Learn what Dr. John Leddy says about the importance of getting a prompt diagnosis for a concussion, as well as how to reduce the severity of symptoms and the risk of serious long-term injury.
Between 1.6 and 3.8 million people report experiencing a concussion every year, with as many as 50% of cases going undetected. While concussions may seem relatively common, especially among athletes in high-contact sports, there can be serious long-term consequences of not seeking proper treatment. About one in five people who experience a concussion have prolonged symptoms, which are defined as symptoms that continue more than a month after the initial injury. This is often because they do not receive appropriate post-concussion care.
We spoke with John Leddy MD, FACSM, FACP, FAMSSM, about the importance of proper post-concussion treatment, including what can be done after a concussion to decrease the severity of symptoms, promote quick recovery, and reduce the risk of serious long-term effects.
Dr. Leddy is a professor of clinical orthopedics, internal medicine, and rehabilitation sciences at the University of Buffalo School of Medicine. He is currently the medical director of the University of Buffalo Concussion Management Clinic.
What to Do After a Concussion
If you or someone you know experiences a concussion, the first week is critical for promoting recovery and reducing the risk of long-term symptoms. Here are Dr. Leddy’s key steps to preventing long-term brain trauma after a concussion:
1. Get evaluated by a doctor as soon as possible.
The most important thing to do if you or someone you know has suffered a head injury is to see a doctor immediately. The amount of time it takes to get a medical evaluation can be one of the biggest factors in the recovery process if you do in fact have a concussion.
Dr. Leddy notes that “the faster somebody gets in [to see] a physician or provider who knows what they’re doing with concussion, the faster they recover.”
2. Scale back activity for the first 48 hours.
For the first 48 hours after a concussion, Dr. Leddy recommends skipping intense exercise and sports, as well as minimizing screen time as much as possible. After the first two days, ease into activity and immediately stop anything that causes symptoms to significantly increase.
Dr. Leddy says to avoid any activity that causes your symptoms to increase beyond a “mild” level. How do you tell if you’re experiencing more than a mild increase in symptoms? Dr. Leddy says that if, “on a 0-10 scale, [you experience] an increase of two or more points during the activity” compared to how you felt before beginning the activity, then you should stop and take a break.
3. Find your exercise “sweet spot.”
Data shows that while you don’t want to overdo it, maintaining some healthy level of activity in the first week after a concussion is especially important for the healing process. This is another reason it’s important to monitor any increases in your symptoms during physical activity. Dr. Leddy notes that by doing so, you can find your activity “threshold”—the point up to which exercise is beneficial following a concussion.
“The more that [a person] can exercise at that subthreshold level… [the faster] they tend to recover,” Dr. Leddy says. Work to find the right level of activity and be sure to hit that “sweet spot” throughout the first week.
4. Take regular breaks, especially if symptoms increase.
Just as you need to give your body time to resume physical activity, you’ll also need to ease your brain into mental activity. This is especially important for students and people with stressful jobs. During mental tasks, Dr. Leddy recommends taking scheduled breaks—such as every 15 to 20 minutes—and stopping if symptoms increase by more than two points on a 0-10 scale.
5. Rehabilitate concussion-related injuries and issues.
“We’ve learned that many concussions are accompanied by neck injuries,” says Dr. Leddy. “[This] shouldn’t be surprising, but it wasn’t realized until maybe a decade ago.” To help promote recovery after a concussion, you may need to receive care for related symptoms, including physical therapy for neck pain or vestibular therapy for balance problems.
Can Activity Help Minimize the Long-Term Effects of a Concussion?
In the past, individuals with a concussion were often told to rest in quiet, dark rooms. “It was sort of considered [forbidden] to have somebody do too much mental or physical activity soon after a concussion, because it typically reliably increases someone’s symptoms,” Dr. Leddy explains. “It was thought that… if you increased the symptoms even a little bit, you were harming the brain and delaying recovery.”
However, while working in sports medicine Dr. Leddy began to think about how doctors could more actively treat athletes who had experienced a concussion. He wondered if there was a way to maintain physical activity while experiencing a healthy, mild level of symptoms rather than restricting all activity and waiting for symptoms to go away.
Dr. Leddy and his team modeled their approach on rehabilitation strategies for people who have recently had a heart attack. “If you take the principles of somebody who has heart disease, for example, and you want to rehabilitate that person from having heart disease or a heart attack, what do you do? You have a cardiac treadmill test—you have a stress test,” says Dr. Leddy.
This type of treadmill test inspired Dr. Leddy’s Buffalo Concussion Treadmill Test (BCTT). The Buffalo Treadmill Test has become the standard of care for treating concussions among experts in the field, including primary care physicians and those involved in evaluating and managing athletes who experience a concussion.
“We started measuring blood pressure and pulse on the treadmill, and we came up with a way to assess how much [concussion] symptoms went up during exercise—and predictably, they did,” he says. When symptoms increased, the research team recorded the participant’s heart rate. They then instructed the person to exercise at 80% of that intensity—using this recorded heart rate as a guide—for 15 to 20 minutes a day, stopping if their symptoms went up more than mildly.
Dr. Leddy and his research partners tested this approach on people who experienced prolonged symptoms, including college-age athletes and older adults who had been injured at work, and found that it helped them recover from a concussion more quickly.
How Exercise Affects the Brain After a Concussion
How does this work? A mild traumatic brain injury or concussion disturbs the autonomic nervous system, which controls a person’s ability to breathe and pump blood throughout the body and brain. The autonomic nervous system adjusts a person’s body functions in response to environmental demands, such as exercise. Typically with increased activity, the brain is able to regulate blood flow, but after a concussion, this control of blood flow to the brain is poorly regulated, especially during exercise.
“Exercise—aerobic exercise specifically—treats the whole autonomic nervous system,” says Dr. Leddy. “We call it ‘exercise as medicine’ for concussion.” In his research studies, adolescent athletes who started an exercise protocol within days of a concussion recovered faster and had a 50% reduction in prolonged symptoms compared to those who were assigned a stretching program.
In recent years, the medical field, sports professionals, media, and the general public have paid more attention to the topic of concussions. Research is still uncovering information about diagnosis and treatment, and it will take time for new learnings to be implemented in clinical practice, at training facilities, and during sporting events. The American Brain Foundation will continue to support ongoing brain disease research and share important findings from experts in the field.
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