Rest Isn’t Always Best: Why You Should Exercise with Post Concussion Syndrome

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Why you should exercise with post concussion syndrome

It’s playoff hockey season and Sydney Crosby’s latest concussion is all the talk in the sports medicine world. Thankfully, he made a quick comeback and just might take home a 3rd Stanley Cup. However, from the professional athlete, to the weekend warrior, to the busy mom, many people do not recover quite so quickly.

Post concussion syndrome (PCS) is defined as 3 or more concussion-related symptoms that persist beyond the “normal recovery time” (10-14 days for adults and >4 weeks for children). Traditionally, individuals diagnosed with concussion were told to rest until they were asymptomatic. However, we now know that there is little to no evidence to recommend absolute rest for >24-48 hours in most cases. This has led to a more active approach to rehabilitation that is allowing individuals get back to doing what they love faster.

Here are 5 reasons why physical activity is a KEY part of concussion management:
  1. Exercise improves cerebral auto-regulation:

One of the leading theories behind the mechanism of PCS is impaired cerebral auto-regulation, or the brain’s ability to maintain it’s blood flow at the right level during changes in blood pressure. Headaches when you’re active? Dizzy when you stand up? Exercise can help!

A graded exercise program that allows you to train at a heart rate that is “sub-threshold” – meaning just below the heart rate that brings on symptoms, allows you to gradually increase your ability to tolerate exercise, until the symptoms are no longer brought on by physical activity or changes in blood pressure.

  1. Increases energy:

Fatigue is a common and debilitating complaint for concussed individuals. Whether your fatigue is attributed to a concussion or not, getting in some regular activity is vital to boost your energy!

  1. Exercise facilitates neuroplasticity:

There is preliminary evidence that exercise facilitates neuroplasticity, which is the ability of the brain to form new brain cells and to re-organize connections among existing cells. It is a natural response to a brain injury, which can be harnessed with physical activity. Basically, we can create new brain cells and connections among those cells when we exercise. Most of the research has been performed with other populations (stroke, Parkinsons, etc), but it has been suggested that concussed individuals respond similarly. This is very exciting in the neuro-rehab world, where we used to think this type of recovery wasn’t possible.



  1. Boosts mood and relieves stress

Changes in mood such as feeling irritable, depressed, anxious or stressed post concussion are extremely common. Cardiovascular exercise releases endorphins, which help elevate mood, decrease anxiety and create feelings of accomplishment and control in one’s life. PCS can be a challenging condition, and the stress that can be brought on by missed school or work, for example, can inhibit recovery. You cannot recover well if your body is always in this “fight or flight state”. Physical exercise is a great outlet to relieve stress, improve mood and promote recovery.

  1. Improves Sleep:

Sleep disturbances are a common issue of individuals with PCS. Regular, scheduled physical activity can help facilitate normal sleep patterns. A lack of sleep can cause fatigue, difficulty concentrating, difficulty remembering, and headaches – all of which overlap with concussion-related symptoms. Sleep is essential for symptom management and overall recovery.

There you have it – exercise is medicine. In order to get started, it is recommended that individuals with persistent symptoms see a regulated health care professional with training in concussion management. We will do a thorough assessment and help develop a safe, graded exercise program that promotes recovery and does not risk making symptoms worse. In addition to an individualized exercise program, a physiotherapist may also recommend concurrent visual, balance and cervical rehabilitation.

If you or someone you know is suffering from persistent symptoms post concussion – contact a physiotherapist today to help you get moving again! Rest is not always best!

Further Reading:

McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. doi:10.1136/ bjsports-2017-097699

A Physiological Approach to Prolonged Recovery From Sport-Related Concussion.

John Leddy, John G. Baker, Mohammad Nadir Haider, Andrea Hinds, Barry Willer

J Athl Train. 2017 Mar; 52(3): 299–308. doi: 10.4085/1062-6050-51.11.08

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