What is a good treatment regimen for a sports-related mild traumatic brain injury (mTBI) or concussion?

From the Guidelines

The most effective treatment regimen for sports concussion involves a stepwise return-to-play protocol, starting with at least 24 hours of complete physical and cognitive rest, followed by gradual progression through light aerobic activity, sport-specific exercise, non-contact training drills, full-contact practice, and finally return to competition, with each stage lasting at least 24 hours and only progressing if symptoms do not worsen, as recommended by the American Academy of Pediatrics 1.

Key Components of Concussion Rehabilitation

• The initial 24-48 hours should focus on complete physical and cognitive rest to allow the brain to recover from the injury.
• A graded return-to-play protocol should be initiated once the athlete is asymptomatic at rest, with progression through stages as outlined in TABLE 5 Concussion Rehabilitation/Stepwise Return to Play 1.
• Each stage of rehabilitation should last no less than 24 hours, with a minimum of 5 days required to consider a full return to competition.
• If symptoms recur during the rehabilitation program, the athlete should stop immediately and resume at the previous asymptomatic level after at least 24 hours of being symptom-free.
• Athletes with multiple concussions or prolonged symptoms may require a longer concussion-rehabilitation program, ideally created by a physician experienced in concussion management 1.

Additional Considerations for Optimal Recovery

• Adequate sleep, proper hydration, and avoiding alcohol and recreational drugs are essential for optimal recovery.
• Acetaminophen (500-1000mg every 6 hours as needed) can be used for headache management, but NSAIDs like ibuprofen should be avoided due to bleeding risk.
• Referral to a concussion specialist is warranted if symptoms persist beyond 10-14 days (adults) or 4 weeks (children).
• The goal of this approach is to allow the brain to heal while minimizing the risk of second impact syndrome, which can occur if an athlete returns to play before full recovery and suffers another concussion, potentially causing severe brain injury.

From the Research

Treatment Regiment for Sports Concussion

• A good treatment regiment for sports concussion includes a brief period (24-48 hours) of cognitive and physical rest, followed by a gradual increase in activity 2, 3, 4
• The exact amount and duration of rest are not yet well defined and require further investigation 3, 4
• Interventions such as cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise, and multifaceted collaborative care may be beneficial 3, 5, 6
• Treatment options should be individualized, based on predominant signs and symptoms, and can include:
  • Sub-symptom threshold aerobic exercise
  • Cervical physical therapy
  • Vestibular therapy
  • Vision therapy
  • Cognitive rehabilitation
  • Cognitive behavioral therapy
  • Pharmacological management 5, 6
• Return to sport should only occur once the patient is symptom-free 2
• Omega 3 fatty acids may have preclinical benefits for acute treatment of concussion, but more research is needed to determine their effectiveness 2