Study aims to determine how aches, pains before and after concussion play role in recovery

Athletes who have medical complaints, like aches and pains, that have no known physical cause may take longer to recover after a concussion, according to a study published in the April 20, 2016, online issue of Neurology, the medical journal of the American Academy of Neurology.

Called psychosomatic symptoms, such complaints are often described as psychological distress expressed as physical illness.

"The goal of this study was to determine how physical complaints before and after concussion play a role in recovery," said study author Lindsay D. Nelson, PhD, assistant professor of Neurosurgery and Neurology at the Medical College of Wisconsin in Milwaukee. "We found the greatest predictor of recovery after a concussion was the severity of early post-concussion symptoms. But somatic complaints before injury also play an important role, either by possibly enhancing how a person experiences the injury or affecting their reporting of post-concussive symptoms."

For the study, 2,055 high school and college athletes were evaluated before the start of the season for balance, thinking and memory skills and psychological problems such as depression, anxiety and psychosomatic problems such as feeling faint or dizzy, nausea or upset stomach or pains in chest or heart. For the psychosomatic problems, the athletes rated how often they had been bothered by these symptoms during the last week. About 50 percent of the participants had at least one of 6 symptoms, and the other 50 percent had no symptoms.

During the season, 127 athletes suffered a concussion. Those athletes were then reassessed within the first 24 hours of injury and then again at 8, 15 and 45 days after the injury.

Of the concussed athletes, 61 percent played football, 24 percent played soccer, 6 percent played lacrosse, 3 percent were wrestlers, 3 percent played hockey, 2 percent played rugby and 1 percent played field hockey. Of the group, 80 percent was male.

On average, concussion symptoms lasted five days, with 64 percent of concussed athletes saying their symptoms were gone after one week and the vast majority, 95 percent, saying they no longer had symptoms after one month.

After concussion, those athletes who had reported pre-injury psychosomatic symptoms had longer recovery times, recovering at a slower rate than those who had no psychosomatic symptoms. For people with symptoms, about 80 percent had recovered within about 20 days of the concussion. For those with no symptoms, about 80 percent had recovered within about 10 days.

Those who had more severe physical symptoms after their concussions, like headache and balance issues, recovered at a slower rate than those with less severe symptoms.

"That these athletes were relatively healthy physically and psychologically highlights the relevance of psychosomatic symptoms and the role they play in recovery even in healthy people," said Nelson. "Our hope is our study will lead to further research, because identifying those at risk for prolonged recovery is critical to developing early interventions that improve outcomes for people who suffer concussions."

Source: American Academy of Neurology (AAN)