Concussion recovery, treatment and return-to-play
by Réjean M. Guerriero, DO*† and William P. Meehan III, MD*‡§║
*Brain Injury Center, †Department of Neurology, ‡Sports Concussion Clinic, Division of Sports Medicine and §Division of Emergency Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, MA; ║The Micheli Center for Injury Prevention and Health Promotion of the Young Athlete, Waltham, MA
Most concussions will heal on their own within a few days to a few weeks. In fact, 98% of high school athletes recover from their concussions within a month of the injury. The most important aspect of treatment and recovery is REST. There are 2 types of rest: physical and cognitive. Physical rest means avoiding vigorous exercise – avoiding activities that increase the heart rate. Cognitive rest is equally important and often overlooked. The word “cognitive” is used to describe activities that involve thinking, concentrating, remembering, or other intellectual activities. Cognitive rest means avoiding or at least minimizing cognitive activities. Common cognitive activities include schoolwork, reading, playing card or board games, playing video or computer games, and text messaging. Typically the more dedicated one is about rest and recovery; the quicker one can return to normal activities.
Returning to sports should be done in progressive stages. The following recovery plan was adapted from the most recent International Conference on Concussion in Sport. Typically, each step occurs over a 24-hour period monitored by medical personnel, such as a doctor or athletic trainer. An individual must remain symptom free in order to progress to the next stage. If symptoms return at an activity level, the athlete should return to the prior symptom-free step for at least 24 hours.
Step:
1. Complete physical rest
2. Light aerobic exercise, such as walking or easy (low effort) stationary cycling.
3. Sport-specific exercise, such as ice skating, swimming, or running.
4. Non-contact training drills and progressive resistance training
5. Medical clearance
6. Full contact practice
7. Return to play
Conclusion
A concussion is temporary, trauma-induced brain dysfunction. It is a complex form of traumatic brain injury. This injury can result in headaches and functional disturbances that lead to the symptoms discussed above. Concussion is not bleeding, bruising, or swelling of the brain. Typically, the brain is able to recover from a sport-related concussion within a few days or weeks; however, some individuals may experience symptoms for several weeks or months. Regardless, the most important aspect of recovery from concussion is physical and cognitive rest. If you think that you or someone you know has sustained a concussion, be sure to talk with a medical professional.
Further Reading and Resources
Website sponsored by the Centers for Disease Control and Prevention:
Website sponsored by the American Academy of Pediatrics. Search “Concussion”:
www.healthychildren.org
Website sponsored by the National Federation of State High School Association. Search “Concussion”:
www.nfhs.org
Meehan, W. P. (2011) Kids, Sports, and Concussion: A Guide for Coaches and Parents.
Satan Barbara, CA: Praeger
McCrory, P., Meeuwisse, W., Johnston, K., Dvorak, J., Aubry, M., Molloy, M., & Cantu, R. (2009). Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008 Journal of athletic training, 44(4), 434–448.
