If you have a child with a concussion, prolonged rest after the first few days may not be the best treatment even though it has been recommended for years.
Instead, a consensus is growing that mild, controlled aerobic exercise may speed recovery.
That’s a reversal of conventional medical wisdom, and more scientific study is needed to confirm the new thinking.
But University at Buffalo researchers may offer an answer as they embark on a clinical trial of exercise and stretching treatments for adolescents with concussions.
The study comes at a time of increased concern over the timely identification and management of concussions.
It has been estimated that as many as 3.8 million sports- and recreation-related traumatic brain injuries, including concussions, occur in the United States each year. But the true incidence is unknown, since many concussions go unreported and professionals use different definitions for the injury.
“If we show a program of controlled exercise works, it will change the treatment,” said Dr. John Leddy, principal investigator on the study and medical director of the UB Concussion Management Clinic.
Similar work by Leddy and his colleagues has shown exercise benefits patients with post-concussion syndrome. But the treatment must be finely calibrated to each patient because too much exercise can set off symptoms and delay recovery.
“There has to be some rest in the first few days. After that, controlled exercise that gets the heart rate up may be advantageous. You can’t just go running around on your own. Stretching may also be helpful, but we don’t know for sure,” he said.
Specialists believe that prompt and active treatment can quicken recovery, and reduce or eliminate the potential long-term effects of concussions. The study, which is being conducted with the University of Manitoba, will enroll about 40 adolescents with concussions ages 13 to 17 into either a stretching or exercise program or standard treatment for comparison. A randomized controlled trial is considered the gold standard in research.
Julia Whipple, 16, an honors student at Hamburg High School, was among the first adolescents to enroll. She was injured playing soccer, one of the most common sports for concussion injuries.
“When I heard that I would be allowed to continue with some exercise while I recovered, I was excited,” Julia said in a statement. “I didn’t want to just go home to my bedroom and wait for symptoms to disappear.”
She recovered after the treatment, which involved exercising on a treadmill while monitoring physiological indicators such as heart rate.
Imaging studies in previous research suggest that changes occur in the brains of concussed patients from hypermetabolic activity that alters blood flow. Concussions also may quiet activity in key areas of the brain, including the cerebellum, responsible for balance and coordination, according to the UB researchers.
The current study is focusing on adolescents because they are the most vulnerable to injury and take the longest time to recover.
Leddy, a professor in the Jacobs School of Medicine and Biomedical Sciences, said graduated aerobic training after a few days of rest – and rest initially is recommended – may improve the regulation of blood flow by conditioning the brain to gradually adapt to repetitive mild elevations of blood pressure.
“We don’t have a way to speed the recovery of concussion patients. There is no pill, no established rehabilitation protocol,” Leddy said. “But word is getting out that rest may not help recovery and may delay it.”
One question that remains unanswered is just how much exercise is beneficial.
“We know that activity helps to speed recovery, but we also know too much activity prevents it,” Barry Willer, director of research for the UB Concussion Management Clinic and coordinator of study design, said in a statement. “A major goal of our research is to determine how much activity, and what activity, is best.”
The study will join a small but growing body of research into exercise as a treatment. Reaction from one source was positive.
“Good steps in the real direction of the real issue here – management of concussion,” read a response by the Concussion Blog on its Twitter account.
The study is seeking participants – adolescents from Western New York who have suffered a very recent concussion. They can contact UBMD Orthopaedics & Sports Medicine at 204-3200 or the UB Concussion Management Clinic at 829-5499.