An athlete who has had a concussion may show an intolerance to exercise. Managing the athlete requires a careful balancing of goals.
WHO criteria for postconcussion syndrome (PCS):
(1) traumatic brain injury
(2) >= 3 symptoms (headache, dizziness, fatigue, irritability, insomnia, difficulty concentrating, impaired memory, stress intolerance, emotional change, alcohol intolerance)
Exacerbation of PCS symptoms associated with exercise is related to autonomic nervous system dysfunction.
Mild exercise may be tolerated but symptoms may get worse with moderate or severe exercise.
A graded exercise test on a treadmill (or other protocol) can be used to monitor recovery. The presence of symptom exacerbation or the appearance of new symptoms during exercise may be a reason to disqualify the athlete for a return to sport. An athlete is usually disqualified from return to sport if symptomatic at rest or after exertion.
If the patient has PCS-like symptoms and if they do not get worse with significant exercise, then another cause for the symptom should be considered.
