Concussion Recovery: Why Athletes Struggle to Sit Out
Sitting out doesn’t feel like recovery. It feels like falling behind.
Your training partners are rolling. Your conditioning is slipping. The competition you’ve been building toward is six weeks away. And you’re on a stationary bike at 60% effort, watching your heart rate like it’s going to give you the answer you want.
This is the part of concussion recovery nobody really talks about. The recovery protocol itself is well-documented. What’s sometimes missed is the internal psychological tug-of-war that follows a motivated athlete facing a non-negotiable reduction in intensity.
I can relate to this, because I’ve been there.
What It Actually Feels Like: From Someone Who’s Been Through It
I had a moderate TBI in March 2025.
I fell backwards and hit my head on concrete outside a work leaving-do in Auckland. One second I was standing, the next my mate was helping me off the ground, with little memory of what happened in between. Twelve hours waiting in the ED lobby, a CT scan, a closed skull fracture. No major intracranial damage. Discharged with instructions to rest.
The hardest part wasn’t the headaches or the nausea. It was lying in a dark room at 28, running the same questions on a loop: would I actually get back to where I was, or was “back to normal” just something people say? Would the people I’d spent a decade training and building trust with still see me the same way if I came back slower, or different? Are they willing to be patient and understand while I try to make a full recovery?
The internal instinct to downplay it, push through, and get back to it is so strong.
Almost every athlete who’s been through a concussion has probably felt some version of this. Here’s why it happens to nearly everyone.
I documented what worked well for me across the full recovery in [I Had a TBI. Here’s What I Actually Did.](/blog/tbi-recovery-return-to-sport)
Why Athletes Hide Concussion Symptoms
Because the consequences feel worse than the injury. Fear of losing their spot, looking weak, or missing competition leads athletes to underreport, and train through concussions that haven’t fully healed.
In combat sports, admitting a head injury carries a different social weight than a knee injury. Everyone knows it. Nobody says it.
Athletes train and compete on unresolved concussions [7], which is precisely what the evidence most strongly warns against. Repeat concussion before full recovery increases the severity and duration of the next event.
With a concussion, you’re not in a moon boot or wearing a neck brace. Nobody around you has a visible reason to push back on you returning to training, as far as everyone’s concerned, you look fully functional. It’s why concussion gets called an “invisible injury,” which is exactly why clinicians use the
SCAT (Sport Concussion Assessment Tool [2]: a structured check on symptoms, balance, memory, and cognitive function, instead of relying on the athlete’s or coach’s word.
What You’re Actually Risking
Returning too early from a concussion doesn’t just slow your recovery, it multiplies the risk. A second concussion sustained before full neurological recovery can extend your total time out from weeks to months.
Second concussions rarely come from a bigger hit. They come from a normal hit, the kind that lands on a brain that hasn’t finished healing from the first one.
Evidence on the clinical effects of repeat concussion is mixed, but additional head impact during the recovery window is an established concern [6]. In high-exposure combat sport athletes, cumulative structural and cognitive changes are well documented in imaging studies [4,5].
The 37-day minimum competition ban in combat sports exists for this reason. Re-exposure to head trauma is inherent to the sport, and the rule is a direct regulatory response to the documented risk of premature return [4,5].
More on the 37-day rule here.
The Fear of Losing Your Base
Athletes navigating injury time rarely say “I’m worried about my health.” It’s more that they feel “I’m going to lose everything I’ve built.”
This fear comes from a real place and worth taking seriously. A couple of weeks off can impact your conditioning, and several months off is certainly not an easy swallow. The anxiety about detraining isn’t irrational.
Often, what loses ground fastest during injury time isn’t your fitness. It’s your mental model of yourself as an athlete.
Sports psychologists have a term for this, athletic identity: how closely your sense of self is tied to your performance, often your primary source of self-worth, social connection, and daily purpose.
The research paper that introduced it was titled “Hercules’ Muscles or Achilles’ Heel?” [3] One of the key takeaways from that paper is that the same traits that make you a reliable training partner (discipline, consistency, the ability to push through discomfort) are exactly what make it easy to downplay a symptom, skip a check-in, or further aggravate symptoms by simply pushing through them.
For athletes like these, those traits were built and reinforced over years. You can’t switch that identity off, and you don’t need to. Point it at the protocol instead of around it. Same discipline, aimed somewhere useful.
What You Can Do While You’re Out
Get professional medical help, this is your priority.
In NZ, start by booking a GP appointment after ED discharge, which is how you get referred into ACC-funded concussion services. If you’re already under ACC care, your medical team will have issued tailored activity recommendations based on your testing results. Some of these tests may include exercise tolerance assessments, vestibular/ocular testing, cervical spine assessment and balance testing.
Depending on your profile, activity recommendations from the clinical team will typically cover:
– Sub-symptom aerobic exercise (walking or exercycle)
– Neck/Shoulder/Jaw mobility and strength exercises
-Neck/Shoulder/Jaw manual therapy (massage)
– Vestibular & Occular training
– Proprioception & Balance training
– Improving sleep quality
– Take regular breaks
– Diaphragmatic breathing
– Avoiding inflammatory foods and drinks, especially alcohol
However, one key thing to note is that your symptom levels can shift day to day depending on the type, frequency, and intensity of what you’re doing. The +3 rule in the next section is how you manage that variability, while still actively participating in everyday life.
Learning To Manage Your Symptoms: The +3 Rule:
It is common to experience a ‘boom-bust’ pattern with your symptoms after a head injury. You start feeling better and rush your return to usual activity levels too soon. As a result, symptoms can flare up, becoming severe, and linger for much longer.
How much longer? I’ve personally experienced a ‘boom-bust’ that left me debilitated for several weeks after half a year of great progress with close to zero symptoms.
Your current symptom pattern may look like this:
The +3 rule: a symptom increase of more than 3/10 during any activity is the signal to stop or reduce intensity until symptoms settle to baseline.
With all activities that you do throughout the day, if your symptoms increase by more than three points out of ten (+3), you need to stop for a break.
A key element to this rule is that the threshold is relative to your starting symptom level, not a fixed number.
For example, if you have a headache that you rate as 2/10 in intensity before doing an activity, it is acceptable for the activity to increase your headache to max 5/10 intensity.
If your symptoms increase beyond this, take a break or reduce the intensity of the activity to help bring them back down. This creates a different pattern in which symptoms are mildly provoked but settle quickly, allowing you to return to the activity after a short rest.
In practice, lets say you start at 3/10. If you reach 5/10 thats +2 and already a warning to slow down. If you reach 6/10 thats +3, a signal to stop what you’re doing and rest.
Consistently applying this strategy each day helps maintain lower symptom levels, supports participation in everyday activities, and gradually increases your tolerance for activity until you have fully recovered.
However, if your symptoms are severe, worsening, or accompanied by red-flag features such as vomiting, confusion, sleepiness, weakness, or seizures, urgent medical assessment is recommended.
