UPMC Concussion Conference: Is Rest Not Best?

Kuechly

It’s well into October so for me, that means football season! Although he plays for my favorite team’s conference rival, Carolina Panthers’ Luke Kuechly will always hold a special place in my heart because he is a Boston College Eagle. The 2013 Defense Player of the year finally returned to the field this week, 34 days after sustaining a head injury during week 1 of the season.

This concussion protocol involving rest and recovery is not uncommon in recent years, during which the NFL has been making huge efforts to combat the negative press that concussions have been making. The league has even introduced “Eye in the Sky,” the sports medical staff high above the action watching for missed injuries – especially contact to the head.

But the way that we identify these injuries isn’t the only thing that’s gone under scrutiny lately. This week an article was published in the Pittsburgh Post-Gazette: “Rest not best for concussion recovery, experts conclude during UPMC Concussion Conference.” In this article, author Craig Meyer discusses a summit that took place this week in Pittsburgh where 37 concussion clinicians and researchers came together to discuss their findings on post-concussion rehabilitation. To date, there is no standardized protocol to treat concussions; however it is generally accepted that a period of rest is necessary for recovery. The consensus from this summit, Meyer writes, was that in fact “prolonged rest, a popular treatment options for concussions, does not aid in recovery and can actually worsen it.” And instead, it is exercise that is most beneficial.

So does that mean Luke Kuechly should have been back on the field week 2? I’m not sure that’s true. The summit conclusions have been under some degree of scrutiny, particularly given UPMC’s relationship with the NFL. It is expected that more questions will be answered once the authors publish their findings in the next couple of months. For me, one thing that jumped out was the panel’s consideration of secondary psychological effects of rest, as mentioned by Dr. Javier Cardena, a neurologist from the Barrow Concussion and Brain Injury Center:

Many times, we see patients who are completely restricted from any physical activity… As one of the major sources of this injury is sports and athletics, for those who are involved in athletics, this is actually a punishment. They become depressed. They become anxious. So allowing them to participate in physical activity — while keeping them out of harms’ way, of course — is actually a rehabilitation method.

But just because rest can cause adverse symptoms, does that mean that exercise is the cure?

Concussion management will continue to be a hot topic, especially given their high visibility in the sports world. I am happy that there we are making strides toward mitigating the long term damages of these injuries through improved identification and exploring modifications in treatment. I look forward to reading more about the findings from this group, and even more importantly, the subsequent studies to come.

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