Complete rest until symptom-free after concussion may not be best for recovery

Rest has long been the cornerstone of concussion treatment. For sports-related head injuries, for example, current guidelines say children should avoid returning to play --and all other physical activity--until all concussion symptoms such as headaches are gone. A research abstract to be presented at the Pediatric Academic Societies (PAS) 2016 Meeting, however, suggests those who exercise within a week of injury, regardless of symptoms, have nearly half the rate of concussion symptoms that linger more than a month. For the study, "Early Resumption of Physical Activities and Persistent Post-Concussive Symptoms Following Pediatric Concussion," 3,063 children between ages of 5 and 18 who visited hospital emergency departments in Canada answered survey questions about their level of physical activity and severity of symptoms 7, 14, and 28 days after injury.

Contrary to recommendations, researchers said, most (58 percent) of the children still experiencing concussion symptoms resumed exercising a week after being injured, and more than three-quarters (76 percent) were physically active two weeks later.

Ordinarily, discovering so many patients weren't following strict medical guidelines might be cause for alarm. But in this case, researchers said, the non-compliance was associated with faster recovery.

"Exercise within seven days of injury was associated with nearly half the rate of persistent post-concussive symptoms, or those that last beyond a month," said principal investigator Roger Zemek, MD, FRCPC, who directs the clinical research unit at Children's Hospital of Eastern Ontario and serves as Associate Professor in the departments of pediatrics and Emergency Medicine and Clinical Research Chair in Pediatric Concussion at the University of Ottawa. He said the findings echo some previous, smaller studies calling into question the benefit of prolonged physical rest following an acute concussion, particularly exceeding three days.

"This is the first large-scale study to provide support for the benefits of early exercise on symptom recovery following acute pediatric concussion, shifting away from conservative rest towards more active physical rehabilitation recommendations," Dr. Zemek said. "We definitely don't want patients resuming any activity that could put them at risk of re-injury, like contact sports drills or games, until they are cleared by a doctor," he said, but he added that light aerobic activity like walking, swimming or stationary cycling might emerge as a beneficial recommendation after further study.

More research is urgently needed to confirm the study's findings and to determine the best timing for return-to-play following youth concussions, Dr. Zemek said. In addition to lessening long-term concussion symptoms, he said, re-introducing exercise sooner after injury could help reduce the undesired effects of physical and mental deconditioning.

"If earlier re-introduction of physical activities is, in fact, confirmed to be beneficial to recovery," he said, "this would have a significant impact on the well-being of millions of children and families worldwide and cause a major shift in concussion management."

Source: American Academy of Pediatrics