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Is Rest After Concussion “The Best Medicine?”: Recommendations for Activity Resumption Following Concussion in Athletes, Civilians, and Military Service Members

Silverberg, Noah D. PhD; Iverson, Grant L. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: July/August 2013 - Volume 28 - Issue 4 - p 250–259
doi: 10.1097/HTR.0b013e31825ad658
Concussion in Sports: 2013

Practice guidelines universally recommend an initial period of rest for people who sustain a sports-related concussion or mild traumatic brain injury (MTBI) in daily life or military service. This practice is difficult to reconcile with the compelling evidence that other health conditions can be worsened by inactivity and improved by early mobilization and exercise. We review the scientific basis for the recommendation to rest after MTBI, the challenges and potential unintended negative consequences of implementing it, and how patient management could be improved by refining it. The best available evidence suggests that complete rest exceeding 3 days is probably not helpful, gradual resumption of preinjury activities should begin as soon as tolerated (with the exception of activities that have a high MTBI exposure risk), and supervised exercise may benefit patients with persistent symptoms.

GF Strong Rehab Centre & Department of Medicine, Division of Physical Medicine & Rehabilitation (Dr Silverberg) and Department of Psychiatry (Dr Iverson), University of British Columbia, Vancouver, British Columbia, Canada; and Defense and Veterans Brain Injury Center, Washington DC (Dr Iverson).

Corresponding Author: Noah Silverberg, PhD, GF Strong Rehab Centre, 4255 Laurel St, Vancouver, BC V5Z 2G9, Canada (

The views expressed in this article are those of the authors and do not reflect the official policy of the US Department of Defense or US Government.

The Vancouver Coastal Health Research Institute provided salary support for Dr Silverberg but was in no way involved in the in the writing of the manuscript or the decision to submit it for publication.

Dr Silverberg receives funding from the Vancouver Coastal Health Research Institute and the BC Rehab Foundation. Dr Iverson has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to MTBI and sports-related concussion at meetings, scientific conferences, and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained MTBIs. He has received honorariums for serving on research panels that provide scientific peer review of programs (eg, the Military Operational Medicine Research Program). He is a coinvestigator, collaborator, or consultant on grants funded by several organizations, including, but not limited to, the Canadian Institute of Health Research, Alcohol Beverage Medical Research Council, Rehabilitation Research and Development Service of the US Department of Veterans Affairs, AstraZeneca Canada, and Lundbeck Canada.

The authors declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins