From the Guidelines
Concussion management should prioritize a stepwise return to play, with an initial 24-48 hours of rest, followed by gradual progression to light aerobic exercise, moderate activity, non-contact training drills, and finally full-contact practice after medical clearance, as recommended by the most recent guidelines 1. The management of concussion involves several key steps to promote recovery and prevent further injury. Initially, rest is crucial for the first 24-48 hours after injury, including both physical and cognitive rest. After this initial period, patients should gradually return to normal activities while staying below the threshold that triggers symptoms.
- Physical activity should follow a stepwise progression:
- Light aerobic exercise (walking, stationary cycling)
- Moderate activity (jogging, brief running)
- Non-contact training drills
- Finally full-contact practice after medical clearance
- Acetaminophen (500-1000mg every 6 hours as needed) is preferred for headache management, while NSAIDs like ibuprofen should be avoided initially due to bleeding risk, as suggested by previous studies 1.
- Patients should avoid alcohol, recreational drugs, and sleep medications during recovery.
- Adequate sleep, proper hydration, and a balanced diet support healing.
- Symptoms typically resolve within 7-10 days for adults and 4 weeks for children, though some may experience prolonged recovery, as noted in recent research 1. Medical attention is necessary for worsening symptoms, persistent vomiting, increasing confusion, seizures, or weakness/numbness in limbs. This careful approach allows the brain time to heal while gradually rebuilding tolerance to activity, reducing the risk of prolonged symptoms or second impact syndrome. The most recent guidelines from the American Heart Association and American Red Cross 1 emphasize the importance of removing individuals with concussion from sports and other activities posing a risk of reinjury until they have fully recovered, and provide a framework for return to play that prioritizes gradual progression and medical clearance.
From the Research
Guidelines for Concussion Management
The management of concussions involves a combination of rest, gradual return to activity, and monitoring of symptoms. The following guidelines are based on current research:
- Immediate cognitive and physical rest is recommended after a concussion, with the goal of reducing symptoms and promoting recovery 2
- However, prolonged cognitive and physical rest can be detrimental, and a gradual return to activity is recommended after 24-48 hours of rest 3, 4
- Return to sport should only occur once the patient is symptom-free 3
- A graded return-to-activity progression is recommended, with a gradual increase in physical and cognitive activity 5
Return to Learn and Play
- Gradual return to learn and play is recommended, with the goal of minimizing symptoms and promoting recovery 3, 6
- Return to full cognitive effort should be guided by the patient's symptoms and progress, with accommodations made as needed 6
- School accommodations may be necessary for students who have experienced a concussion, such as reduced workload or modified assignments 6
Treatment and Rehabilitation
- There are no FDA-approved medications for the acute treatment of concussion, but omega-3 fatty acids may have potential benefits 3
- Active rehabilitation, including physical therapy and vestibular-ocular exercises, may be beneficial in promoting recovery and reducing symptoms 4, 5
- Further research is needed to determine the effectiveness of various treatments and rehabilitation strategies for concussion management 3, 5