Jordan Wackett MD, MPH, Joshua Kornegay, MD, Craig Rudy, MD
The most recent recommendation from the Concussion in Sport Group calls for 24-48 hours of rest and a graded return to activity (unrestricted once asymptomatic)2.
Unfortunately, asymptomatic from a concussion standpoint is not always obvious, which can make the new recommendation difficult to implement as patients may remain symptomatic while adhering to rest. Symptomatology is often multifactorial and they may be instructed to rest despite symptoms from etiologies other than concussion.3
Animal models have demonstrated loss of ionic gradients in the CNS following concussion and reduced cerebral blood flow.5 Increased activity of Na/K ATPase leads to a relative insufficiency in ATP
REFERENCES
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2. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847.
3. Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is medicine for concussion. Curr Sports Med Rep. 2018;17(8):262-270.
4. De Maio VJ, Joseph DO, Tibbo-Valeriote H, et al. Variability in discharge instructions and activity restrictions for patients in a children’s ED postconcussion. Pediatr Emerg Care. 2014;30(1):20-25.
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9. Difazio M, Silverberg ND, Kirkwood MW, et al. Prolonged Activity Restriction After Concussion. Clin Pediatr. 2016;55(5):443-451.
10. Lempke L, Jaffri A, Erdman N. The effects of early physical activity compared to early physical rest on concussion symptoms. J Sport Rehab. 2019;28(1):99-105.
11. Leddy JJ, Haider MN, Ellis MJ, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion. JAMA Pediatrics. 2019;173(4):319.
12. Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?” Recommendations for activity resumption following concussion in athletes, civilians, and military service members. J Head Trauma Rehab. 2013;28(4):250-259.
Jordan Wackett, MD, MPH
Craig Rudy, MD
