Traumatic Brain Injury Blog


Continuing to Play Following Concussion Can Prolong Recovery And Expose Athletes to Catastrophic Second Impact Syndrome

By on September 29, 2016 In Rehabilitation, Research, TBI In Sports

There’s new evidence supporting immediate removal of athletes from play following concussion.

A new study published in the September, 2016 issue of Pediatrics provides evidence that returning to play immediately following a sports related concussion, even without a “second impact” nearly doubles, on average, the length of time required to recover and exposes athletes to a greater risk of protracted symptoms. As the authors point out in their report, the Institute of Medicine and National Research Council stated in 2013 that

“the culture of sports negatively influences SRC [sports related concussion] reporting and that athletes, coaches, and parents do not fully acknowledge the risks of playing while injured.”

The Pediatrics study demonstrates that the risk exists even without a second impact and is likely a consequence of the activity itself. The study was undertaken to build on prior research involving animal subjects, cited in the study, suggesting that exposure to physical activity immediately after a concussion decreases neuroplasticity and cognitive performance and increases neuroinflammation. (We have discussed in prior posts the growing evidence that persistent neuroinflammation explains many persistent post concussive symptoms as well as the increased vulnerability of patients with pre-accident conditions such as migraine.) The authors posit that the prolonged recovery in athletes that continue to play following an SRC “may be a consequence of continued physical exertion that exacerbates the pathophysiologic and metabolic events that underlie concussive brain injury.”

Current clinical guidelines and international sports standards consistently recommend immediate removal from play if an athlete is suspect of having an SRC.  These guidelines are based not only on the catastrophic risk of second impact syndrome, but also on factors such as the delayed onset of symptoms in many cases and compromised neurometabolic function that can increase the risk of another SRC. This current research adds an additional justification for these guidelines: that physical exertion immediately after a concussion can itself impair the body’s  ability to recover from the acute effects of the concussion.

It is important to keep in mind that although immediate return to activity is not advised based on this research,  progressive return to activity in the days of weeks following concussion – to the extent possible with exacerbating symptoms – may contribute to recovery. (This is the premise of the Buffalo Protocol for concussion recovery discussed in other posts.)

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