Lots of rest may not be best after suffering a concussion: experts

TORONTO -- An international panel of experts has issued an updated consensus statement on evaluating and treating sports-related concussions, which includes some tweaks on managing the brain injury and a discussion on the possible link with chronic traumatic encephalopathy, or CTE.

The goal of the statement is to update doctors, athletic therapists and other health-care providers on the best way to diagnose a concussion at a sporting event and to manage the patient's recovery over time.

"Concussion is one of the most complex injuries to diagnose and treat, and our understanding of concussion is constantly evolving," said panel co-chairman Dr. Willem Meeuwisse, leader of the University of Calgary's Brain Injury Initiative.

"This document attempts to give health-care professionals a road map to what we believe will provide the best patient outcomes."

The paper is also intended to help advise sports federations -- among them those representing hockey, football and soccer -- on how to adapt the guidelines to their individual sport.

Published in the April issue of the British Journal of Sports Medicine, the statement was penned following a meeting of 32 experts, including several Canadians, in Zurich last November. Experts have met roughly every four years since 2001, and this is the fourth consensus document to be issued.

One change in the updated version is that an athlete who has suffered a concussion may not always have to rest their brains and bodies as long as previously thought before returning to cognitive and physical activities.

Based on the latest studies, the panel agreed some of the current treatment protocols -- including extended rest -- are largely unproven and may not be ideal after the first week following injury.

They suggest a gradual return to school, social and physical activities is "a sensible approach," but athletes should receive medical clearance before returning to competition.

"Typically, we see around 80 per cent of athletes will be recovered within about a week to 10 days," Meeuwisse said Monday from Calgary.

"What's changed is in the past, we would say if you're not better, well 'get more rest.' And now we're recognizing that in the 20 per cent or so who are not recovered by 10 days, that often there are other things that are going on that require a more detailed assessment and often can benefit from rehabilitation."

Even some light exercise can be beneficial after the acute phase of concussion has passed, recent research now suggests.

Dr. Paul Echlin, a sports-medicine physician who treats concussion and also conducts research on the injury, said it's helpful to have experts weigh the research as it evolves over time and disseminate any new knowledge to health providers, athletes of all ages and levels of play, parents and coaches.

"I think it's important that this continue, this centralized and this sequential review of knowledge, and the promotion of when the knowledge does change to pay attention and document it, so there's not multiple entities saying this is the way to proceed on this injury," Echlin said from Burlington, Ont.

"I think having one source is much better than having three or four sources, which sometimes confuses the patient."

After sifting through the latest studies, the panel also confirmed that even the most state-of-the-art helmets and mouthguards do not prevent a concussion, which occurs when the brain is shaken inside the skull, similar to an egg yoke slamming the inside of its shell.

-- The Canadian Press

Republished from the Winnipeg Free Press print edition March 12, 2013 D5