Is Extended Rest the Best Treatment for a Concussion?

A new study has called into question the effectiveness of treating concussions with extended periods of rest.

After a concussion, patients are typically instructed to rest for 24-48 hours before returning to any sort of physical activities, schooling, driving, or other normal activities. Some doctors may even recommend longer periods of rest to avoid re-injury or second impact syndrome, and others may advise patients to spend several days in a darkened room to allow the head and brain time to recover.

However, researchers from the Medical College of Wisconsin’s Department of Pediatrics found that extended periods of strict rest did not necessarily have the expected or doctor-recommended effects. While the study reinforces the fact that rest is necessary for concussion recovery, it questions the effectiveness of strict rest, i.e. not being allowed to make any substantial physical movements or perform any sort of normal activities.

A study by the American Academy of Pediatrics in 2015 focused on patients between 11 and 22 years of age who were brought to emergency departments within one day of suffering a concussion. Pediatric head trauma continues to fill up emergency rooms around the country, and emergency department visits for sports-related brain injuries have increased 60 percent over the last 10 years.

“Participants underwent neurocognitive, balance, and symptom assessment in the [emergency department] and were randomized to strict rest for 5 days versus usual care (1–2 days rest, followed by stepwise return to activity),” according to the text of the study. “Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups.”

The study found that strict rest after a concussion resulted in prolonged and increased symptoms. The results of the study recommend the usual care (i.e. 1-2 days of rest and a gradual return to normal activities) over strict rest when it comes to juvenile concussion recovery.

“Recommending strict rest from the [emergency department] did not improve symptom, neurocognitive, and balance outcomes in youth diagnosed with concussion,” according to the study. “Surprisingly, adolescents who were recommended strict rest after injury reported more symptoms over the course of this study.”

However, it is still established knowledge that returning to physical activity too soon after a concussion can have serious consequences. Another study, published in Medicine & Science in Sports & Exercise, studied 19 high school athletes who suffered concussions and returned to the field within 60 days of the injury; the results of the study showed 12 of the 19 athletes experienced a significant regression in their ability to simultaneously walk and perform simple mental tasks. A different study published in Medicine & Science in Sports & Exercise in 2013 found that 25 concussed high school athletes showed decreased ability to focus and difficulty switching from one task to another for up to two months after the injury.