After a concussion — return-to-sport timeline (Seremban & Nilai)

Old guidance said rest in a dark room for days. Current international consensus has moved on: 24–48 hours of relative rest (no sport, no screens for long periods, no alcohol, no heavy cognitive load), then a gradual return to light activity is better than extended bed rest. What helps in the first 48 hours: sleep, hydration, paracetamol (not ibuprofen or aspirin in the first 48 hours in case of intracranial bleed), light meals, and someone checking on you every few hours for the first night. Symptoms to monitor: headache, nausea, dizziness, light or noise sensitivity, difficulty concentrating, memory fog, sleep disturbance, mood change. Score them morning and evening — this gives us data for progression decisions later. What does NOT help: prolonged total rest (more than 48 hours often makes symptoms worse), returning to training the next day, self-medicating with ibuprofen, alcohol, driving, or late-night screen time. Most Nilai university students and Seremban school-team athletes start feeling better within 3–5 days. If you are 10 days in and symptoms are not improving, we move to the post-concussion rehab pathway — which is different from the graduated return-to-sport programme described below.

Once symptoms have been settling for at least 24 hours, we start the 6-stage return-to-sport protocol. Minimum 24 hours per stage, and you only progress if that stage has not triggered or worsened any concussion symptom. Any symptom return means drop back one stage for at least 24 hours. Stage 1 — symptom-limited activities of daily living: light housework, short walks, gentle stretching. Keep phone and screen use brief. Stage 2 — light aerobic exercise: stationary cycle or walk on a flat loop at Taman Tasik Seremban at up to 70% of max heart rate, 10–15 minutes. No resistance training. Stage 3 — sport-specific exercise: running drills, gentle skill work (e.g. dribbling a futsal ball, light bag work). No impact drills, no heading, no contact. Stage 4 — non-contact training drills: progression of sport drills with a full training session's worth of cognitive load, plus resistance training. Still no contact, no scrums, no sparring. Stage 5 — full-contact practice: normal training activities with medical clearance to take and give contact. Cleared to return to contact by the doctor or physio following you. Stage 6 — return to competition (match, fight, race). Fastest possible timeline for an uncomplicated concussion is about 7 days in adults. For under-18s the consensus is a longer return — minimum 14 days symptom-free before resuming contact, and often longer. Nilai university students and Seremban school-team athletes almost never fall into the fastest-possible bucket.

Return to school or work runs in parallel with the sport protocol — not after it. Most concussed students and office workers need 1–2 weeks of partial school or office attendance before full cognitive load is tolerated. Principles we use with Nilai university students, Seremban school-team athletes, and daily Seremban–KL commuters: (1) Start with half-days, finish by lunch; gradually extend to full days as symptoms allow. (2) Breaks of 10–15 minutes every 45–60 minutes of study or screen-based work. If headache or fog appears, the next break is mandatory, not optional. (3) Avoid high-stakes exams and deadline-heavy work for the first 7–10 days. Teaching staff at INTI University and Nilai University usually cooperate with a short medical letter requesting deadline extensions. (4) No driving until you are clean on reaction time and cognitive load for at least 24 hours. For daily Seremban–KL PLUS commuters we usually sign off driving at the same checkpoint as stage 2–3 of the sport protocol. (5) Limit late-night screens, social media scrolling, and alcohol for the full symptom-free period — these often cause symptom rebound. If symptoms persist beyond 2–4 weeks we move to post-concussion rehab: supervised sub-symptom aerobic work (Buffalo Treadmill Test-style progression), cervical-origin symptom screening, and vestibular rehabilitation for dizziness — see our vestibular blog post for more detail.

Most concussions recover well, but a small number hide a more serious brain injury. Please go to Hospital Tuanku Ja'afar (HTJ) A&E immediately — do not wait, do not self-drive — if any of the following develop within the first 48–72 hours: (1) severe or worsening headache, especially if not responding to paracetamol; (2) repeated vomiting — more than 2 episodes after the injury; (3) seizure or loss of consciousness after the initial impact, even briefly; (4) weakness, numbness, or coordination loss in any limb, slurred speech, facial droop, or new visual disturbance; (5) confusion that is getting worse, not better; inability to recognise people or place; unusual drowsiness or difficulty waking; (6) clear fluid or blood from nose or ears, bruising behind the ears or around the eyes (raccoon eyes); (7) any neck pain with pins and needles in the arms or hands — the cervical spine may have been injured along with the head. Children and adolescents, anyone on blood-thinners (warfarin, DOACs), pregnant women, and anyone who had a loss of consciousness of any duration should get a same-day medical review even without red flags — do not wait for symptoms to worsen. For routine questions — progressing through stages, symptom tracking, school letters, training volume — WhatsApp your Seremban physio team between visits.