Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jun;51(12):930-934.
doi: 10.1136/bjsports-2016-097475. Epub 2017 Mar 24.

Rest and treatment/rehabilitation following sport-related concussion: a systematic review

Kathryn J Schneider  1 , John J Leddy  2 , Kevin M Guskiewicz  3 , Tad Seifert  4 , Michael McCrea  5 , Noah D Silverberg  6 , Nina Feddermann-Demont  7   8 , Grant L Iverson  9 , Alix Hayden  10 , Michael Makdissi  11   12
Affiliations

Rest and treatment/rehabilitation following sport-related concussion: a systematic review

Kathryn J Schneider et al. Br J Sports Med. 2017 Jun.

Abstract

Aim or objective: The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

Design: Systematic review.

Data sources: MEDLINE (OVID), CINAHL (EbscoHost), PsycInfo (OVID), Cochrane Central Register of Controlled Trials (OVID), SPORTDiscus (EbscoHost), EMBASE (OVID) and Proquest DissertationsandTheses Global (Proquest) were searched systematically.

Eligibility criteria for selecting studies: Studies were included if they met the following criteria: (1) original research; (2) reported SRC as the diagnosis; and (3) evaluated the effect of rest or active treatment/rehabilitation. Review articles were excluded.

Results: Twenty-eight studies met the inclusion criteria (9 regarding the effects of rest and 19 evaluating active treatment). The methodological quality of the literature was limited; only five randomised controlled trials (RCTs) met the eligibility criteria. Those RCTs included rest, cervical and vestibular rehabilitation, subsymptom threshold aerobic exercise and multifaceted collaborative care.

Summary/conclusions: A brief period (24-48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit.

Systematic review registration: PROSPERO 2016:CRD42016039570.

Keywords: Concussion; mild traumatic brain injury; rehabilitation; rest; sports; treatment.

PubMed Disclaimer

Conflict of interest statement

Competing interests: KS has received speaking honoraria for presentations at scientific meetings. She is a physiotherapy consultant at Evidence Sport and Spinal Therapy in Calgary, Alberta, Canada and for athletic teams. KG is the Founding Director of the Matthew Gfeller Sport-Related TBI Research Center at the University of North Carolina, USA. He is a member of the National Collegiate Athletic Association's Concussion Committee and the US Soccer Federation (unpaid consultant for both). KG at times receives honoraria and reimbursement of expenses to speak at professional meetings. TS is a member of the Speakers Bureau, Avanir Pharmaceuticals. MMC receives research funding from the National Collegiate Athletic Association (NCAA). NS reports a research salary grant from the Vancouver Coastal Health Research Institute, grants and consultant fees from WorkSafeBC, consultant fees from the National Hockey League, receiving salary from the Vancouver Coastal Health Authority and Home Base, a Red Sox Foundation and Massachusetts General Hospital programme, outside the submitted work. GI has been reimbursed by the government, professional scientific bodies and commercial organisations for discussing or presenting research relating to MTBI and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs (including athletes). He receives support from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation and ImPACT Applications, Inc. MM is a consultant Sport and Exercise Medicine physician at Olympic Park Sports Medicine Centre and team physician for the Hawthorn football club (Australian Football League, AFL). He receives research funding from the Australian Football League (AFL) and non-financial support from CogState Pty Ltd. He has attended meetings organised by the IOC, National Football League (USA), National Rugby League (Australia) and FIFA (Switzerland); however has not received any payment, research funding, or other monies from these groups other than for travel costs. He is an honorary member of concussion working/advisory groups for AFL, Australian Rugby Union and World Rugby.

Publication types