Concussion: A New Approach to Treatment

Caroline Sizer, MD, FAAPMR

Concussion is the most common type of brain injury. It is caused by trauma to the head, such as blunt force or shaking as in whiplash injuries.  

Research has shown that concussions cause abnormal brain functioning by disturbing the work of the “energy-generators” of the cells of the brain, the mitochondria, and disrupting the brain’s normal blood flow pattern.  For this reason, many experts refer to an acute concussion as an “energy crisis” of the brain, particularly within the first one to two days after injury. 

The signs of concussion

There are different grades of concussion, ranging from mild to severe, and symptoms may vary from one person to another. Signs of concussion may appear immediately or may arise days after the initial injury. The many possible signs of concussion include:

  • headache
  • confusion
  • sensitivity to light or noise
  • dizziness
  • blurred vision
  • memory loss or amnesia
  • ringing in ears
  • problems with concentration
  • nausea or vomiting
  • behavior or personality changes

The old approach:  Complete rest, gradual return

Excessive physical activity immediately after concussion has been shown to prolong concussion signs and symptoms.  More seriously, a second concussion during this time can cause further damage and result in potentially fatal consequences due to what is known as second impact syndrome.  That’s why the traditional recommendation for recovery from concussion was a prolonged period of complete physical and cognitive rest. Once the symptoms stopped while at rest, a gradual return to activity could begin. 

Lessons learned:  prolonged concussion symptoms, new problems

Some of the newer research on concussions shows that complete rest prolongs concussion symptoms. This has forced health care providers to reconsider this once favored approach to concussion treatment. In addition, research on sensory deprivation shows no benefit for concussion recovery. In fact, it may actually cause significant harm by keeping individuals from rewarding and enjoyable life experiences and activities. Complete physical rest and sensory deprivation has been shown to cause:

  • mood disorders such as depression and anxiety
  • sleep and energy problems including insomnia, or a worsening of conditions such as chronic fatigue syndrome
  • physical ailments such as weakness, muscle loss, and balance problems
  • pain

The new approach: active rehabilitation

Given all that we now know, the preferred approach to concussions is active rehabilitation. This approach is not a new idea for concussion recovery. In fact, a research study in the 1970s showed that workers with a concussion who participated in active rehabilitation went back to work 14 days sooner than those who were placed on bed rest.  Also, other studies of exercise after concussion show that important chemicals for learning and brain recovery called neurotrophic factors (specifically, brain-derived neurotrophic factor, or BDNF) are increased by exercise, and actually help to protect the brain.

So, how do we know how much activity is safe in children and adults?  Research shows that gradually increasing aerobic exercise with a specialized physical therapist can safely begin as early as one week after concussion. However, it is important that the exertion from the exercise be kept at a level so as not to worsen symptoms of concussion. Active rehabilitation has been shown to speed recovery from concussion in both children and adults. 

While it is still good practice to minimize highly stimulating activities, such as use of screens and smartphones, relative rest is preferred, with gradual return to regular activities by using pacing techniques and taking breaks. These strategies help to ensure that symptoms do not increase and optimize the chances of having a speedy recovery. 

Learn more about our Lifespan Concussion Care Center.

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