Return to Learn and Return to Sport After Concussion

This is the part most commonly skipped, and it is the part the guidelines are most consistent about. A student returns to school before they return to sport, and a worker returns to meaningful duties before extra-curricular activity. Full-time school attendance comes before training, not alongside it.

Children should go back to school as soon as they can tolerate cognitive activity without symptoms flaring badly — even while still having some symptoms. Being absent from school for more than a week is generally not recommended. The evidence favours a supported return over waiting for a symptom-free day that may not come for weeks.

Temporary school accommodations do the work: part-time attendance to begin with, rest breaks, a reduced workload, and extra time in assessments. These are meant to be short-term scaffolding, tapering as tolerance improves, and are only extended if symptoms persist well beyond the usual course.

The old rule was to do nothing that produced any symptom at all. That is not current advice and it slowed people down. Light physical activity can generally begin between 24 and 48 hours after the injury, building gradually from low to moderate intensity.

A small increase in symptoms during activity — of the order of 20 per cent — is acceptable and does not mean harm is being done. What matters is what happens afterwards: a transient increase that settles within 24 hours is fine, while symptoms that are still up the next day mean the threshold was crossed and the next attempt should be a smaller step.

Australian codes use a graded loading progression of the same shape. Rugby Australia's Graduated Return to Play sets it out in six stages, with a minimum of 24 hours at each loading stage and a requirement that the previous stage was completed without a symptom flare. Australian football uses an equivalent graded loading program.

The rule across the codes is the same: if symptoms return or worsen during a stage, rest for at least 24 hours until they settle, then go back to the last stage completed without symptoms and build again from there. Severe or repeated symptom recurrence during the progression is a reason for medical review, not a reason to push through.

A progression that keeps failing at the same stage is telling you something, and it is usually one of three things — the diagnosis needs revisiting, an untreated contributor such as the neck or the vestibular system is driving symptoms, or the load is being increased faster than tolerance is recovering.

The ANZ Concussion Guidelines set a minimum of 21 days from injury before return to play, and note plainly that deferring return reduces the risk of a repeat concussion. Full return also requires being symptom-free across all activities, including school or work — not just symptom-free during exercise.

The codes have landed in different places, and it is worth knowing the rule that applies to you rather than assuming.

Two things stand out and are worth stating rather than glossing over. The first is that the adult rugby stand-down of 12 days sits below the 21-day minimum in the national clinical guideline. The second is that elite AFL retains a 12-day minimum on the basis that elite players are monitored in an advanced care setting, while community players — the same injury, far less oversight — are held to 21 days.

What follows from that is simple. A code's stand-down is a floor, not a target, and it is not a clearance. Meeting the minimum number of days does not mean a player is ready; it means they are no longer prohibited by the rule from being assessed as ready. The clinical decision is separate from the calendar, and where the two disagree, the clinical decision governs.

Both the AFL community guidelines and Rugby Australia require that a medical doctor — not a physiotherapist, not a coach, not a trainer — clears a player to return to full-contact training and competition. That requirement exists because the decision carries real consequences and needs someone able to reconsider the diagnosis.

A clearance consultation is an assessment, not paperwork. It covers the history of the injury and any previous concussions, current symptoms at rest and on exertion, a neurological and cervical spine examination, how the graded progression actually went rather than how it was meant to go, and how school or work has been tolerated. Where a player has had repeated concussions, or the recovery has been prolonged, the conversation about ongoing participation is part of it.

Clearance is documented for the club — Australian football clubs now manage this digitally through PlayHQ, and rugby uses the Concussion Referral and Return form. A rugby player who does not complete that form is excluded from contact indefinitely.