Concussion Management: Early Activity, Return-to-Play Decisions, and Multimodal Assessment

Course overview

Concussion care has changed direction. Rest until symptoms clear, the standard advice for two decades, has given way to a brief period of relative rest followed by early activity within a symptom limit, assessment across several domains rather than a single test, and a staged return to learning and to sport that a healthcare provider authorizes. Most patients are seen off the sideline, in primary care, emergency departments, pediatrics, neurology, physical medicine and rehabilitation, and occupational medicine, which places the decisions that shape recovery with clinicians who may not have encountered the updated guidance. The content is built on the Amsterdam 2022 international consensus statement, the Sport Concussion Assessment Tool 6 (SCAT6) family, and the CDC return-to-sports guidance updated in September 2025, together with the evidence behind each. Prolonged rest continues to be recommended in some settings, acute sideline tools are sometimes applied in the office days after injury, and clearance decisions are sometimes based on symptom report alone. A United Kingdom scoping review found that roughly one in five general practitioners advised immediate return to play once a patient was asymptomatic, using no return-to-play protocol at all. The gap is not awareness that concussion matters. It is knowing what current guidance directs, which assessment findings carry weight and which do not, how to prescribe activity rather than withhold it, and who holds the authority to authorize return.