Concussion in Sport

In its earliest statements, based on animal research data and expert opinion, the Concussion in Sport Group (CISG) proposed cognitive and physical rest until acute symptoms resolved as a prerequisite for post-concussion (CC) management. In 2016, he qualified his position by pointing out the lack of evidence regarding the effectiveness of prolonged rest compared to a short period of 24-48 hours. At the same time, several studies suggested the beneficial effect of short periods of physical activity (PA) after CC. At least in rats…

Faced with CC, frequent in sports, the practitioner is confronted with two difficulties. The first is to identify them, because the signs are often not very suggestive, except in severe forms with postural disorders or loss of consciousness. The second is that in about a third of cases, adolescents who have suffered from CC retain signs of it a month later, with potential impairment in their academic performance, physical activity and quality of life. .

In order to optimize post-CC management, an American team (University at Buffalo) conducted a systematic review with meta-analysis to determine the best strategy to offer within 14 days (PA, rest, sleep), and to when to prescribe a PA.

Querying the usual databases revealed 11,078 articles, of which 46 were retained for analysis (34 with an acceptable risk of bias, 17 prospective), representing 9,432 people (40% women, aged 5 to 33).

Better light physical activity in the next two days and no screen!

The authors observe that, compared to strict rest or the absence of PA, the practice of a light intensity PA within 2 days after CC, then an endurance PA prescribed within 2-14 days, the all coupled with reduced screen usage within 2 days, shortens recovery by 4.6 days. The level of evidence is high for adolescents and young adults, and reasonably transposable to children.

Concretely, during 48 h post-CC, it would be advisable to avoid strict rest, to propose a walking-type AP, of an intensity low enough not to exacerbate the symptoms (no more than 2 points of increase on a scale from 0 to 10 in relation to the level of preactivity) and to limit the screens (smartphones, computers, etc.). Finally, clinicians who have access to an exercise test could prescribe an aerobic PA from the 3rd day whose maximum heart rate (HR) would correspond to 90% of the HR from which a notable exacerbation of symptoms appears.

Dr. Patrick Laure

Référence : Leddy JJ, Burma JS et al. : Rest and exercise early after sport-related concussion: a systematic review and meta-analysis. Br J Sports Med 2023;57:762 – 770. doi: 10.1136/bjsports-2022-106676.