COMMENTARY

Helping Teens Recover Faster Post Concussion

William T. Basco, Jr, MD, MS

Disclosures

October 16, 2019

The guidelines are well known and quite clear: Teens who experience a concussion should not be allowed to return to contact, collision, or any high-risk activities like vigorous sports until symptoms of the concussion have resolved. Subsymptom activity—activity that does not result in headache, dizziness, or other symptoms—is allowed. In fact, more recent research suggests that quickly returning to light activity, like brisk walking, may be beneficial.

A new study, this time a randomized controlled trial (RCT) in teens who had experienced a sport-related concussion within the previous 10 days, provides even more evidence. The trial participants were randomly assigned to either a structured stretching program or a treatment program that emphasized aerobic exercise up until the point of experiencing symptoms.

The main goal was to determine the number of days until recovery—defined as the ability to exercise "to exhaustion" without experiencing any concussion symptoms—for teens in both groups. Teens in the exercise group hit that milestone by 13 days (on average) compared with the 17 days it took for the adolescents in the stretching-program arm. Even after adjusting for age, sex, concussion history, and time from injury to enrollment, the aerobic exercise group recovered faster. Seven of the kids in the stretching group had "delayed recovery" (> 30 days) compared with two in the exercise group, a difference that was not statistically significant.

So, for the first time, an RCT has found that subthreshold aerobic exercise that did not trigger symptoms actually improved time to recovery in adolescents with a sport-related concussion.

Viewpoint

The authors make a good point that their findings alone are not enough to say that rapid return to play is advisable. Instead, their work represents another brick in the wall of research currently being conducted in the care of kids with sport-related concussion. But I suspect that this study, especially when combined with other research, will prompt additional, similar ones to try to determine whether early return to "light" physical activity, or even aerobic exercise, can be beneficial or at least not harmful for teenagers after experiencing a concussion.

A lot has changed in our approach to concussion in a fairly short amount of time. The 2018 guidelines from the American Academy of Pediatrics, the first update since 2010, made substantive changes in recommendations in a number of areas. Initial acute evaluation should ideally be conducted off the field in a quiet area like a locker room, using objective tools like the Sport Concussion Assessment Tool (SCAT). And as this study details, treatment continues to evolve.

William T. Basco, Jr, MD, MS, is a professor of pediatrics at the Medical University of South Carolina and director of the Division of General Pediatrics. He is an active health services researcher and has published more than 60 manuscripts in the peer-reviewed literature.

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