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Light Exercise May Lead To Faster Recovery After Concussion

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When athletes suffer concussions, the common practice has been to prescribe lots of rest, both physically and cognitively. But a new take on treatment, where small amounts of light exercise are encouraged, may actually lead to faster recoveries from concussions, according to two studies recently published by researchers at Canisius College and the University of Buffalo, both located in Buffalo, New York.

The first study experimented with a new style of treatment that actually encourages exercise for the purpose of improving patients’ health who are suffering from post-concussion syndrome (PCS).1-2 “We started out wanting to determine if athletes who suffer from PCS could exercise at a level that wouldn’t bring out symptoms but would allow them to stay conditioned while recuperating,” said Karl Kozlowski, PhD, assistant professor of kinesiology at Canisius College.

To do this, Dr. Kozlowski and his co-researchers tested 34 patients with PCS to determine their threshold for exercise.2 From that, they developed a low-level workout program (only 10 or 15 minutes) for each patient. Patients were asked to keep track of their symptoms and within 3 weeks, they reported feeling better. New regimens were tailored and after several months of this routine, concussion symptoms were significantly reduced or went away entirely for all the patients.

“The brain likes blood pressure to be very stable,” Dr. Kozlowski told Practical Pain Management. After a concussion, however, healthy blood flow to the brain is compromised. Rest is the commonly prescribed cure for concussion patients, but Dr. Kozlowski and his team, who referenced rehabilitation exercise for curing other sports injuries, felt that exercise could be used to help cure concussions as well.

“We found that gradual exercise, rather than rest alone, actually helps to restore the balance of the brain’s auto-regulation mechanism, which controls the blood pressure and supply to the brain,” Dr. Kozlowski said. While he stressed that the treatment has yet to be established as an effective form of therapy for PCS, he believes that this is a step in the right direction. “The fact that we’re ready to move towards a real treatment option is encouraging,” he added.

“With brain injuries we were asking why athletes were being told not to do anything,” Dr. Kozlowski said. “This seemed to go against what we learned about with rehabilitation therapy.” Dr. Kozlowski noted that scientists are still learning about why concussions affect the brain the way they do, but their new research points to better solutions than strict rest. “We’re still in the infancy of what we know about concussions,” Dr. Kozlowski said. “It is an interesting paradigm that we’re exploring but so far the results seem very positive.”

Significantly Improved Recovery

Researchers at the University at Buffalo School of Medicine and Biomedical Sciences have conducted similar tests where they also have found positive results from a “graded exercise program."3 In their tests, researchers measured concussion patients’ threshold for cardiovascular stress. After finding the threshold of aerobic exercise that the athletes could do without exasperating their symptoms, they prescribed them a regular routine of this graded exercise.

When they compared the results with concussion patients that simply did stretching exercises, they found much faster recoveries in the patients that were exercising.

“People recover two times faster,” said Barry Willer, PhD, director of research at University of Buffalo’s Concussion Management Clinic. “Our approach is proactive and it works.” Dr. Willer and his colleagues even worked with the Department of Defense in bringing these new treatments to soldiers who suffer concussions on the battlefield. The new research allowed the Department of Defense to draft a new system of treating soldiers with concussions.

Prior to these findings, soldiers who suffered concussions were told to rest in their tents, away from light, physical activity or cognitive stimulation for a long period of time. “Psychologically, it’s a bad idea,” Dr. Willer said, “[rest] isn’t going to give [them] the speediest recovery.”

With new evidence to support a change in how concussions are being treated, researchers are excited about the future of treating PCS. “We’re changing the nature by which concussions are being managed,” Dr. Willer said.


Falling Risk After Knee Replacement Decline With Regional Anesthesia

Regional anesthesia may be a safe pain management option for patients undergoing knee replacement. A recent study of almost 200,000 patients found that spinal and epidural anesthesia, as well as peripheral nerve blocks, did not increase the risk of falls in the first days after surgery.4 This finding contradicts earlier studies that raised the question about fall-risks following regional anesthesia.

A number of studies have shown that spinal or epidural (neuraxial) anesthesia and peripheral nerve blocks (PNB) provide better pain control and lead to faster rehabilitation and fewer complications than general anesthesia. But some surgeons avoid using them due to concerns regional anesthesia may cause motor weakness, making patients more likely to fall when they are walking in the first days after knee replacement surgery.

“We found that not only do these types of anesthesia not increase the risk of falls, but also spinal or epidural anesthesia may even decrease the risk compared to general anesthesia,” said Stavros G. Memtsoudis, MD, PhD, professor of anesthesiology and public health and director of critical care services, Hospital for Special Surgery, New York City, and lead author of the article. “This work suggests that fear of in-hospital falls is not a reason to avoid regional anesthesia for orthopedic surgery,” according to a press release from the American Society of Anesthesiologists.

Study Design

The researchers analyzed the types of anesthesia used in 191,570 knee replacement surgeries in the Premier Perspective database: 76.2% of patients had general anesthesia, 10.9% had spinal or epidural anesthesia, and 12.9% had a combination of neuraxial and general anesthesia. In addition, 12.1% of all patients had PNB. Researchers then analyzed the type of anesthesia used for those who suffered from an inpatient fall.

Of patients who had general anesthesia, 1.62% fell, compared to 1.3% of those who had neuraxial anesthesia and 1.5% who had general and neuraxial anesthesia. Patients who also received a PNB had a fall rate of 1.58%.

When patients fall during recovery, they are more likely to have worse outcomes, including increased cardiac and respiratory problems and higher rates of death within 30 days of surgery. Spinal or epidural anesthesia and PNB are used far less often than general anesthesia because of concern that regional forms of anesthesia – particularly PNB – may increase muscle weakness and make patients more prone to falls.

Last updated on: October 28, 2014
First published on: March 1, 2014