JOHN DOHERTY: The 'rest' of the concussion story

2014-01-13T20:00:00Z JOHN DOHERTY: The 'rest' of the concussion storyJohn Doherty Times Columnist
January 13, 2014 8:00 pm  • 

Since concussion became a greater cause of concern 15 years ago, the first question from mouths of afflicted players has been: “How soon can I play again?”

Mounting evidence, though, suggests that whether or not they are receiving an accurate or satisfactory answer, student-athletes — as well as their parents and coaches — are asking the wrong question.

Instead, they should be asking, “When am I able to return to school?”

After all, concussion is an injury to the brain, and the theory has been that stressing that organ in the immediate aftermath of injury will only prolong recovery.

A study published eight days ago in the journal Pediatrics, takes theory closer to fact.

Looking at 335 concussed athletes with an average age of 15, researchers at Children’s Hospital in Boston found that the 80 or so athletes who were the most cognitively active took roughly 100 days to become symptom-free, while the remaining 250 were well in an average of 40 days.

Confirming work published in Pediatrics in May 2013 and in the Journal of Athletic Training in 2008, this most recent study suggests victims of concussion require cognitive (thinking) rest.

That means no going to school.

How long that absence should be is debatable.

In last year’s Pediatrics article, neuropsychologist Rosemarie Moser, PhD of the Sports Concussion Center of New Jersey found that one week of total cognitive rest resulted in a significant improvement in cognitive function thereafter. Total cognitive rest meant no attending school, homework, reading, computers, video games, texting or cell phone use, exercise, athletics and chores that resulted in perspiration or exertion. Limited television viewing was allowed.

For the athlete with relatively minor symptoms, though, is all that entirely necessary? For an entire week?

The more recent Pediatrics study suggests probably not. Only the 25 percent most active had a prolonged recovery.

So the question remains: How long should an enforced school absence be?

Two days is a reasonable start.

For years we have known that while football players experience the highest rate of concussion, they also seem to recover faster than other athletes. One reason is that males recover faster than females. The guys have stronger necks and there may be some hormonal issues. Furthermore, the helmet may help — a little. However, the key seems to be when in the week the concussion occurs.

A disproportionate share of football concussions takes place on Friday night. Thereafter, the athlete has the weekend — two days — off from school.

If a concussion victim is symptom-free or nearly so after being absent for two days, requiring him or her to continue to miss school entirely may very well be counter-productive. If, on the other hand, symptoms persist, continued rest remains reasonable on a case-by-case basis.

A decade-and-a-half into medicine’s effort to better manage concussion, coaches — sometimes prompted by state law — are better accepting the science behind cautious return-to-play protocols.

School administrators and teachers are now on the same learning curve regarding cognitive rest. If they don’t complete that process soon, they will be subject to legislative action, too. Just last week, a bill was introduced in the Nebraska legislature that would mandate academic accommodations following a concussion.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

Copyright 2014 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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