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Injury Prevention

Is it Safe to Exercise After a Concussion?

Don't rush to return to training after a concussion! Dr. Daya Grant explains how to recover from a concussion and return to training safely.

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Triathletes are tough. We thrive in challenging situations and we love putting our body through adversity. But that adventurous spirit also puts us at risk of injury. When that happens, we need to play smart in an effort to recover fully, so that we can get back to doing what we love. One injury that receives a lot of attention in mainstream media, but is under-diagnosed due to its “invisible” nature, is concussion. Here, we’ll define what a concussion is and discuss what you should do if you think you’ve experienced one.

RELATED: An Injury Guide for Triathletes

What is a concussion?

A concussion is a type of mild traumatic brain injury (TBI), although it’s hardly mild for the person experiencing it. It’s caused by a direct blow to the head, neck, or body that results in force transmitted to the brain. It is the result of the brain moving rapidly in the skull and, perhaps surprisingly, does not require a loss of consciousness. This “invisible” injury triggers an inflammatory response in the brain as it tries to heal itself, which activates a sequence of functional impairments. These impairments manifest as common concussion symptoms, such as headache, dizziness, nausea, difficulty concentrating, impaired memory, sleep disturbances, changes in mood, sensitivity to light/sound, or feeling like you’re “in a fog.”

What should I do immediately after a concussion?

Imagine that you crash your bike, fall on a run, or get kicked in the head on the swim (not a fun thought experiment, I know). What should you do next? It can be tricky to figure out when to seek help, but here are some steps to take:

  1. Assess your symptoms. Adrenaline can mask concussion symptoms, so monitor symptoms over time and have a friend/family member/coach do the same. You’re looking for changes in mood, vision, cognition (your ability to think, concentrate, remember), energy levels, headache, balance, or a general feeling of fogginess.
  2. Rest and observe. If anything seems off, then rest and observe yourself. It’s not worth pushing through it.
  3. Seek medical help. For a more comprehensive evaluation, or if your concern grows, then seek help from a medical professional trained in concussion management. They will be able to administer an assessment, such as the Sport Concussion Assessment Tool (SCAT-5), to confirm a concussion. Note that in most cases, a mild TBI won’t show up on a normal MRI scan, so unless your symptoms are severe or get worse over time, it’s usually not recommended.

In rare occasions, brain bleeding can occur. To monitor this, pay attention to the presence of any dangerous signs: one pupil larger than the other, an inability to wake up, an increasingly worse headache, slurred speech or muscle weakness, seizures or repeated vomiting, or any loss of consciousness. If any of those symptoms exist, get to an emergency room immediately, as you’ll probably need a CT scan and other monitoring.

How do I know when it’s safe to return to training after a concussion?

Don’t go back too soon. I know it’s frustrating, but if you had a concussion, premature return to activity can make matters worse – and it’s just not worth it. Your chances of having a second concussion are much higher immediately after a first, which may be due to slower reaction time, dizziness, or other symptoms that impair judgement and motor function. Also, research has shown that if a second concussion occurs before the brain has healed from the first one, then the symptoms are typically worse, with the second recovery taking much longer. So, it’s prudent to be cautious at least until all symptoms have fully resolved. And here’s the kicker: your brain may still be recovering at the cellular level, even after you “feel” better. That’s why scientists and medical professionals suggest a graduated, return-to-activity protocol with athletes progressing to the next step only if symptoms are completely gone at the previous step. Follow these steps (no faster than one step per day; often much slower), preferably with guidance from a concussion-trained medical professional, to give your brain the best opportunity to fully recover.

Returning to exercise after a concussion

Step 1: Rest Physical and cognitive rest is suggested in the 24-48 hours immediately after a concussion.
Step 2: Light aerobic activity After no more than 48 hours, begin easy (5-10 minutes) walking/jogging/spinning/swimming. Bodyweight only.
Step 3: Moderate activity Start to increase your heart rate with moderate intensity movement, taking frequent breaks (every 20 minutes)
Step 4: Heavy, non-contact activity Introduce movements involving resistance and increased coordination. 
Step 5: Full training Ramp up your training, paying attention to any symptom flare-ups and stopping when necessary.
Step 6: Competition Get back to racing! You should be good to go. 

Getting cleared to return to triathlon and feeling mentally prepared to return are two separate beasts. If you feel anxious, concerned, or fearful, don’t hesitate to seek help from a certified mental performance consultant (CMPC). They can help you navigate the oftentimes challenging transition back into training and competing.

Do I need to worry about long-term consequences of a concussion?

The simple answer is probably not. The mental performance consultant in me says, “it’s never beneficial to worry”, but the neuroscientist in me knows there are some things worth addressing when it comes to concussions. 80-90% of sport-related concussion symptoms typically resolve within 7-10 days, although they tend to persist beyond that with younger athletes and in those with a history of multiple concussions. If repeat concussions are spaced out with enough time for the brain to return to baseline in the interim, then the risk of long-term damage and functional deficits is low. Furthermore, it’s important to note that recovery isn’t always linear. You may be feeling good and training normally when seemingly out of nowhere symptoms return. Know that this is normal. Any number of things, from stress to nutrition to sleep, can trigger concussion symptoms, so recognize that and force yourself to rest. Then, follow the return-to-activity guidelines outlined above and get back to it.

Concussions are alarming and they need to be taken seriously, but if you rest wisely (“when in doubt, sit it out”) and seek help from a concussion specialist for any persistent symptoms, then you’ll give yourself the best chance for a full recovery.

Disclaimer: This article should not be considered medical advice. Use this as guidance and seek help from a medical professional should you suspect a concussion.

Daya Grant, Ph.D. is a neuroscientist who specializes in concussions, a certified mental performance consultant (CMPC), and yoga teacher who empowers athletes to get out of their own way and tap into their greatness. She swims, bikes, and runs in Los Angeles, where she lives with her husband and their young son.

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