Orthop J Sports Med. 2017 Oct 17;5(10):2325967117732516. doi: 10.1177/2325967117732516. eCollection 2017 Oct.
Sport-Related Concussions: Symptom Recurrence After Return to Exercise.
Orthopaedic journal of sports medicine
Michael J O'Brien, David R Howell, Michael J Pepin, William P Meehan
Affiliations
Affiliations
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA.
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.
- Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA.
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
PMID: 29085846
PMCID: PMC5648095 DOI: 10.1177/2325967117732516
Abstract
BACKGROUND: Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols.
PURPOSE: To determine the proportion and associated risk factors of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest.
STUDY DESIGN: Case-control study; Level of evidence, 3.
METHODS: Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children's hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss of consciousness with injury, prior concussion (diagnosed and undiagnosed), Post-Concussion Symptom Scale (PCSS) score, time until clinical presentation, and duration of symptoms.
RESULTS: Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury and a longer duration between injury and clinical presentation were associated with a decreased risk of symptoms recurring with exercise. Conversely, athletes who had sustained previously undiagnosed concussions and had suffered a longer duration of symptoms at rest were at an increased risk of symptom recurrence with exercise.
CONCLUSION: Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they resume exercise. The risk of symptoms recurring with exercise may be greater among those athletes who sustained previously undiagnosed concussions and had a longer period of symptoms at rest. The early identification of athletes who may be at risk of symptom recurrence will help mold treatment guidelines and exercise progression protocols.
Keywords: exercise; return to play; sport-related concussion; symptoms
Conflict of interest statement
The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.
References
- Pediatrics. 2015 Feb;135(2):213-23 - PubMed
- J Athl Train. 2009 Jul-Aug;44(4):434-48 - PubMed
- Clin J Sport Med. 1999 Oct;9(4):193-8 - PubMed
- Am J Sports Med. 2011 May;39(5):958-63 - PubMed
- Am J Sports Med. 2011 Nov;39(11):2304-10 - PubMed
- Am J Sports Med. 2011 Nov;39(11):2311-8 - PubMed
- Pediatrics. 2009 Jan;123(1):114-23 - PubMed
- Brain Inj. 2013;27(1):1-9 - PubMed
- Pediatrics. 2015 Jun;135(6):1043-50 - PubMed
- J Sci Med Sport. 2015 Sep;18(5):507-11 - PubMed
- JAMA Pediatr. 2013 Feb;167(2):156-61 - PubMed
- Acta Paediatr. 2016 Sep;105(9):e426-32 - PubMed
- Am J Sports Med. 2010 Mar;38(3):464-71 - PubMed
- Neurosurgery. 2008 Jun;62(6):1286-95; discussion 1295-6 - PubMed
- Neurosurg Focus. 2012 Dec;33(6):E11: 1-9 - PubMed
- Res Q Exerc Sport. 1994 Dec;65(4):347-54 - PubMed
- Clin Pediatr (Phila). 2012 Mar;51(3):283-7 - PubMed
- J Neurosurg. 2003 Feb;98(2):296-301 - PubMed
- JAMA Pediatr. 2015 Feb;169(2):163-8 - PubMed
- Br J Sports Med. 2013 Apr;47(5):250-8 - PubMed
- JAMA. 2003 Nov 19;290(19):2549-55 - PubMed
- PM R. 2011 Jun;3(6 Suppl 1):S64-72 - PubMed
- Br J Sports Med. 2006 Feb;40(2):184-5 - PubMed
- Clin J Sport Med. 2010 Jan;20(1):21-7 - PubMed
- Clin J Sport Med. 2011 Jul;21(4):315-9 - PubMed
- J Pediatr. 2013 Sep;163(3):721-5 - PubMed
- Curr Opin Pediatr. 2012 Dec;24(6):696-701 - PubMed
- J Sci Med Sport. 2016 Sep;19(9):722-5 - PubMed
- JAMA. 1999 Sep 8;282(10):958-63 - PubMed
- J Neurotrauma. 2017 Feb 15;34(4):838-844 - PubMed
- Pediatrics. 2010 Sep;126(3):597-615 - PubMed
- Br J Sports Med. 2013 Apr;47(5):314-20 - PubMed
- Brain Inj. 2013;27(7-8):839-42 - PubMed
- Am J Sports Med. 2012 Apr;40(4):747-55 - PubMed
- Clin J Sport Med. 2003 Jul;13(4):222-9 - PubMed
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