Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

McLeod, Tamara C. Valovich; Lewis, Joy H.; Whelihan, Kate; Bacon, Cailee E. Welch

doi:10.4085/1052-6050-51.6.06

Cited by 83 publications

(65 citation statements)

References 65 publications

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“…1 Previous reasoning behind rest was that it reduced the risk for subsequent concussion 2 and reduced potential stresses on the brain to promote recovery. 3 However, recent systematic reviews 4,5 determined that the extended rest may not be beneficial to patients, and moderate activity levels and early activity may help to decrease the risk of postconcussion syndrome and improve symptom duration. 6 Furthermore, recent statements have proposed a framework for more active treatments targeting specific clusters of symptoms following concussion to decrease comorbidities and day-to-day symptoms.…”

Section: Clinical Scenariomentioning

confidence: 99%

Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

Hattrup¹,

Gray²,

Krumholtz³

et al. 2020

Journal of Sport Rehabilitation

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Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

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Section: Clinical Scenariomentioning

confidence: 99%

Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

Hattrup¹,

Gray²,

Krumholtz³

et al. 2020

Journal of Sport Rehabilitation

View full text Add to dashboard Cite

show abstract

“…However, recent research has been unable to provide evidence to support the use of complete rest in the management of concussion beyond the acute phase following injury 3 , 14 , 15 . Three systematic reviews concluded that physical and cognitive rest may only be of use in the acute phase after concussion; however, they all found the evidence to be low level and inconclusive 3 , 14 , 15 . One review, focused on children, found that rest beyond the acute period may prolong symptoms 14 .…”

Section: Boxmentioning

confidence: 99%

“…Evidence does not support that rest beyond this period improves recovery; in children, prolonged rest may prolong symptoms 3,14,15 New recommendation: light intensity activity beyond initial period until the resolution of symptoms Consensus statement supports early introduction of symptom-limited physical activity if appropriate, although the evidence is not strong 3 the past 4 years. 2 Previously, consensus opinion recommended complete rest until the resolution of symptoms as the cornerstone of concussion management.…”

mentioning

confidence: 99%

“…3,14,15 Three systematic reviews concluded that physical and cognitive rest may only be of use in the acute phase after concussion; however, they all found the evidence to be low level and inconclusive. 3,14,15 One review, focused on children, found that rest beyond the acute period may prolong symptoms. 14 Accordingly, the new consensus supports light intensity physical and cognitive activity beyond the initial 24e48-hour rest period.…”

mentioning

confidence: 99%

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An update to the AIS–AMA position statement on concussion in sport

Elkington¹,

Manzanero

Hughes

2018

Medical Journal of Australia

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“…Emerging literature has indicated that prolonged periods of physical rest may be detrimental to SRC symptom recovery. 3,4 Physical activity during the subacute phase (≥ 6 weeks following diagnosis) has been explored as a potential intervention to facilitate physical and psychological recovery from SRC as well as to improve academic outcomes in young athletes experiencing prolonged recovery. 5 Though several governing bodies 1,2 have recommended cognitive and physical rest following SRC, it is imperative for researchers to investigate viable post-concussion treatment strategies to appropriately manage symptoms and facilitate positive outcomes following SRC in the acute phase.…”

mentioning

confidence: 99%

The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

Lempke¹,

Jaffri²,

Erdman³

2019

Journal of Sport Rehabilitation

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Clinical Scenario: Currently, rest following concussion serves as the keystone of concussion treatment, but substantial evidence to support it is lacking. Recent literature suggests that early physical activity may be beneficial in reducing concussion symptoms which may influence clinical recovery time. Clinical Question: Does early physical activity decrease postconcussion symptoms compared to physical rest following concussion? Summary of Key Findings: A total of 5 articles were included that examined symptom duration changes at multiple time points. All 5 studies utilized follow-up time points compared to initial examination, but there was variance in the specific time points reported. Two studies employed control groups and compared strict or recommended rest to early activity or limited rest. Three studies were observational studies that directly compared baseline measurements to follow-up assessments. Clinical Bottom Line: Current evidence suggests that early physical activity in the acute phase following a concussion may decrease the time needed for symptom resolution compared to immediate rest. Strength of Recommendation: Using Centre for Evidence-Based Medicine 2011 level 3 evidence and higher, the results suggest that early physical activity during the acute phase of a concussion may decrease symptom duration; however, a lack of high-quality studies and inconsistent interventions are limitations to this recommendation.

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Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature

Cited by 83 publications

References 65 publications

Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

An update to the AIS–AMA position statement on concussion in sport

The Effects of Early Physical Activity Compared to Early Physical Rest on Concussion Symptoms

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