One of the most common things you will get told after a concussion is to rest up to 2 weeks, until your symptoms go away. No jogging, no quick walking, no jumping. What we now know is that complete rest can be one of the WORST things you can do for a concussion!!!
Let us explain…
Concussion is a completely recoverable brain injury which is initially caused by an action that has caused your brain to accelerate or decelerate really quickly. An example would be a head-to-head collision during soccer or a ‘head whip’ through a shoulder-to-shoulder contact during AFL. Due to this quick acceleration/deceleration, the nerves in your brain ‘stretch and shear’ which causes a huge release of energy.
However, all things that go up must come down. With such a huge release of energy in the brain, all energy stores are used up, resulting in an extreme sense of tiredness! It takes some time to get the brain energy levels back to normal, but it does get there! Now, the reason and rationale that rest is prescribed is basically because the brain is in a state of energy fatigue after a concussion and resting will help get the brain back to normal.
It makes sense, right? However, there is limited evidence suggesting rest is beneficial and ALOT of evidence suggesting that light to moderate (not vigorous) physical activity, in the early stages of a concussion, is appropriate. Now to be clear, 24-48 hours of rest from activity is appropriate and when you do any physical activity after the short rest period, you should not do anything which may put you at risk of hitting your head. Think of doing gentle things like power walking, jogging and lap swimming. Excessive rest, after 48 hours, is one of the worst things you can do in your concussion recovery journey.
WHY CAN REST BE BAD FOR YOU?
• In as little as 48 hours physical deconditioning can start to happen. We also know that rest alone can reduce blood flow to the brain. We need blood flow to help with the recovery of the brain!
• It can feel pretty average being confined to your house, being told you can’t go walking, use your phone or socialise. We all experienced this, first hand, during COVID and it wasn’t great for our mental health. It can make us anxious and depressed.
• Being told to stay at home and even a ‘text message can damage the brain’ is pretty scary to hear! This can cause anxiety which may add ‘fuel to the fire’ of any symptoms you may have.
Generally, 24-48 hours of rest is perfectly fine to give your brain a bit of a break after an injury – just like your ankle needs a break after an ankle sprain. Thankfully, your brain will start to recover with time. Most activities are fine to do in the first day as long as it doesn’t increase symptoms. So, if you wanted to watch 15 mins of TV or send a text message – go for it! However, if it brings on symptoms, give it some more time and try again later!
WHY EXERCISE CAN BE VERY GOOD FOR YOU!
• Exercise helps regulate the autonomic nervous system; this system controls certain body processes such as heart rate, blood flow to the brain and digestion. Concussion can change some of these processes such as a reduction in blood flow to the brain and exercise can certainly help with its recovery.
• Maintain your physical conditioning; It can be so hard to get back to sport if you had a few weeks off and not allowed to exercise. By staying conditioned you’re less likely to get fatigued as much on your return and stay injury-proof.
• Ward off anxiety and depression; exercise can naturally release an army of endorphins that can make us feel great. It really helps for us to have these ‘mini-wins’ to set us up well for the battle of concussion.
In theory this all sounds great… but if that’s true why does everyone keep telling me I need to rest anyway? Unfortunately, it can take YEARS for any new evidence discovered to reach the community level. So, it may just be that some doctors, healthcare providers or trainers aren’t aware of the most recent research. In one strange study in 2015 by Moor et al., they found that adolescents who didn’t adhere to their doctor’s advice of ‘rest’, recovered quicker than the patients who actually adhered to the doctor’s advice.
Another study, by Lawrence et al. in 2018, found that for each successive delay to the initiation of aerobic exercise, people had a less favorable recovery trajectory. Compared to day 1,
• Exercise initiated on day 5 had a 59% reduced probability of returning to sport within 30 days. • Exercise initiated on day 7 had a 75% reduced probability of returning to sport by day 30. • Exercise initiated on day 14 had an 89% reduced probability of returning to sport by day 30.
One of the biggest studies we have on the positive effects of exercise came from Leddy et al. in 2019. They looked at people, in the early stage of concussion, who felt symptoms when starting to exercise at a certain intensity. Leddy et al. divided these people into a stretching group or into an exercise group, who were allowed to exercise at a level which didn’t make their symptoms worse. They found that the sub-symptom threshold exercise group recovered from concussion significantly quicker than the stretching group. This was a huge study that showed that individualized sub-symptom threshold exercise, which was prescribed to them by a healthcare practitioner during the first week of concussion, sped up recovery with no compromise whatsoever to a person’s safety!
It is important for you to be assessed and treated by a healthcare provider with experience in concussion management. This is to determine what level is safe for you to exercise, using a heart rate monitor. Going too easy may not lead to a positive effect, whereas going too hard may lead to symptom exacerbation. Finding the sweet spot is the name of the game!
Matthew Gregory
Matt is a physiotherapist who graduated with a Masters of Physiotherapy from the University of Sydney in 2017. Matt developed a passion for the treatment and prevention of concussion injuries after seeing an abundance of these injuries while treating winter athletes. Matt has completed both the CCMI concussion course and the Levels 1&2 Watson Headache® Approach course, using these methods together while treating patients.
He offers his services from both our Sydney CBD and Gymea practices.
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