Return to Normal Activity After Concussion Does Not Worsen Symptoms For Most Patients Interview with:

Danny G. Thomas, MD, MPH Department of Pediatrics, Emergency Medicine Children’s Hospital of Wisconsin Corporate Center Milwaukee, WI

Dr. Danny Thomas

Danny G. Thomas, MD, MPH
Department of Pediatrics, Emergency Medicine
Children’s Hospital of Wisconsin Corporate Center
Milwaukee, WI What is the background for this study? What are the main findings?

Response: This was a secondary analysis of a randomized controlled trial of strict rest after concussion published last year. We wanted to find out how mental and physical activity levels related to symptom spikes or sudden increases in concussion symptoms. We found that one in three patients had symptoms spikes in recovery. Patients who had symptom spikes tended to have higher symptoms in the emergency department and throughout recovery. Most symptom spikes were not associated with an increase in physical and mental activity level the day prior. We did find that a sudden increase in activity like returning to school did increase the risk of having a symptom spike, but the good news is these symptom spikes seemed to resolve the following day and did not impact recovery by 10 days. What should readers take away from your report?

Response: Returning to mental activities may cause an increase in symptoms, but this is not a set-back in recovery. This is pretty common, gets better with time, and do not seem to change your recovery time. What recommendations do you have for future research as a result of this study?

Response: Our treatment for concussion have centered on the assumption that all mental and physical activity worsen your symptoms and prolong your recovery. This data suggests that for most patients, normal activity does not worsen symptoms. Future studies should challenge this assumption by testing a rehabilitation approach, which uses structured physical and mental activity as a treatment for a concussion rather than something to avoid at all costs. Is there anything else you would like to add?

Response: While it is important to note that an increase in physical activity level did not contribute to worse symptoms, this does not mean it is safe to return to high-risk activities (e.g. football, tree climbing, etc.) until you have recovered from concussion. Thank you for your contribution to the community.


Noah D. Silverberg, Grant L. Iverson, Michael McCrea, Jennifer N. Apps, Thomas A. Hammeke, Danny G. Thomas. Activity-Related Symptom Exacerbations After Pediatric Concussion. JAMA Pediatrics, 2016; DOI:10.1001/jamapediatrics.2016.1187

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 2, 2016 by Marie Benz MD FAAD