Concussion management has been a constantly evolving concept in recent years. To date, physical and mental rest has been described as a key element in the treatment of concussion in the period immediately following injury – the acute phase (1). During this phase, it is generally recognized that excessive activity prolongs the time required for recovery, hence the importance of monitoring the progress of the return-to-play protocol (2). The acute phase varies in duration depending on a number of factors, including age, gender and history of concussion.

A different approach to post-concussion syndrome
Clinically, physical and mental rest has long been and is still sometimes recommended for post-concussion syndromes (PCS), i.e. concussions presenting symptoms that persist for several weeks or even months (3). However, recent studies show that inactivity could negatively affect concussion recovery by promoting anxiety, depression and loss of self-confidence in athletes (2). According to Leddy et al. (2013), aerobic exercise could, among other things, reduce concussion-related dysfunction. Firstly, exercise could restore balance to the autonomic nervous system by, among other things, stabilizing heart rhythm, and could also improve blood supply to the brain (4). In this study, subjects with post-concussive syndrome trained at 80% of their maximum heart rate as assessed by a treadmill test. Training (20 minutes a day, 6 times a week) was monitored by measuring heart rate and concussive symptoms. When cardiovascular fitness was assessed on the treadmill, the aerobic training group was able to reach its maximum heart rate without increasing symptoms, whereas the light training group (40-50% of maximum heart rate) was unable to do so. Another study reported similar results, indicating that it was safe for adults with PCS to exercise up to 74% of their maximum heart rate (5). The results of this study come to the same conclusions as the previous one: aerobic exercise improves concussion symptoms, general fitness and autonomic nervous system function during exercise.

In short, the optimum duration of physical and mental rest for recovery in the acute phase following concussion remains uncertain and depends on a number of factors. However, aerobic exercise supervised and controlled by a health professional could be an interesting avenue of treatment for athletes with persistent symptoms over time. Since every concussion is unique, as is every athlete who suffers one, it’s important to always consult a healthcare professional with up-to-date skills in concussion care and management to return to activity safely.

Written by Ève Poisson, Physiotherapist

References:
1. McCrory P. et al. (2013) Consensus statement on concussion in sports V the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Athl Train, 48(4); 554-575.
2. Howell D.R. et al (2016) Physical Activity Level and Symptom Duration Are Not Associated After Concussion. The American Journal of Sports Medicine, 44(4); 1040-1046.
3. Jotwani V. and Harmon K.G. (2010) Postconcussion syndrome in athletes. Curr. Sports Med. Rep, 9(1); 21-26.
4. Leddy J.J. et al. (2013) Exercise Treatment for Postconcussion Syndrome: A Pilot Study of Changes in Functional Magnetic Resonance Imaging Activation, Physiology and Symptoms. J Head Trauma Rehabil, 28(4); 241-249.
5. Leddy J.J. and Willer B. (2013) Use of Graded Exercise Testing in Concussion and Return-to-Activity Management. Curr. Sports Med. Rep, 12(6); 370-276.