Concussion Treatment – when to rest and when to exercise
Many individuals who have sustained a concussion are told to rest in a dark room until their symptoms have gone away. Health care practitioners often prescribe rest as the frontline treatment for a concussion. It is a widely accepted and popular advice. The rationale for this is to minimize the energy use of the brain as it is recovering, and it is thought to prevent prolonged or persistent symptoms. But, is that really the best way to manage a concussion? Research is emerging to challenge this wide used and accepted protocol for patients suffering from concussion.
At the most recent international conference on concussion in sport held in Berlin, in October 2016, the consensus statement on concussion in sport was updated and stated that prolonged rest is no longer considered to have sufficient evidence to support its use and rationale.
The most update to date research suggests “after a brief period of rest during the acute phase (24–48 hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (ie, activity level should not bring on or worsen their symptoms).”1
Furthermore, evidence suggests now that an active sub-symptom exercise program is safe and may benefit in facilitating recovery.1 It is thought that aerobic exercise may improve recovery by restoring normal cerebral blood flow regulation.2 However, it is imperative that this exercise is done in a safe way, monitored by a trained professional, and in a symptom free range.
In order to determine how and when to start physical activity after a concussion it is recommended that you visit a trained health care practitioner with experience in concussion management. A graded aerobic exercise test should be performed to determine the amount and intensity of exercise that is safe at the specific stage concussion recovery and prescribe an individual exercise program.
By Jennifer Harvey
Registered Physiotherapist
References
1 – 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 Br J Sports Med 2017;51:838-847
2 – Grool AM, Aglipay M, Momoli F, et al. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA. 2016;316(23):2504–2514. doi:10.1001/jama.2016.17396
