Physical Activity or Rest After Concussion in Youth: Questions About Timing and Potential Benefit

Mild traumatic brain injury, of which concussion is a subset, has garnered increasing attention in recent years due to the frequency of this injury and its potential for at least temporary disability. Much of the attention has focused on sports- and recreation-related concussions in youth, estimated to occur in 1.1 million to 1.9 million youth annually. Since the First International Conference on Concussion in Sport held in Vienna in 2001, consensus guidelines have recommended that athletes with concussion rest until they are completely asymptomatic, and then begin a graduated return to play over approximately 5 days. The rationale for this approach has been based on concerns about risk of second impact syndrome if athletes resume play while still symptomatic and laboratory data suggesting early physical activity prolongs recovery in animal models. There is also a sense that athletes should not be allowed to return to play too soon, or they might be tempted to play injured. Here, Chrisman and Rivara examine the relationship between early physical activity and persistent symptoms after concussion.