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December 20, 2016

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

Author Affiliations
  • 1Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
  • 2The Harborview Injury Prevention and Research Center and Department of Pediatrics, University of Washington, Seattle
  • 3Editor, JAMA Pediatrics
JAMA. 2016;316(23):2491-2492. doi:10.1001/jama.2016.17562

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.1 Since the First International Conference on Concussion in Sport held in Vienna in 2001,2 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 (ie, a superimposed traumatic brain injury) if athletes resume play while still symptomatic3 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.