Faster recovery from concussion following immediate removal from play


Getting off the field is key to getting athletes back in the game

A recent study out of the University of Florida confirmed the importance of immediately removing athletes from play after they have suffered a sports-related concussion.

Shorter symptoms and quicker return to play

The study, which looked at more than 500 athletes across 18 different sports, showed that immediate removal from sport not only reduced the number of days that the athlete experienced symptoms but it also resulted in quicker return to play. According to the report, student-athletes immediately removed from activity experienced symptoms for two days less— and were able to return to play three days earlier— than their peers who experienced a delayed removal from activities.  The data also suggests that immediate removal may lessen the severity of acute symptoms.[i]

These findings echo previous research, adding weight to current management practices that require athletes suspected of having a concussion be immediately removed from play.[ii] For those working with adolescents, immediate removal from play may be even more important—one study showed that adolescents immediately removed from activity returned to play 22 days earlier than their peers who were not.[iii]

The right rest

Multiple studies show that immediate rest is key, but this study suggests that too much rest may not be the best approach. While there is a consensus that 24-48 hours of rest immediately after sustaining a concussion is crucial to a speedy recovery, prolonged rest may increase the risk of an extended recovery. [iv] Instead, properly timed physical activity could improve outcomes. [v] Researchers believe physical activity may encourage better outcomes by increasing the brain’s uptake of proteins associated with healing and neural repair and could speed up a return to homeostasis.[vi]

Catch it when you can

Despite the strong evidence that immediate removal is essential, as many as 50% of athletes are delayed in being removed from sport after sustaining a concussion.[vii] It’s unlikely that all of these delays are simply caused by a failure to report or non-compliance with concussion guidelines. In this study, a high proportion of those who were not immediately removed from sport were people who experienced delayed symptom onset— helping to explain why so many athletes continue to play after the impact responsible for the concussion.

Unfortunately, not every concussion is immediately detectable. Still, as soon as symptoms are noticed, it is time to get off the field immediately. Mounting data shows that removal from play at the time of symptom onset— even if that is after the impact that caused the concussion— gives the best chance of avoiding a prolonged recovery. [viii]

Further to go

There have been great strides in the recognition and reporting of sports-related industries over the last two decades, but there is still a long way to go. Too many athletes are still not immediately removed from play.

This study, like several before it, highlights the importance of educating athletes, coaches, and trainers on how to identify symptoms and the importance of immediate removal from play—it’s what is best for recovery, and the fastest way to get athletes back in the game.


[i] Asken, B. M., Bauer, R. M., Guskiewicz, K. M., McCrea, M. A., Schmidt, J. D., Giza, C. C., … & Broglio, S. P. (2018). Immediate removal from activity after sport-related concussion is associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes. The American journal of sports medicine46(6), 1465-1474.

[ii] Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM. “Playing through it”: delayed reporting and removal from athletic activity after concussion predicts prolonged recovery.  J Athi Train. 20016; 51(4):329-335.

[iii] Elbin R. Sufrinko A, Schatz, et al. Removal from play after concussion and recovery time. Pediatrics. 2016; 183(3):e20160910

[iv]  McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016 [published online April 26, 2017]. Br J Sports Med. Doi: 10, 1136/bjsports-2017-097699

[v] Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?” Recommendations for activity resumption following concussion in athletes, civilians, and military service members.  J Head Trauma Rehabil. 2013 28(4) 250-259

[vi] Griesbach GS, Hovda D, Molteni R, Wu A, Gomez-Pinilla F. Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function, Neuroscience. 2005; 125(1):129-139.

[vii] Asken (2016).

[viii] Asken (2018).

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