Monday, January 6, 2014
The NFL playoffs are the culmination of the 17 week regular season, a season where more than 150 concussions were reported. And the first playoff round increased that number by more than a few. It is then appropriate that in its first article for 2014 published online, the Journal of Pediatrics highlighted research that has finally confirmed what most doctors who looked after athletes with concussions knew intuitively: brain rest makes the brain heal faster. This concept is really not rocket science. Sprain an ankle? Bruise an arm? The key to recovery is rest. The time invested early helps speed the time of healing. The medical world expected the same for minor head injury or concussion, but until the collaborative study form Boston Children’s Hospital, the University of Pittsburgh and Children’s Hospital of Philadelphia, there was no scientific weight to that presumption.
While the average age of the athlete studied was 15, the range was from 5 to 23, or the age of a NFL rookie or second year player. For those who did not take the time to rest the brain, symptoms lasted 100 days, more than three months, while for those who took it easy, their symptoms lasted from 3 to 7 weeks.
The time it takes for the brain to recover has always been underestimated in athletes. A generation ago, the Cantu guidelines would allow a player with a grade 1 concussion to return to the field of play within a few minutes. Even now, the accelerated return to play guidelines suggest that the brain might be healed and ready to go within a week. But 10 years ago, studies were published in the Journal of Neurosurgery that for concussed high school football players, memory and function had not returned to preseason baseline even after 7 days of rest.
Brain rest is tough in today’s connected age. Rest in a dark room is no better than moderate mental activity but that means giving up television, smart phones including texting (a tough punishment for a teenager), computers and videogames. The refresh rate of the latest iPad is more than 250 frames per second, meaning that the brain has to process new information that quickly. In comparison, a book magazine or newspaper has no refresh rate, but tell that to a high school or college athlete.
This latest study suggests that homework also needs to be reconsidered but that should not come as a surprise to parents of high school athletes who have sustained a concussion. Grades often drop, even with increased studying and it may take a semester or more for the student to return to their previous level of achievement. School advisors and counsellors also know the consequences of concussion. 10% of high school players in a contact sport will sustain a concussion each year.
Unfortunately, this information has taken its time to be noticed in the college and pro football ranks, both players, coaches and owners. The idea that the brain can recover within a week and allow the player to return is suspect. The idea that concussions can be assessed on the field or in the locker and perhaps allow the player to rerun if the “testing” is negative is also suspect. There is yet no specific test that can determine whether a player has sustained a minor head injury and there is no specific test that can prove that the brain has recovered. All medicine has to offer is a “best guess” approximation of whether the brain has healed enough to withstand another injury.
Attempts to change the rules to make the game safer are a good first step, but players need to be educated and those rules need to be enforced. Most recently, it was deemed unsafe for a running back to lower his helmet to attack a defender, but television replay will show that action as routine and announcers will celebrate the back’s ability to finish off the run. Culture changes slowly but the good news about the latest research about brain rest, is that it keeps the worry of concussion in the headlines. It is also a reminder that the NFL players are real people and while they seem to have superhuman athletic capabilities, their brains are just like the rest of us.
Lovell MR, et al. Recovery from Mild Concussion in High School Athletes. Journal of Neurosurgery 2003;98:295-301This entry was tagged brain rest, Cantu, concussion, duration of symptoms, head injury, Meehan, NFL
Dr. Wedro weighs in
“The difference between doctors who look after mere mortals and those who look after elite athletes may have to do with how many tests they can order, regardless of the cost.”