New first concussion protocols show faster recovery

Author Erik Magraken is a British Columbia litigation lawyer, combat sports law consultant, combat sports law blogger, and deeply, deeply appreciated UGer.

In recent years concussion recovery advice has shifted from a model of strict physical and mental rest while symptoms persist to a more active model with activity being recommended so long as symptoms are not aggravated. A recent study was published in the Journal of Osteopathic Medicine reviewing the recovery of athletes who suffered and recovered from a first time sports concussion following modern advice as contrasted with the older strict rest model. The study found that the modern active recovery model led to decreased duration of symptoms.

The study, titled First-time sports-related concussion recovery revisited: management changes and impact on recovery was authored by Dr. John Neidecker, a sports medicine physician and an active ringside physician in combat sports. In it Dr. Neidecker reviewed the clinical records of 182 11-18 year old athletes who sustained their first concussion during sports. The records were reviewed to gauge their recovery time using the active model and then contrasted with data from athletes several years ago who used the physical and mental rest model. The data revealed fairly significant reduction of recovery time using the more modern methods revealing “a shorter median duration of concussion symptoms compared with the 2011–2013 athletes (median duration 5 vs. 11 days for male athletes and 7 vs. 28 days for female athletes“.

The full abstract reads as follows:

Context: Concussion is among the most common injuries in athletes. Over the past 10 years, concussion knowledge has expanded, and guidelines for management have changed. Recent changes include recommendations against strict mental and physical rest after sustaining a concussion, a better recognition of preexisting conditions predisposing protracted concussion recovery, and the addition of preliminary patient counseling and education about the expected course of concussion recovery.

Objective: To assess the impact of changes in concussion management on the duration of symptoms in middle school and high school athletes after sustaining a first-time, sports-related concussion.

Methods: A retrospective review was performed of medical records of athletes who sustained a concussion between 2016 and 2018 and were treated by the same primary care physician (J.M.N) using the revised approach to concussion management described. Patients were included if they were 11 to 18 years old and had a diagnosis of first-time concussion sustained while playing organized sports. Athletes who sustained a concomitant injury or sustained a concussion outside of organized sports were excluded from the study; athletes lost to follow-up or with incomplete forms were also excluded. Each athlete’s length of symptomatic time from his or her concussion was calculated. This data was then compared with a previously-published data set of athletes who sustained a concussion between 2011 and 2013, with the same inclusion criteria but a different approach to concussion management.

Results: A total of 110 male and 72 female athletes (N=182) met the study’s eligibility criteria. Collectively, athletes of both sexes from the 2016–2018 data set reported a higher incidence of preexisting conditions associated with prolonged concussion recovery compared with the data set of 2011–2013 athletes. However, both sexes from the 2016–2018 data set also reported a shorter median duration of concussion symptoms compared with the 2011–2013 athletes (median duration 5 vs. 11 days for male athletes and 7 vs. 28 days for female athletes, respectively; p<0.001).

Conclusion: Recent changes in concussion management have led to decreased duration of symptoms among 11- to 18-year-old athletes with first-time, sports-related concussions. These management changes include advocating for early activity, recognizing preexisting conditions, and educating athletes about the realities of concussion recovery.


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