Driving After a Concussion: Risks, Guidelines, and What to Consider
Returning to the driver’s seat after a concussion is not a simple milestone.
It requires more than just the absence of symptoms—it demands a careful assessment of physical, cognitive, and visual readiness. Advising patients on when it’s safe to drive again involves understanding the neurological aftermath of a concussion and how it impacts reaction time, decision-making, and motor coordination.
In this article, we’ll explore the clinical considerations behind returning to driving post-concussion, examine relevant research, and offer practical strategies for supporting patient safety during recovery.
The Cognitive and Physical Demands of Driving
Driving is a complex task that integrates multiple brain systems. It’s not just about steering and pressing pedals—it's about fast, efficient decision-making, continuous visual scanning, sustained attention, and rapid motor responses. After a concussion, these abilities can be compromised even if outward symptoms appear mild or transient.
According to the Children's Hospital of Philadelphia, individuals with a concussion may experience slower reaction times, impaired judgment, decreased concentration, and poor coordination—factors that significantly increase crash risk when behind the wheel (source).
From a vestibular and neuromotor perspective, lingering issues like dizziness, light sensitivity, and visual tracking problems can also undermine driving safety. In clinical practice, these subtle deficits often outlast the acute phase of symptoms and may only reveal themselves during high-demand tasks like driving.
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Research continues to show that even after symptoms resolve, individuals may exhibit residual impairments that interfere with driving.
A study published by the National Institutes of Health revealed that adolescents, in particular, often resume driving before being medically cleared for other activities like sports or exercise. This trend raises concerns about unmonitored cognitive load and potential for delayed reaction times (source).
Another integrative review highlights the need for structured assessments to determine driving readiness. It points to the lack of consensus on return-to-drive timelines and calls for more defined clinical tools to evaluate neurocognitive function related to driving demands (source).
Vestibular dysfunction, often observed in concussed patients, can lead to disorientation, balance issues, and blurred vision—symptoms that are especially risky in high-speed environments where sensory integration is critical. Driving while dealing with these deficits is akin to performing a complex motor task in a foggy mirror: functional on the surface but deeply impaired underneath.
How Long Should Patients Wait Before Driving?
Most concussion guidelines recommend waiting at least 24–48 hours before considering driving, but this is only a starting point—not an endpoint for clearance.
Sunnybrook Hospital’s concussion care guidance outlines that individuals should only resume driving once their vision, reaction time, and concentration have returned to baseline levels. It further advises that the return to driving should be approached gradually, beginning with short, low-risk routes and avoiding situations that increase cognitive load, such as night driving or heavy traffic (source).
From a clinical standpoint, it's essential to consider not just the duration of rest but the quality of functional recovery. This includes:
Restoration of normal vestibulo-ocular reflex (VOR) function
Resolution of visual motion sensitivity
Normalization of dual-task performance (e.g., walking while talking)
Stabilized mood and sleep patterns
Each of these elements plays a part in determining whether a concussed patient can respond adequately to the real-time demands of driving.
Clinical Scenarios: Applying Research to Practice
Consider a 17-year-old high school athlete recovering from a concussion sustained during football season. He's eager to return to school, sports, and social life. By day five, he reports feeling “almost normal” and wants to drive to practice. However, during a vestibular screening, you note slight gaze instability and delayed tandem gait performance. Cognitive testing also reveals subtle lapses in attention.
Although the athlete feels ready, your clinical assessment suggests otherwise. In this case, involving the athlete’s parents and reinforcing the rationale behind delaying driving is crucial. Using visual examples or analogies (e.g., “your brain is still lagging behind your reflexes”) can improve compliance and safety outcomes.
Another example involves a collegiate soccer player evaluated one week post-concussion. Her balance score is within normal limits, but she continues to struggle with visual tracking during horizontal saccades and reports increased fatigue while navigating busy environments. She may be cleared for light activity but not yet for driving—especially if her commute involves urban traffic patterns or nighttime visibility challenges.
The Role of Healthcare Professionals in Driving Readiness
Athletic trainers and physical therapists are often the first to detect subtle deficits in post-concussion patients. As a result, they play a key role in guiding return-to-driving decisions in collaboration with team physicians and neurologists.
Key responsibilities include:
Performing vestibular and oculomotor assessments to identify hidden impairments
Administering dual-task cognitive tests that simulate driving complexity
Monitoring symptom trends and recovery trajectories across different environments
Communicating clearly with families about the risks of premature driving
Importantly, clinicians should avoid giving blanket timelines. Instead, decisions should be individualized, based on clinical presentation, neurocognitive function, and environmental demands.
Gradual Return to Driving: Building a Safe Plan
Much like return-to-play or return-to-learn protocols, returning to driving after a concussion should follow a phased approach:
No Driving During Acute Recovery (First 24–48 hours): Patients should avoid all driving and be supervised or assisted with transportation.
Symptom Monitoring Phase: Focus on symptom resolution at rest and during daily tasks. Ensure no recurrence with light physical activity.
Vestibular and Cognitive Testing Phase: Assess visual tracking, balance, attention, and dual-task tolerance.
Short Trial Drives: Begin with short, local drives in familiar, low-traffic areas during daylight. Supervision by a family member is recommended.
Full Return When Clinically Cleared: Only after all symptom domains have resolved and the patient demonstrates normal reaction times and cognitive endurance.
This approach mirrors findings from adolescent studies, which advocate for driving as part of a gradual reintroduction to cognitively demanding activities, rather than an all-or-nothing decision (source).
Prioritizing Safety and Communication
Driving is not just a personal milestone—it's a public safety issue. For athletic trainers, physical therapists, and clinicians working with concussed individuals, reinforcing a cautious, criteria-based return to driving is essential.
Too often, the return to driving is overlooked in post-concussion care, treated as a passive decision rather than a critical clinical milestone. With growing research highlighting the risks of premature driving—especially among adolescents and student-athletes—this needs to change.
Empowering patients and families with clear information, involving multidisciplinary teams in decision-making, and prioritizing objective assessments over subjective readiness will lead to better outcomes, fewer risks, and stronger adherence to recovery plans.
