Creatine Supplementation for Concussion
Based on the available evidence, creatine supplementation may be beneficial for adolescents and young adults with concussion, though this recommendation is based on limited but promising data from a single pediatric trial showing significant improvements in recovery outcomes.
Evidence Supporting Creatine Use
The strongest evidence comes from an open-label randomized pilot study in children and adolescents (ages 1-18) with traumatic brain injury, which demonstrated that creatine supplementation (0.4 g/kg daily for 6 months) significantly improved multiple recovery parameters 1:
- Reduced duration of post-traumatic amnesia 1
- Shorter ICU stays and intubation duration 1
- Improved cognitive function (p < 0.001) 1
- Better personality/behavior outcomes (p < 0.001) 1
- Enhanced communication abilities (p = 0.018) 1
- Improved self-care capacity (p = 0.029) 1
- No adverse events reported during the 6-month supplementation period 1
Mechanistic Rationale
Creatine directly targets the pathophysiological derangements that occur after traumatic brain injury, including energy metabolism disruption, glutamate excitotoxicity, and diffuse axonal injury 2. The supplement has demonstrated cognitive enhancement in healthy adults and shows promise for improving recovery from TBI by addressing these underlying metabolic disturbances 2.
Safety Profile in Adolescents
While creatine supplementation is widely used among adolescent athletes (with prevalence approaching 44% in 12th-grade athletes), the safety data is reassuring 3, 4:
- Extensive research supports creatine as safe in adults with minimal adverse events 5
- Limited but consistent evidence in adolescents shows no safety concerns 4
- The pediatric TBI trial reported zero side effects from creatine administration 1
- Growing evidence supports therapeutic benefits in multiple pediatric clinical populations 4
Important Caveats
The evidence base is extremely limited - only one randomized trial specifically examined creatine for concussion/TBI in the target population 1. This was an open-label study without blinding, which introduces potential bias. Additionally, the 2023 PM&R consensus guidelines on concussion management do not address creatine supplementation at all, focusing instead on exercise, cognitive rehabilitation, and multimodal approaches 6.
Practical Recommendation
For adolescents and young adults with concussion, consider creatine supplementation at 0.4 g/kg daily based on the pediatric TBI trial protocol 1. This dosing regimen showed benefit across multiple recovery domains without safety concerns. However, counsel patients and families that:
- Evidence is preliminary and based on a single small trial 1
- The supplement is not FDA-regulated for this indication
- Traditional concussion management (including appropriate aerobic exercise for adolescents) should remain the foundation of care 6
The risk-benefit profile appears favorable given the lack of adverse events and potential for meaningful clinical improvement in recovery parameters that directly impact quality of life 1.