

Ready for a plan you can follow? Book an appointment at our Subiaco clinic or read more about Jimmy Milligan and the team.