What is the recommended treatment for a concussion?

Concussion Treatment

For concussion management, a brief period of 24-48 hours of relative rest followed by a graded return to activity protocol is recommended, avoiding both strict bed rest and high-intensity physical activity. 1

Initial Management (First 24-48 Hours)

• Immediate removal from activity if concussion is suspected with no same-day return to play 1
• Relative rest for 24-48 hours (not strict bed rest) 1
• Acetaminophen (1000mg) is the preferred medication for headache management 1
• Avoid NSAIDs, opioids, alcohol, and recreational drugs during recovery 1
• Monitor for red flags requiring emergency care:
  • Worsening headache
  • Repeated vomiting
  • Increasing confusion
  • Visual changes
  • Seizures
  • Loss of consciousness 1

Post-Initial Rest Period (After 48 Hours)

After the initial 24-48 hours of relative rest, evidence supports a gradual return to activity:

5-Stage Graded Return Protocol

Each stage must last a minimum of 24 hours, with progression only if asymptomatic:

1. Symptom-limited activity - Daily activities that don't provoke symptoms
2. Light aerobic exercise - Walking, swimming, stationary cycling at slow pace
3. Sport-specific exercise - Running drills, no head impact activities
4. Non-contact training drills - More complex training drills, progressive resistance training
5. Full-contact practice - Following medical clearance 1

If symptoms return during any stage, stop activity immediately, rest for 24 hours, and resume at the previous asymptomatic level 1.

Evidence for Treatment Approaches

Recent evidence challenges older recommendations of prolonged complete rest. The 2023 consensus statement from PM&R indicates that:

• Strict physical rest may be detrimental rather than beneficial 2
• Aerobic exercise is appropriate for adolescents with acute concussion 2
• Combined cognitive and physical rest shows mixed evidence, with some studies showing detrimental effects of prolonged rest 2

Special Considerations

• Adolescents: Manage more conservatively due to longer recovery times and risk of second-impact syndrome 1
• Athletes with history of concussions: Consider more conservative approach; temporary or permanent disqualification from contact sports may be warranted after three or more concussions 1
• Persistent symptoms (>10 days): Require multidisciplinary management with targeted interventions including:
  • Graded physical exercise
  • Vestibular rehabilitation
  • Manual therapy
  • Psychological treatment
  • Vision therapy
  • Cognitive rehabilitation 1, 3

Common Pitfalls to Avoid

1. Prolonged complete rest - May actually delay recovery 2, 4
2. Returning to activity too soon - Can worsen symptoms and prolong recovery 5
3. Ignoring symptom triggers - Activities that provoke symptoms should be avoided until appropriate stage of recovery 1
4. Medication overuse - Can lead to rebound headaches 1
5. Failing to recognize red flags - Missing signs of more serious injury 1

Return to Full Activity

Medical clearance from a licensed healthcare provider trained in concussion management is required before full return to play or activity 1. The minimum recovery time is 5 days to progress through the protocol, provided symptoms do not return 1.