The traditional guidelines of rest after a concussion suggest that a patient needs at least three days of minimal activity or exertion after injury. But a recent study has shown that these guidelines may be doing more harm than good.
Past research has shown that being sedentary after injury is a risk factor for chronic disability and chronic pain. Minimal activity can also increase the risk of developing depression. Avoidance of exercise soon after injury might create anxiety about returning to exercise later. On the other hand, gradual build-up of activity is shown to promote recovery.
Other research has shown that exertion can provoke or worsen post-concussion symptoms, which is why the guidelines are currently in place. However, it is not entirely known if the worsening of symptoms is directly related to the concussion, or the exertion itself. Some studies show that exercise at any time after a concussion can elicit symptoms. Exercise can also elicit similar symptoms in people who have not had a concussion.
So then, the difficult question is-when exactly is it safe to return to activity or exercise after concussion? A recent study suggests that the guidelines should not be rigid, but that there are some recommendations that should be safe for anyone who has suffered a concussion, whether during combat, sports, or civilian activities.
These recommendations are as follows:
1. Bed rest exceeding 3 days is not recommended.
2. Gradual resumption of pre-injury activities should begin as soon as tolerated.
3. Heavy exertion in the first two weeks after injury may or may not be harmful, and so patients should temporarily reduce their pace and gradually resume to normal activity.
4. One month after injury, supervised exercise should be part of the treatment plan, even if the patient still has symptoms.
In addition, clinicians should be alert to the personality of the patient. Some will be eager to resume activity as normal, and others will be reluctant. The treatments should therefore be individualized to the capacity, as well as the personality, of the patient. Compliance may be a challenge, and so follow-up phone calls or screening will help to determine whether the patient is on course, or is experiencing any obstacles.
Finally, people who sustain a concussion should not return too quickly to a situation that increases their risk of exposure to another concussion. In the case of athletes or soldiers, the gradual increase of activity should not occur on the active field.
Silverberg ND & Iverson GL. Is rest after concussion “The Best Medicine?”: Recommendations for activity resumption following concussion in athletes, civilians, and military service members. Journal of Head Trauma Rehabilitation. (July 2012).