Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review.

When young athletes or adults are slow to recover from a sport-related concussion, clinicians have long debated whether structured rehabilitation helps more than simply waiting it out. This systematic review pulled together 13 studies, mostly randomised trials, that tested targeted interventions like cervicovestibular rehabilitation, vestibular rehabilitation, and active rehabilitation or collaborative care programmes against rest-based or less active comparisons. The broad pattern suggests these targeted approaches may speed recovery in specific symptom groups, such as people with lingering dizziness, neck pain or headaches beyond 10 days, or adolescents with vestibular impairments or symptoms persisting beyond 30 days. But the authors could not pool results statistically because interventions, comparisons and timing varied so much across studies, and only one study was judged high quality while five carried a high risk of bias, meaning these encouraging signals remain preliminary rather than settled.

If you or your child has had a sport-related concussion and symptoms like dizziness, neck pain or headaches are sticking around, you might wonder whether doing structured exercises helps more than just resting. This review looked at 13 studies testing things like targeted neck and balance-focused rehabilitation, exercises for dizziness, and programmes combining gradual activity with coordinated care, compared with rest or less active approaches. The findings suggest these approaches may help some people return to sport sooner, particularly when dizziness, neck pain or headaches last more than 10 days, or when vestibular (balance and inner-ear related) symptoms persist.

For adolescents with symptoms still present after 30 days, active rehabilitation and collaborative care also showed some promise for easing symptoms. However, this is based on a small number of studies, several of which had notable weaknesses in how they were conducted, so these results should be seen as encouraging early evidence rather than a definitive answer.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review addresses a practical question in concussion management: once rest-based approaches fail to resolve symptoms, does targeted rehabilitation accelerate recovery? Drawing on 13 studies (10 randomised trials, one quasi-experimental design, two cohort studies), the authors could not perform a meta-analysis because interventions, comparators, timing and outcomes were too heterogeneous, so conclusions rest on individual study results rather than pooled estimates. The most notable finding concerns individualised cervicovestibular rehabilitation in adolescents and adults with dizziness, neck pain or headache persisting beyond 10 days, where it was associated with faster return to sport compared with rest followed by gradual exertion (hazard ratio 3.91, 95% CI 1.34 to 11.34) and compared with a subtherapeutic intervention (hazard ratio 2.91, 95% CI 1.01 to 8.43). Vestibular rehabilitation in adolescents with vestibular symptoms showed a shorter mean time to medical clearance (50.2 versus 58.4 days) in one study, and active rehabilitation plus collaborative care showed symptom benefits in adolescents with symptoms persisting beyond 30 days, though these rest on single or few studies.

Overall, only one included study was rated high quality, seven acceptable, and five at high risk of bias, so these findings inform rather than establish practice, and the abstract does not report adverse event data for these interventions.