- Level Up Physical Therapy
How Long Should I Rest After a Concussion?
Your brain certainly needs some rest after a concussion.
But how much?
Let's look at some research and then come to some conclusions.
One 2015 study looked at students between 11 and 22 years old, and followed them over a 10 day period after concussion.
Half were recommended to rest for 2 days.
The other half were told to observe strict rest for 5 days. Strict rest meant specifically, no school, work, or physical activity.
In the 5 day rest group, half of them took longer to recover from the concussion than the 2 day rest group.
The 5 day rest group also had a larger number of symptoms over the 10 day follow up period, and rated more severe symptoms.
So the 2 day rest group did better!
In a 2014 study, researchers looked back at 335 athletes aged 8 – 23 years old after concussion. The researches categorized cognitive rest into 5 categories:
1. Complete Cognitive Rest
No reading, homework, text messaging, video games, online activity, crossword puzzles, or similar activity. Able to watch TV / movies, or listen to music.
2. Minimal Cognitive Activity:
No reading, homework, crossword puzzles or similar activities. Less than 20 minutes total online and video games.
3. Moderate Cognitive Activity:
Reading less than 10 pages per day. Less than one hour combined homework, online activity, and video games per day.
4. Significant Cognitive Activity:
Doing less reading, homework, online activity than normal but more than the moderate category of activity.
5. Full Cognitive Activity:
No limitations of cognitive activity at all.
The athletes in the highest 25% of cognitive activity took the longest to recover – about 4 times longer!
In a 2008 study, 95 teenagers with concussion were reviewed and their physical activity level was categorized:
1. No school or exercise activity.
2. School activity only.
3. School activity and light activity at home (slow jogging, mowing the lawn)
4. School activity and sports practice.
5. School activity and participation in a sports game.
The student athletes in the highest level of physical activity category took the longest to recover based on neurocognitive assessments and specifically in the areas of visual memory and reaction time.
In a 2019 study, 103 teenage athletes were studied; half were allocated to a specific aerobic treadmill exercise program, and the other half to a stretching routine group.
The athletes involved in the aerobic exercise group recovered faster.
Finally, let's look at the consensus of experts:
The 5th Consensus Statement on Concussion in Sport (2016) states, “After a brief period of rest during the acute phase (24–48hours) after injury, patients can be encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom-exacerbation thresholds (ie, activity level should not bring on or worsen their symptoms).”
Some take home messages about rest after concussion:
Complete rest beyond 2 days may slow your recovery from concussion.
Exercising as if nothing happened and ignoring all resting recommendations may slow your recovery.
Specifically prescribed aerobic exercise testing in the first week after concussion is safe and doesn’t cause prolonged symptoms.
Properly scheduled and monitored aerobic exercise may promote a faster recovery from concussion.
After a couple days of rest, it’s time to gradually get back to regular life while using symptom exacerbation as a guide in terms of specific tolerance. For example, your tolerance to computer use might be 15 minutes, but a brisk walk might be 30 minutes.
Work with what you tolerate well and expect your tolerance to improve as you progress through the recovery process.
As a guideline, typically you would like to have any exacerbated symptoms to settle after about a 20 minute rest break.
Some low level symptom exacerbation should not be feared to make your concussion worse or to delay your recovery. Just use your symptoms to intelligently guide your activity level through the day. One rule of thumb is to use a 10 point scale to monitor your symptoms: An increase of 1 or 2 points of symptom severity (headache, for example) during an activity is not concerning. If the symptom severity increases by 3 points then take a break and make a note that the next time you are involved in the activity, you should probably set a timer so you don't push into that irritated state.