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Turning concussion research on its head

Concussed athletes should commence moderate intensity exercise within two days of injury according to new Australian Catholic University research that challenges traditional approaches recommending rest.

Risk of brain injury is a hot topic in contact sports, with the NFL, Australia’s NRL and England’s RFL involved in litigation over neurological complications experienced by players during their careers.

Strict return to participation protocols have been introduced and Sports Medicine Australia concussion policy advises “the main treatment for concussion is rest. After 24–48 hours of rest, light intensity physical activity is allowed as long as such activity does not cause a significant and sustained deterioration in symptoms.”

However, a new study from researchers at ACU’s School of Allied Health and published in the British Journal of Sports Medicine found better results could be achieved by beginning moderate intensity exercise soon after concussion as long as it didn’t exacerbate symptoms.

“They should commence a well-designed exercise program straight away,” lead researcher Sue Reid said.

“Our research showed concussed individuals with persistent symptoms were three times more likely to have returned to sport within eight weeks if they received tailored, presentation-specific, multimodal interventions that includes physiotherapy to the neck, eye and vestibular (inner ear) system.”

The findings were drawn from a systematic review of almost 3000 articles. Of those, 12 studies with a combined 647 participants were identified.

In exploring the effect of physical interventions on outcomes following concussions, Dr Reid identified two key takeaways:

• That physiotherapist-prescribed neck and eye exercises can reduce symptoms in concussed individuals, an approach that leads to faster return to sport for those with persistent (>2 weeks) symptoms.
• Subthreshold exercise, or activity at 80-90 per cent of the heartrate at which symptoms were exacerbated, has a small to moderate effect on reducing symptoms and could commence within 48 hours.

Subthreshold exercise could be performed on a stationary bike, treadmill, fast walking up an incline/stairs, or jogging and a guide is about 20 minutes a day.

“The contrast between the old and this new approach is striking,” Dr Reid said.

“Following the 2016 International Consensus Conference on Concussion in Sport (Berlin), it was advised that people have 24-48 hours of physical and cognitive rest followed by a graduated return to physical activity.

“But our recent review of the literature and recent research studies shows this advice needs to be reassessed.”

Dr Sue Reid is available for interview

Media Contact: Damien Stannard, 0484387349, damien.stannard@acu.edu.au