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Concussion Guidelines: Pure Rest is a Bad Idea

I suffered a moderate to severe concussion in a bike crash at mile 87 of the Solvang Spring Double Century:

Lloyd’s Mild Traumatic Brain Injury (mTBI / concussion) Experience and Log

A few weeks ago, I told two of my doctors that I felt that I knew more about recovery from concussion than just about every neurologist. I meant it and I still think that’s true. One does not have to be a doctor to have a high level of self awareness, and of how critical attitude and the mind and the body are—a synergistic whole, not a bag of parts. No person (or doctor) can have more than an a dim inkling of the complex physical and mental situation of another individual, particularly a highly self aware individual—I paid very close attention to myself (greatly heightened by the concussion), and that was my guideline for my own healing.

The medical profession is finally (this is 2018 isn’t it?) starting to figure out what took me all of two weeks: exercise made me feel better (and the best of the day), every day and for the rest of the day after it. That is, after the acute phase (in my case, about 10 days)—a critical point.

It is my unshakable belief that riding my bike every day for 80 to 120 minutes sped up my recovery remarkably—good enough for a win 8 weeks later in a grueling double century.

New concussion guidelines updated to eliminate one key component: prolonged rest

May 17, 2017: BUFFALO – Prolonged rest is not ideal when it comes to treating concussion, and in fact, those who are active faster, appear to get better faster. This is an idea that John Leddy, MD, director of the University at Buffalo Concussion Management Clinic, first proposed about 10 years ago, and now, he says, several studies later, is beginning to be confirmed. It is also an idea that is now reflected in the latest document that guides treatment when it comes to sport-related concussion.
...

The old guidelines indicated that individuals should not return to activity until they were asymptomatic. Until that time, the individual was told to do nothing. “This was known as ‘cocoon therapy’,” Leddy says, “That was how the old guidelines were interpreted and patients were resting, literally being told to do nothing, until they were asymptomatic. The problem with that was even non-concussed people often have some symptoms on any given day.

“The guidelines were good at keeping kids from participating at activities that risk another head injury before recovery, but were being interpreted to recommend that any level of exertion was detrimental to the brain. We now know that interpretation was wrong. All over the world, the treatment of complete rest was prolonging symptoms in many people.”
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See also: Exercise may be best medicine to treat Post-Concussion Syndrome and other concussion articles.

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