No Resting for Concussions

If you grew up playing any kind of contact sport at all, there's a good chance you suffered a concussion one time along the way. So you know that bed rest is the standard prescription for treatment. But after so many years, it looks like the team doctors and school nurses may have had it all wrong.

New evidence suggests that "multiple active rehabilitation strategies" would be a better bet than simply recommending rest for every patient with concussion. This was the conclusion of a team of concussion experts from various healthcare disciplines as well as from sport, military, and public health organizations who convened as part of a "Targeted Evaluation and Active Management" (TEAM) panel, sponsored by the NFL and the University of Pittsburgh.

"Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles," wrote Dr. Michael W. Collins, lead author of the resulting report. "Recovery varies on the basis of modifying factors, injury severity, and treatments."

The early research indicates that active treatment can be started early after concussion, and that matching targeted and active treatments to the patient's particular needs may improve recovery. As an example, some patients might receive individualized management to support them in returning to school or work, while others might receive medications to treat certain concussion-related symptoms and impairments.

This has all been a bit of a quantum shift in the understanding of how to care for concussions, and there has been very little strong research to support specific treatments or medications for concussion management.

"No single treatment strategy will be effective for all patients after concussion because of the individualized natures of the injury and its clinical consequences," Dr. Collins and coauthors write. "Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments."

Concussions, or minor head traumas, are the most common type of brain injury. They usually involve a variety of physical, emotional and cognitive symptoms, some of which may be quite subtle. Historically, with bed rest treatment, symptoms usually resolve within three months. However, it is possible for complications to persist for long afterwards, a fact that has yielded a public outcry against the way concussions have been treated in amateur and professional sports, particularly the National Football League.

The TEAM panel believes that their experience can help to increase awareness that all concussions are not the same and that, for some patients, treatment based on individual clinical profiles might be more effective than prescribed rest.

“Concussion symptoms and impairments are treatable, and active rehabilitations involving a multidisciplinary treatment team may enhance recovery,” their report concluded.

The research was published in Neurosurgery.