New guidelines on concussions

When young athletes sustain concussions, they are typically told to rest until all symptoms disappear. That means no physical activity, reading, screen time or friends, and little light exposure, for multiple days and, in severe cases, weeks.

 

Restricting all forms of activity after a concussion is known as “cocooning.” But now new guidelines, written by an international panel of concussion experts and published this month in The British Journal of Sports Medicine, question that practice. Instead of cocooning, the new guidelines suggest that most young athletes should be encouraged to start being physically active within a day or two after the injury.

 

“The brain benefits from movement and exercise, including after a concussion,” says Dr. John Leddy, a professor of orthopedics at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and one of the co-authors of the new guidelines.

 

There has long been controversy, of course, about the best ways to identify and treat sports-related concussions. Twenty years ago, athletes who banged their heads during play were allowed to remain in the practice or game, even if they stumbled, seemed disoriented, or were “seeing stars.” Little was known then about any possible immediate or long-term consequences from head trauma during sports or about the best responses on the sidelines and afterward.

 

Since then, mounting evidence has indicated that sports-related concussions are not benign and require appropriate treatment. The question has been what these appropriate treatments should be.

 

In the early 2000s, dozens of the world’s premier experts on sports-related concussions started meeting to review studies about concussions, with plans to issue a consensus set of guidelines on how best to identify and deal with the condition.

 

The panel, called the Concussion in Sport Group, does not make formal clinical practice guidelines. But the group’s findings do represent the latest thinking about sports concussions by the world’s experts, based on the newest published science, says Dr. Leddy, who is also medical director of the Buffalo Concussion Management Clinic.

 

In its 2012 guidelines the Concussion in Sport Group recommended broadly that if an athlete of any age was found to have a sports-related concussion, he or she should rest as completely as possible, remaining in a darkened room with little visual or physical stimuli, until all symptoms had gone away and did not return once the athlete began easing back into normal activities, which could be a week or more.

 

This approach was thought to “promote recovery by minimizing brain energy demands following concussion,” the authors write in the new statement.