As research evolves related to the issue of concussion, diagnosis and treatment, recommendations are changing.1 This means that in some cases, patients with excruciating headaches no longer have to spend hours in a dark room, trying not to move.
Physicians continue to use advanced brain imaging, but now also rely on extensive health history and functional examination to assess and plan care.1 In the near future, blood markers may be more available to aid in objective diagnosis of concussion. A combination of assessment of clinical signs and symptoms, combined with objective measurement of physiologic markers, might provide the greatest diagnostic accuracy.
Sports-related concussion (SRC) is a traumatic physiologic brain injury having a variety of cognitive, emotional, and physical effects. A commonly seen effect is inability to exercise to the usual, expected level predicted for one’s age and fitness.
Concussion is common in the general population, with 128 in 100,000 Americans experiencing some level of concussion annually. In most cases, full recovery can be expected ranging from a few days to one month. However, up to 1/3 of patients have symptoms that persist longer than one month, which may become part of post-concussion syndrome (PCS). There is much interest in how to best manage concussion patients, especially those suffering from PCS, as there is a lack of evidence-based therapies for concussion management.
Past consensus-based recommendations emphasized physical and cognitive rest until complete symptom resolution before return to training, sport, or normal activities. This concept emphasizing rest was supported by animal and human evidence related to a vulnerable period early after concussion, when the brain is susceptible to repeat injury and worsening of symptoms. There is some evidence that excessive and higher threshold exercise/activity often worsens concussion symptoms and leads to prolonged recovery.2
However, according to Dr. Mark Pfefer, director of research at Cleveland University-Kansas City, there are some indications that moderate activity after SRC can be beneficial to recovery.
“Current guidelines acknowledge the potential role of active rehabilitation programs, including graded, low-threshold, symptom-limited aerobic exercise interventions for individuals with ongoing post-concussion symptoms,” Pfefer said. “A number of published reviews demonstrate that spontaneous physical activity is safe after SRC, and that subsymptom threshold aerobic exercise may shorten recovery time after SRC, and likely reduces symptoms in individuals with PCS.”
Exercise tolerance should be assessed with physician supervision, and is safe in the absence of contraindications. Cautious use of graded exertion test protocols early post (uncomplicated) concussion may be useful in diagnosis and prognosis of concussion recovery.3, 4
Based upon review of recent studies, subsymptom threshold aerobic exercise is likely safe and effective for the treatment of PCS. Further research is needed to establish the most effective timing and dose of aerobic exercise for the active treatment of concussion. Also, research is needed to determine if exercise implementation can prevent prolonged symptoms following concussion.
1 Millard J. (2020, June 24). Updated Concussion Recommendations for Team Physicians. Medscape. https://www.medscape.com/viewarticle/932896
2 Leddy, J. J., Haider, M. N., Ellis, M., & Willer, B. S. (2018). Exercise is Medicine for Concussion. Current sports medicine reports, 17(8), 262–270. https://doi.org/10.1249/JSR.0000000000000505
3 Haider MN, Bezherano I, Wertheimer A, Siddiqui AH, Horn EC, Willer BS, Leddy JJ. Exercise for sport-related concussion and persistent postconcussive symptoms. Sports health. 2021 Mar;13(2):154-60. https://journals.sagepub.com/doi/full/10.1177/1941738120946015
4 Maurer A, Pfefer M, Peters T, Gilmore R, Segovia A, Todden C, Pulliam P. The role of exercise in concussion management: an umbrella review. Association of Chiropractic Colleges Research Agenda Conference, March 26-27, 2021, Virtual Conference. https://meridian.allenpress.com/jce/article/35/1/81/461451/Association-of-Chiropractic-Colleges-Research