• Many of us have heard that resting in a dark room is the best way to recover from a concussion.
• However, evidence shows us the contrary; that after a few days of rest low level exercise can improve brain function.
• Carefully selected and monitored exercise can help promote recovery by combating low energy, depression, insomnia, autonomic dysfunction and their consequences.
• Exercise also promotes neuroplasticity
• Neuroplasticity in the context of a concussion is the ability to recover and adapt new strategies to compensate for the deficiencies caused by the head injury.
• After you have received concussion rehabilitation therapy, how do you test the waters to see if your brain has the capacity for physical activities, exercise and sport?
• How does one know where to start once one starts to feel “good”?
• Do you just start where you left off?
• If things go well in one practice, do you return to the game?
Following a step-wise approach is the standard of care in order to promote safety and to best support neurological recovery.
Our approach combines individualized exercise progression strategies in the context of the traditional step-wise framework for returning to sport.
We also incorporate more objective data through exertion testing in facilitating our treatment decisions. The traditional framework generally involves the following stages:
1. Physical and Cognitive Rest
This allows a crucial initial period of neurological recovery and avoiding the risk of second impact syndrome. This period of no activity also allows one to learn about the injury and how to care for it. It gives time for medical assessment and to implement ideal lifestyle strategies that will set the foundation for optimal rehabilitation and optimal recovery. Complete rest for a concussion should be limited to 2-3 days as per recent research and clinical experience.
2. Low Intensity Cardiovascular Activity
The goal is to increase the heart rate. This is an essential component to the rehabilitation process for many individuals as active rehabilitation may promote the reduction of symptoms and enhance neurological recovery, in addition to the many other physical and psychological benefits of activity. During this stage symptom monitoring and a gradual increase in intensity are essential.
When the individual is able to tolerate increased cardiovascular activity, this is often the ideal time to engage in exertion testing. Exertion testing can provide a more objective and thorough evaluation of the individual’s physical and neurological functioning. This involves a cardiovascular assessment that carefully tests the various neuromuscular, vestibular, visual, and cognitive processes that are commonly affected after a concussion and may impact the individual’s ability so safely engage in sport. Often impairments can be detected during an exertion test that the individual otherwise may not notice when returning to sport-specific activity, making this a valuable component to the return to sport protocol.
3. Sport Specific Exercise
The next step is to begin the return to sport-specific activity, and gradually add more challenging components, for example challenging balance and coordination, strength, vision, or adding cognitive demand. This stage typically begins with independent exercise and then non-contact drills. Before returning to practice with the team for non-contact training drills, one would ideally undergo another more advanced exertional test to assure ourselves that the patient is ready for this transition. After successfully reintegrating with the team, the medical team will then be left with the decision of clearing the athlete for contact practice and then normal game play.
Our team will ensure that the individual progresses at the ideal pace through these stages, taking into consideration the unique challenges each patient faces and methods to effectively work through them. That is, although there is a rough guideline, return-to-athletics management is individualized in keeping with the variable nature of concussion and its recovery.
Research & writing: Dr. Taher Chugh
Last update: March 2018