Update on Return to Activity After Sport-Related Concussions

 In Naturopathic News

Node Smith, ND

The American Academy of Pediatrics recently released an updated guidance report on sport-related concussions

An estimated 1.1 million to 1.9 million U.S. children and teens are treated for a recreational or sport-related concussion every year, and yet the true number of youth concussions likely remains under-reported, according to a report released by the American Academy of Pediatrics (AAP).

First update in 8 years; Specific changes include a recommendation to reduce, but not eliminate a return to physical and cognitive activity following concussion

In its first update in 8 years, the AAP cites the latest research into the incidence and treatment of these injuries in the clinical report, “Sport-Related Concussion in Children and Adolescents,” published in the December issue of Pediatrics (published online Nov. 12).

Research shows the following

Research shows that sport-related concussion remains common in nearly all sports at all levels, with boys’ tackle football and girls’ soccer reporting the most incidents, followed by other high-contact sports.

“While more families, physicians and coaches are aware of the health risks of a blow to the head – and more concussions are being reported – we remain concerned about players who try to tough it out without seeking help,” said Mark E. Halstead, MD, FAAP, lead author of the clinical report. “We know from surveys that many high school athletes will continue to play after a head injury out of fear they won’t be allowed back on the field.”

Guidance on treatment and recovery of injured players has evolved

Over the past few years, guidance on treatment and recovery of injured players has evolved. The AAP report reflects the latest research on recommendations, which now call for reducing – but not eliminating – a return to some physical and cognitive activity in the days following a concussion.

Effective management of injury can shorten recovery time and reduce risk of long-term effects

Effective management of the injury can shorten recovery time and potentially reduce the risk of long-term symptoms and complications that interfere with school, social life, family relationships and emotional well-being.

“Athletes absolutely need to take an immediate break from play after a concussion, but we find that, during the recovery process, it is best to encourage a reasonable amount of activity, such as brisk walking,” said Dr. Halstead, an associate professor of pediatrics and of orthopedics at Washington University School of Medicine in St. Louis.

“Students shouldn’t need to take a prolonged amount of time away from school, though they should work with teachers on lessening the academic workload. These are individual decisions that families should discuss and evaluate with their child’s physician.”

No research shows that a youth’s use of electronics is harmful after concussion

There is also no research that shows that a youth’s use of electronics, such as computers, television, video games or texting, is harmful after concussion. In fact, complete elimination of electronics may lead to a child’s feeling of social isolation, anxiety or depression, the report states.

Health risks of concussions and mild traumatic brain injury

Even as a national focus on health risks of concussions and mild traumatic brain injury has increased awareness and led to state legislation, much remains unknown, according to the AAP. For instance, recent research has shown that middle school tackle football has the highest concussion rate – at 2.6 to 2.9 out of 1,000 athletic exposures. Yet, most research has focused on treatment of high school athletes, according to the report, which states that football, lacrosse, ice hockey and wrestling carry the highest concussion risks for boys.

In girls’ sports, soccer, followed by lacrosse, field hockey and basketball, carry the highest risks, according to the report. Concussions also are more likely to occur in competition than during practice for male and female athletes, except for cheer leading.

The AAP report also concludes:

  • Further research is needed on sport-related concussions, especially in middle school and younger athletes.
  • Each concussion is unique and has a spectrum of severity and types of symptoms, which may overlap with other medical conditions.
  • Most pediatric athletes will recover from symptoms within 4 weeks of their injury.
  • The long-term effects of a single concussion or multiple concussions has not been determined.

More specific recommendations on methods of diagnosis and treatment are included in the report.


Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.

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