Physical rest has long been the mainstay of concussion rehabilitation, due to increased risk of more debilitating injury should the patient sustain secondary trauma before metabolic homeostasis has been restored. As well as that, rest may ease discomfort during the acute recovery period by mitigating post-concussion symptoms. The concept of “rest until asymptomatic” is also implemented by some clinicians in patients with prolonged recovery after concussion (post-concussion syndrome).
The use of prolonged rest in the treatment of concussion and post-concussion syndrome is, however, being challenged, with the most recent consensus statement on sport-related concussion (SRC) identifying that there is currently insufficient evidence that prescribing complete rest achieves these objectives. Specifically, they recommend that after a brief period of rest during the acute phase (24–48 hours post-injury), patients should be encouraged to become gradually and progressively more physically active, whilst ensuring that they remain below their cognitive and physical symptom-threshold. This is hugely important to recovery, as exercise intolerance tends to be prevalent amongst patients who are more symptomatic on presentation as well as those who take longer to recover.
At our Concussion Clinic, we implement this approach of active rehabilitation in patients who are still symptomatic at the 10-14 day mark. In order to do this, we administer a sub-symptom exercise test on either a treadmill or cycle ergometer in order to identify the intensity at which the patient’s symptoms increase. We then prescribe an exercise programme at 80% of this threshold in order to improve exercise tolerance and aid symptom management. This exercise is monitored and adjusted according to symptom reports from the patient and involves gradually increasing both the duration and intensity of exercise. After successful completion of this (i.e. increased duration and intensity without symptom exacerbation), a return to play protocol is implemented (this includes non-contact skills training, resistance training and eventually full contact training). Active rehabilitation is a hugely important component of concussion treatment, especially for those who remain symptomatic at the 10-14 day mark. Not only does it aid in symptom management and recovery, but it also helps rebuild the confidence of athletes post-injury as they look to return to the sport in which they sustained their injury.
Have you, or do you know someone who has, suffered a concussion recently? It’s better to play it safe and have your injury assessed by an experienced professional before you return to play, than risk further injury. We run Auckland’s most comprehensive sports concussion service.
Learn more here or call 09 521 9811 to make an appointment