Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Conservative Management of Acute Sports-Related Concussions: A Narrative Review

Version 1 : Received: 12 December 2023 / Approved: 13 December 2023 / Online: 13 December 2023 (11:33:11 CET)

A peer-reviewed article of this Preprint also exists.

Kureshi, S.; Mendizabal, M.; Francis, J.; Djalilian, H.R. Conservative Management of Acute Sports-Related Concussions: A Narrative Review. Healthcare 2024, 12, 289. Kureshi, S.; Mendizabal, M.; Francis, J.; Djalilian, H.R. Conservative Management of Acute Sports-Related Concussions: A Narrative Review. Healthcare 2024, 12, 289.

Abstract

This review explores the application of the conservative management model for pain to sports-related concussions (SRCs), framing concussions as a distinct form of pain syndrome with a pathophysiological foundation in central sensitization. Drawing parallels with proven pain management models, we underscore the significance of a proactive approach to concussion management. Recognizing concussions as a pain syndrome allows for the tailoring of interventions in alignment with conservative principles. This review first covers the epidemiology and controversies surrounding prolonged concussion recovery and persistent post-concussion symptoms (PPCS). Next, the pathophysiology of concussions is presented within the central sensitization framework, emphasizing the need for early intervention to mitigate the neuroplastic changes that lead to heightened pain sensitivity. Five components of the central sensitization process specific to concussion injuries are highlighted as targets for conservative interventions in the acute period: peripheral sensitization, cerebral metabolic dysfunction, neuroinflammation, glymphatic system dysfunction, and pain catastrophizing. These proactive interventions are emphasized as pivotal in accelerating concussion recovery and reducing the risk of prolonged symptoms and PPCS, in line with the philosophy of conservative management.

Keywords

concussion; mild traumatic brain injury (mTBI); central sensitization; sports-related concussion; peripheral sensitization; glymphatic system; neuroinflammation; pain catastrophizing.

Subject

Medicine and Pharmacology, Clinical Medicine

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