The most common recommendation you will hear after a concussion is “get some rest,” but a growing body of evidence suggests rest may not be best after all.
A new study from the Pediatric Emergency Research Canada Concussion Team suggests that concussed children who completely remove themselves from activity actually experience worse symptoms that last longer than in children who resume a low level of physical activity.
Children who resumed activity within 7 days of their injury showed lower rates of persistent post-concussive symptoms (PPCS) four weeks after their injury than children who had no physical activity. This was even true for children who resumed intense exercise.
“In my opinion, these findings suggest that the current practice of keeping children out of physical activity for weeks (or months) until children are fully asymptomatic should change,” lead investigator Roger Zemek, MD, FRCPC, clinical research chair in pediatric concussion, University of Ottawa, and director, clinical research unit, Children’s Hospital of Eastern Ontario, Canada, told Medscape Medical News.
Rest and isolation have been considered the cornerstone to recovering from a concussion, but “no clear evidence has determined that avoiding physical activity expedites recovery”, the team writes in their report published in JAMA.
For the study, the researchers evaluated patients between the ages of 5 and 17-years-old, who had sustained a concussion and were evaluated at one of 9 Pediatric Emergency Research Canada network emergency departments.
The team defined PPCS as the presence of 3 or more new or worsening concussion symptoms 28 days after an injury. Out of the 2413 total participants, over 30% (773) developed PPCS.
After one week, almost 70% of the participants had resumed some form of physical exercise. Most participated in light aerobic exercise (32.9%), but others did sport-specific exercise (8.9%), noncontact drills (5.9%), full contact practice (4.4%), and full competition (30.5%). The other 736 participants (30.5%) reported no physical activity.
While the study doesn’t explain how physical activity may aid the recovery process after brain injury, the researchers believe it could be related to a number of biological and psychological factors.
“Some physiological reasons why physical activity may be better than rest may include improved cerebral blood flow and the release of factors during exercise which promote neuroplasticity and brain healing. Psychologically, getting released from ‘home jail’ may also be an important factor in that it may reinforce the message that they are going to get better. In general, exercise is a good medicine,” Dr. Zemek explained.
Zemek also believes with more research the team can create a model based on their data which can be used to create an optimal timetable for returning to activity. “For most children it will likely be beneficial to begin with a short walk several days after their injury,” he said.
“However, regardless of the potential benefit of early physical activity, the current policy of safety and caution in the immediate postinjury period should not change; patients should always be removed from the field of play if a concussion is suspected. Further, return to participation activities that might introduce risk for collision (such as contact sports) or falls (such as skiing, skating) should remain prohibited until the patient has been cleared by a qualified health professional,” Dr. Zemek explained.
Returning to light physical activity may be beneficial after a concussion, but that doesn’t mean you should immediately make a full return to play. It is important to balance the need for physical activity with preventing another injury while the brain may still be vulnerable.