The Recommendation for Rest Following Acute Concussion

The Effect of Physical Exercise After a Concussion: A Systematic Review and Meta-analysis

“…In addition, the benefits of rest are assumed rather than supported by evidence. 22,31,35 A recent randomized controlled trial (RCT) showed a decrease in the Post-Concussion Symptom Scale (PCSS) score with 1 to 2 days of rest after a concussion, followed by a gradual return to activity, compared with a strict rest of 5 days. 34 Other studies showed decreases 23,27 with no effect 13,19 of exercise on the PCSS score in patients with an acute concussion.…”

Clinical features and biomarkers of concussion and mild traumatic brain injury in pediatric patients

“…However, on the basis of the current understanding of mTBI and concussion in children, these consensus statements all recommend using a more conservative approach when applying the guidelines to the pediatric population. Recent evidence has further highlighted some of the uncertainty regarding the appropriate amount of rest to recommend for pediatric patients following a concussion by showing that adolescents adhering to 5 days of strict at‐home rest had a slower resolution of symptoms and higher symptom burden in the first 10 days after concussion when compared to adolescents who followed less strict rest protocols . As a result of the increased attention to mTBI in children, every state has now passed legislation outlining the appropriate medical care for children and adolescents with concussion, as of January 2014.…”

“…Recent evidence has further highlighted some of the uncertainty regarding the appropriate amount of rest to recommend for pediatric patients following a concussion by showing that adolescents adhering to 5 days of strict at-home rest had a slower resolution of symptoms and higher symptom burden in the first 10 days after concussion when compared to adolescents who followed less strict rest protocols. 22,23 As a result of the increased attention to mTBI in children, every state has now passed legislation outlining the appropriate medical care for children and adolescents with concussion, as of January 2014. A recent study looked at the impact on healthcare utilization since the original state legislation was passed in Washington, D.C. in 2009 (the Zackery Lystedt Law) and found that despite overall increased healthcare utilization for children with concussions in all states, there was a significantly higher rate of utilization in states where specific legislation had been passed.…”

Mode and Intensity of Physical Activity During the Postacute Phase of Sport-Related Concussion: A Systematic Review

“…[5][6][7] It is common for individuals to experience a spontaneous resolution of symptoms within 2 to 3 weeks; therefore, until recently, the consensus regarding traditional treatment included physical and cognitive rest until the symptoms were resolved. [8][9][10] McCrea et al 11 studied 635 concussed collegiate and high school athletes and concluded that a symptom-free waiting period that was used in 60% of their cases did not influence clinical recovery or reduce the risk of another concussion. Yet, there was continued high utilization of waiting periods until the symptomfree state was reached.…”

“…Recent studies have contradicted the idea that complete rest facilitates optimal recovery. Meehan and Bachur 10 completed a study that found that participants who were prescribed strict rest had a slower symptom resolution and had a higher symptom burden during the first 10 days after their emergency department visit than those prescribed usual care. Thomas et al 13 found that adolescents who received usual care, including 1 to 2 days of rest (acute phase) followed by a gradual increase in nonsymptom-producing activities during the postacute period, had fewer symptoms over 10 days compared with the intervention group prescribed strict rest.…”