Athletes who have experienced a mild concussion should avoid total rest and resume light physical and mental activities to aid their recovery, according to a consensus statement issued by more than 100 international researchers and clinicians.
The statement, which took more than five years to complete and was informed by 10 systematic reviews of concussion-related evidence, updates previous guidance to avoid all physical activity until symptoms are completely resolved. It contradicts recent UK guidance to avoid contact sport for 21 days after sustaining a concussion and avoid any form of training for 14 days.
A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head, resulting in symptoms such as disorientation, dizziness, headache, amnesia or sensitivity to light and sound, which may last for several weeks.
To help shape concussion policy across elite and grassroots sport, the Concussion in Sport Group (CISG) hosts a conference every four years and subsequently issues a consensus statement aimed at optimising the care of athletes who have or are at risk of brain injury. Its latest statement, published in the British Journal of Sports Medicine, is based on the outcomes of a meeting held in Amsterdam in October 2022.
A key recommendation is that individuals can return to light-intensity physical activity, such as walking or stationary cycling, 24–48 hours after a concussion, and systematically increase their exercise intensity after this. However, they should stop if they experience a significant increase in the intensity of concussion symptoms – defined as a greater than two-point increase on a scale of 0 to 10, where 0 represents no symptoms and 10 represents the worst symptoms imaginable.
It also advised a limit on screen time in the first 48 hours after a concussion, as this may drain cognitive energy and impede recovery during the first few days.
“The message is to get patients moving, but in a controlled fashion, and that mild symptom exacerbation is OK,” said Prof John Leddy, director of the University of Buffalo’s concussion management clinic in New York and a member of the consensus panel. “But we do want people to stop physical or cognitive activity that is more than mild.”
Previous CISG guidance recommended complete rest until concussion symptoms had gone away. “But over the past five to six years we’ve had the emergence of new evidence, which is now quite strong, to show that doing that does not help recovery – it probably actually delays recovery,” said Leddy. “Whereas this more controlled form of physical activity, and even aerobic exercise, speeds recovery and reduces the incidence of persistent symptoms.”
The statement also included a series of new tools that clinicians and sports organisations could use to help them better identify and manage sports-related concussion in the short and longer term, and called for a working group to be set up to guide further research on the potential long-term effects of concussion on health.
