Active Rehabilitation

Why Physical Activity Helps Recovery

Research shows that gradual, controlled physical activity can help the brain recover after a concussion. Light exercise improves blood flow to the brain, supports regulation of the nervous system, and helps the brain relearn how to tolerate movement and activity.

Rather than complete rest, recovery now focuses on active rehabilitation -slowly reintroducing physical activity in a safe and controlled way. The 2-point tolerance rule helps guide this process by allowing you to gently challenge your symptoms without overloading your brain. Staying within this range helps promote recovery while reducing the risk of aggravating symptoms.

The 2-Point Tolerance Rule

When returning to physical activity after a concussion, a small increase in symptoms is normal and can actually support recovery. The key is keeping any increase within a safe range.

Rate your symptoms on a scale from 0 to 10, where:
0 = no symptoms
10 = unbearable symptoms

When you begin an activity such as walking, cycling, or light exercise, monitor how your symptoms respond.

If your symptoms increase by 1 point, this is normal and acceptable. A small increase can help your brain gradually adapt to activity.
If your symptoms increase by 2 points, this is still acceptable, but it signals you are approaching your limit.
If symptoms continue to rise beyond this, it usually means you have reached your current heart-rate or activity threshold.

At this point:

Slow your pace
Reduce the intensity of the activity
Allow your heart rate to come down

Your symptoms should settle as your body recovers.

The goal is to stay within the 2-point increase. Think of recovery as gently nudging into symptoms rather than pushing through them. Doing too much too soon can aggravate symptoms and slow your progress.

Stage one: Day one and two

Symptom limited physical activity

This is the relative rest stage. You can complete light daily activities such as short walks and normal household tasks, provided there is only a minimal increase in symptoms.

Use the 2-point tolerance rule to guide activity. If symptoms increase more than this, reduce your activity and allow your body time to settle.

Stage two: Light physical activity

Begin gentle exercise such as walking on flat ground or riding a stationary bike.

Sessions may range from 5 to 30 minutes, depending on your fitness level and symptoms.

Your aim is to maintain a steady heart rate by exercising at a consistent, manageable pace, rather than starting and stopping or suddenly increasing intensity.

Continue to apply the 2-point tolerance rule. If symptoms increase by 2 points, slow your pace or stop and allow your heart rate to decrease. Symptoms should return to your previous level within about an hour after finishing the activity.

When starting out, stay close to home in case symptoms increase and you need to stop early. Everyone recovers at a different pace, so be patient with your body. A slight increase in symptoms (1–2 points) is not concerning and can help your recovery.

Note: Lifting weights in the gym is not recommended until Stage 4.

Stage three: Increasing physical activity

Gradually increase the duration and intensity of exercise as tolerated, continuing to use the 2-point tolerance rule as your guide.

If symptoms increase by more than 2 points, reduce the intensity or shorten the duration of your exercise until symptoms settle. This indicates that your body is not quite ready for that level of activity yet.

Remember, concussion recovery is not an injury you can push through. Progress gradually and allow your body time to adapt.

If you are unsure how to progress, or if symptoms continue to worsen or persist, we encourage you to seek guidance from a healthcare professional trained in concussion management.

Stage four: Higher intensity exercise

During this stage you can begin higher intensity exercise and return to lifting weights in the gym, provided your symptoms remain stable.

Gradually increase your effort, duration, and training load while continuing to monitor symptoms using the 2-point tolerance rule.

By the end of this stage, you should be able to exercise at a high effort or high heart rate without causing an increase in symptoms. This indicates that your brain and nervous system are tolerating physical exertion well.

If symptoms increase, reduce the intensity and allow more time before progressing further.

For People Returning to Sport

If you are returning to sport or activities with a risk of head injury, you must follow a graduated Return-to-Play programme before returning to training or competition.