Strict rest slows recovery, say sports physicians in new guidelines.


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Sports-related concussion is a common injury among U.S. athletes, with an estimated 1 to 1.8 million cases per year in youths up to the age of 18 years. When sports-related concussion occurs, earlier guidelines called for complete rest until symptoms resolve, followed by a gradual return to sports and other activities. But a new consensus statement says that strict rest actually slows recovery and may increase the probability of prolonged symptoms.


The consensus statement was developed by the Team Physician Consensus Conference (TPCC), an alliance of six major professional associations. It updates a previous version issued in 2011.


The idea that some activity following a concussion is useful is not a new concept, and it was presented during the 2011 consensus conference deliberations, according to Margot Putukian, an author of the new consensus statement. "Many sports physicians working with athletes have been advocating for aerobic activity after the first 24 to 48 hours at a level that doesn't exacerbate or create new symptoms," Putukian told AJN.


Previously, however, the premise was supported only by animal studies; its elevation to a recommendation in the new consensus statement is because of stronger research evidence. "To me, this makes a lot of sense, as athletes get very frustrated and often depressed when they aren't able to exercise," said Putukian. "So, allowing them to participate in low-level exercise that doesn't put them at risk for contact makes them feel like they're still athletes. We just don't want them to get knocked in the head again while they continue to recover."


Nurses need to be aware of this change in guidelines when educating parents. Another important take-home point from the consensus statement: concussions are treatable, and most athletes recover. In individuals with persisting symptoms (more than two weeks for adults and more than four weeks for youths), treatment should target specific symptoms.


To read the new TPCC consensus statement, go to https://bjsm.bmj.com/content/bjsports/early/2021/06/23/bjsports-2021-104235.full.-Roxanne Nelson