Brain Rest and Concussion Recovery

People who experience concussions are advised to halt or limit certain physical activities until they are recovered. Another important treatment recommendation is to limit cognitive (mental) activity.

See Concussion Treatment and Recovery

Evidence shows that brain rest, also called cognitive rest, aids the concussion recovery process.¹Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP 3rd. Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics. 2014 Jan 6. While almost all physicians will prescribe brain rest to concussion patients, research in this area is ongoing and exact recommendations may vary among physicians.

See Concussion and the Importance of Recovery Time

Defining Brain Rest

Concussion experts define brain rest as limiting any cognitive activities that may be metabolically demanding and/or aggravate concussion symptoms. These cognitive activities can range from focused work, like doing math problems, to attending large social gatherings with lots of people, visual stimuli, and background noise.

Why is brain rest important?
The brain needs energy for normal cognitive and physical activity. These energy demands increase after a concussive event because:

• An injured brain needs additional energy to heal itself.
• A concussive event can decrease cerebral blood flow,²Maugans TA, Farley C, Altaye M, Leach J, Cecil KM. Pediatric sports-related concussion produces cerebral blood flow alterations. Pediatrics. 2012;129(1):28-37.^,3Toledo E, Lebel A, Becerra L, et al. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev. 2012;36(6):1510-31. which restricts the brain’s ability to access and use energy.⁴Giza CC, Hovda DA. The Neurometabolic Cascade of Concussion. J Athl Train. 2001;36(3):228-235.

Engaging in brain rest helps maximize the amount of energy the body can devote to healing. Not engaging in brain rest can prolong or worsen concussion symptoms.

See Risks of Inadequate Concussion Recovery Time

Brain Rest for Concussion Recovery

Deciding how much cognitive rest is appropriate can be difficult. Every person is different, and patients must work with their doctors to figure out the optimal amount of brain rest for concussion recovery.

Brain rest is essential for concussion recovery
Research suggests¹Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP 3rd. Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics. 2014 Jan 6. cognitive rest can allow patients to recover more quickly, and that a lack of brain rest during early recovery can:

• Lead to prolonged or worsened post-concussion symptoms
• Make the brain more susceptible to repeat injury

See Factors Affecting Concussion Recovery

A concussion patient who exerts unnecessary mental effort can diminish the brain’s ability to heal in a timely manner.

Too much brain rest may slow down concussion recovery
Perhaps confusingly, engaging in too much brain rest has also been associated with slower recovery.⁵Majerske CW, Mihalik JP, Ren D, et al. Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. J Athl Train. 2008;43(3):265–274. As cited in McLeod TC, Lewis JH, Whelihan K, Bacon CE. Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature. J Athl Train. 2017;52(3):262-287.^,6Brown NJ, Mannix RC, O’Brien MJ, Gostine D, Collins MW, Meehan WP. Effect of cognitive activity level on duration of post- concussion symptoms. Pediatrics. 2014;133(2):E299–E304. As cited in McLeod TC, Lewis JH, Whelihan K, Bacon CE. Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature. J Athl Train. 2017;52(3):262-287.^,7Maerlender A, Rieman W, Lichtenstein J, Condiracci C. Programmed physical exertion in recovery from sports-related concussion: a randomized pilot study. Dev Neuropsychol. 2015;40(5):273–279. As cited in McLeod TC, Lewis JH, Whelihan K, Bacon CE. Rest and Return to Activity After Sport-Related Concussion: A Systematic Review of the Literature. J Athl Train. 2017;52(3):262-287. Research suggests that brain rest should not be too strict nor extended; for example, patients are no longer advised to sit in a dark room doing nothing for days in a row.

Finding the right balance between brain rest and brain activity
Getting brain rest should be part of the immediate, post-injury recovery process—generally considered the first 24 to 48 hours after injury. After this time, patients are advised to gradually add cognitive activities into their routines. If symptoms worsen, it is a sign that the mental exertion is too much and cognitive activity should be decreased.

See Helping Kids Get Brain Rest after a Concussion

The exact amount of cognitive rest required during recovery varies from person to person, and the plan for brain rest should be individualized.