A new Canadian study carried out with adolescents confirms that resuming physical activity 72 hours after a concussion is safe and even speeds recovery.
Not so long ago, concussion victims who presented to the emergency room were advised to rest completely until their symptoms disappeared. They were advised to lie on their beds with the lights off and in silence. Since then, several scientific studies have questioned these recommendations.
“This way of doing things had serious consequences, insofar as it led to a complete deconditioning, psychological, emotional and physical. Some people fell into torpor and then could develop kinesiophobia, a fear of moving and going out,” explains Dave Ellemberg, professor at the School of Kinesiology and Physical Activity Sciences at the University of Montreal.
The clinical trial conducted by researchers from the CHEO (Children’s Hospital of Eastern Ontario) Research Institute and the University of Ottawa involved 456 young people aged 10 to 18 who found in the emergency room of three pediatric hospitals in Ontario between March 2017 and December 2019 following a fall on the head associated with symptoms of concussion.
These 456 patients, who were not necessarily athletic, were randomly separated into two groups. A first group was instructed to resume physical activity 72 hours after the trauma, according to a very gradual protocol, even if the individuals were still experiencing symptoms, while the second group was not to activate until the symptoms had not completely disappeared.
When the researchers compared the participants’ symptoms two weeks after enrolling in the study, they found no significant difference between the two groups: a result that indicates that “early physical activity is not harmful”, explains Andrée-Anne Ledoux, the first author of the study, which was published in the British Journal of Sports Medicine.
On closer inspection, however, the researchers noticed that many participants did not adhere to the protocol assigned to them. Nearly 32% of participants who had to resume physical activity after 72 hours did not follow this instruction. The researchers then made a new comparison between the two groups, after eliminating the participants who had not adhered to the protocol.
They then found that subjects who had resumed physical exercise 72 hours after their trauma had significantly fewer symptoms after two weeks than those who had waited until they were asymptomatic. “Their recovery was better and faster than that of the second group,” says researcher Ledoux, of the CHEO Research Institute.
Case by case
“We are not saying that, 72 hours after a concussion, a young person can put on their skates, jump on the ice and play a game of hockey. We are not talking about a return to sport after 72 hours, but about a gradual reintroduction of physical activity in the routine of the child, provided that this activity does not aggravate his symptoms and that these remain tolerable. precise Mme Ledoux, also a professor at the University of Ottawa.
These symptoms are most often headaches, nausea, even vomiting, fatigue, irritation, sadness, depressive symptoms, confusion or dizziness.
Researchers recommend walking 15 minutes at a time a day as a starting point, but not running or doing resistance training, such as free weights, or activities with a high risk of causing another concussion. If all went well, the next day they can begin aerobic activities, such as low-intensity jogging or stationary cycling, but the activity should be “moderate and not too vigorous”.
Today, we know that physical activity is probably the best, if not the only way to recover from a concussion. The question that remains unanswered is when to start physical activity again. This is where it is critical and this is where there is some vagueness. The University of Ottawa study guides us.
Then, we further increase the intensity of physical activity, but “we still do not allow [au jeune] to return to sports like football. In a fourth stage, the subject can begin to go to his sports training, but avoiding collisions. “It is only when he has returned to school full time, that his symptoms have completely disappeared and that he has gone to see his doctor that he can return to his contact sport”, specifies Mme Ledoux.
According to Mr. Ellemberg, “32% of the participants in the first group may not have adhered to the protocol because it did not suit them to return to activity so quickly. Perhaps, when these young people resumed physical activity, they saw their symptoms increase”. “That leads me to say, he adds, that we don’t necessarily have to apply this three-day protocol to everyone. I think doctors and athletic therapists still have to do a case-by-case analysis. »
“You also have to take into consideration the patient’s history, because we know that for a person who has suffered two, three or even four concussions, recovery will be slower, more difficult. And the same will be true for people who experience more symptoms (on average six or seven symptoms) as well as for those who report post-traumatic amnesia,” he adds.
“Today, we know that physical activity is probably the best, if not the only way to recover from a concussion. The question that remains unanswered is when to start physical activity again. This is where it is critical and this is where there is some vagueness. The University of Ottawa study comes to guide us,” he notes.
The Dr Jocelyn Gravel, pediatric emergency physician at the CHU Sainte-Justine, finds this study particularly interesting because it examined a general pediatric population that better represents the reality of emergencies, whereas the majority of past studies have been carried out in sports clinics on top athletes.
The Dr Gravel is increasingly convinced that it is appropriate to resume light, aerobic physical activity as long as it does not involve the risk of trauma to the head, “because it is very dangerous to suffer a second concussion before ‘to have healed the first,’ he warns, citing in support a study of the The Lancet Child Adolescent Health.
Researcher Andrée-Anne Ledoux also points out that, in several other medical contexts, such as following a cerebrovascular accident (CVA), one of the first prescriptions for rehabilitation is to resume physical activity as soon as possible, because the latter “is beneficial for the brain and for physical health”.