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Rest or exercise following concussion?
An updated body of work suggests the latter, building on substantial evidence that bedrest can potentially cause long-term risk.
A graded return to daily activities is more beneficial than rest after the first 24–48 hours following concussion, experts say.
Moderate exercise in the first week following concussion is more effective at aiding recovery than strict rest, which can slow recovery and increase the likelihood of prolonged symptoms.
These findings are presented in the latest consensus statement on concussion management, updated from the 2011 version, from a US concussion expert panel developed by the Team Physician Consensus Conference (TPCC).
Published in the British Journal of Sports Medicine, the consensus statement outlines that ‘strict rest’, or total bedrest after a sports-related concussion, slows recovery and may prolong symptoms.
Although sometimes difficult to diagnose due to being under-reported, most concussions improve within a month and can be effectively treated with exercise such as progressive moderate aerobic activity, according to the TPCC.
Sports doctor, Dr Gill Cowen told newsGP the updated findings build on ‘standard practice’ since the sports-related concussion consensus statement was published in 2017. Prior to this, it was recommended that complete physical and mental rest be taken after a concussion.
‘Evidence suggests that a graded-paced return to daily activities is more beneficial than rest after the first 24–48 hours,’ Dr Cowen said.
‘This is supported by evidence that sub-symptom threshold aerobic activity programs can aid rehab.
‘Typically we aim to slowly increment activity after 48 hours, but avoid [it] if [there is a] worsening of symptoms.
‘If symptoms recur or are exacerbated, then the person’s activity level is stepped down – typically to a level of two days’ previous, and the process starts again.’
The consensus states that key factors contributing to ‘prolonged or complicated’ recovery from concussion include:
- previous concussions
- loss of consciousness for more than one minute
- younger age
- pre-existing conditions, including migraine, cognitive disability, depression and anxiety.
According to the expert panel, persisting symptoms such as fatigue, headache and anxiety are a ‘complex interplay’ between the physical and psychological effects of the new concussion injury and underlying conditions.
In these circumstances, treatment should focus on the particular symptom, such as cognitive behavioural therapy and/or lifestyle changes to sleep and nutrition.
‘Each injury is unique and will have its own timeline,’ TPCC member Dr Margot Putukian said.
‘Most athletes [for example] who have been concussed will get better, and will be able to return to play … and there are steps they can take to aid their own recovery.’
Although short-term diagnosis and management of concussion is more clearly defined,
experts say that more understanding of assessment and diagnosis of persistent post-concussion symptoms is needed.
The call for more research is especially relevant as
emerging evidence suggests that long-term symptoms are becoming increasingly common among professional athletes, who may sustain repeated head injury, concussions, and diagnosis of chronic traumatic encephalopathy (CTE).
The TPCC expert panel says there is still uncertainty about the long-term impact of concussion for young people, and more research is needed to fully understand young people’s risks of taking part in sport after concussion and the effects on their long-term brain health and wellbeing.
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