The nature of concussion treatment has changed and the University at Buffalo Concussion Management Clinic has been among those leading the way.
Standard protocol used to be to encourage rest as those concussed – many of them young athletes – recovered, said Dr. John J. Leddy, director of the South Campus clinic, the first U.S. center to use a standardized exercise treadmill test to diagnose, monitor and treat concussions.
“It’s been established that a little rest is good but too much rest is bad for these kids,” said Leddy, professor of clinical orthopedics at UB and a primary care sports medicine specialist with UBMD Orthopaedics & Sports Medicine.
“Physicians used to take them out of circulation completely – take them out of their social element in school, tell them to stay home, watch a little TV, but stay off your computer and don’t use your phone a lot,” Leddy said. “But recent research has shown that if you do that for more than a few days, they actually report more symptoms than if they get back into their normal levels of activity.”
The UB clinic uses controlled treadmill exercise similar to how cardiologists use it with heart patients. A normal response in both cases is walking or running until you’re tired, with few or no signs of trouble.
“Someone with concussion symptoms has an intolerance to exercise,” Leddy said. “They cannot get near their maximum because when they raise their pulse and blood pressure during exercise, the brain can’t regulate that normally. You get a headache. You get dizzy and you literally have to stop. You reach your threshold.
“If you’re not sure whether someone’s had a concussion or not, that’s one way to figure it out.”
Concussions are most common among student athletes who play football, hockey, soccer or lacrosse, and are a potential danger to anyone jumping on a trampoline, Leddy said.
When someone recovering from a concussion starts to reach their treadmill exercise threshold, Leddy said, “and their physical exam is normal, and I’m satisfied they’re doing OK at school and sleeping well – they’re back into the normal life – then I’ll let them go back and do the return-to-play protocol,” a five-step program that allows someone to get back to sports and other exercise.
The treadmill protocol also can be used as an “exercise prescription” for those lagging in recovery, the doctor said. The dose of exercise is 20 minutes on the treadmill at 80 percent to 90 percent of the predetermined threshold, followed by a cool down. “That kind of treatment speeds their treatment versus doing nothing at all,” Leddy said.
He said concussion research continues at the clinic.
“The real question for researchers now,” Leddy said, “is how much rest is optimal and when is the optimal time to introduce controlled physical activity?” Researchers also have started a trial to learn which recovery protocol might be more effective: treadmill exercise or stretching.
– Scott Scanlon