Return to Sport Following Concussion-New Research on Exertion Testing

If you have gone through concussion therapy at Next Level you are probably familiar with strapping on the heart rate monitor and getting your sweat on with exertion testing and training.  Now the research is starting to take a closer look at intensive and dynamic exertion testing and its importance in the return to play process.

A recent study published in October 2018 looked at using a new concussion exertion protocol called the Gapski-Goodman Test (GGT) developed by the Chicago Blackhawks medical staff.  This test was designed to help with clearing athletes as one piece of the return to play process following a concussion.

Currently the most researched physical exertion test has been the Buffalo Concussion Treadmill Test (BCTT).  This test (as described in the name) is performed on the treadmill with increasing difficulty through a progressive increase in incline.  The BCTT tests aerobic capacity in a single linear direction only which may not be provocative enough to reproduce symptoms in high level athletes. As stated in this current study, “The BCTT, therefore, may not provide an adequate challenge to all physiologic, vestibular, and oculomotor systems necessary for athletes returning to anaerobic and dynamic, multiplanar, high-risk contact sports"¹ The GGT in comparison has been created to provide “alternating aerobic and anaerobic states in addition to sport-based vestibular and vision challenges designed to mimic a dynamic sporting environment.”¹

The study found that while 100% of the athletes successfully passed the BCTT, 14.6% had an exacerbation of symptoms with the GGT (or modified GGT). The study discusses how the GGT with its more intensive and dynamic exercise selection potentially tests the vestibular and oculomotor and anaerobic systems more thoroughly than the BCTT.  This is important because these systems must be functioning properly for safe return to the unique challenges of sports.

New research is taking a closer look at testing similar to what we have been doing here at Next Level: dynamic, intensive, and sport specific exertion testing and training

It is exciting to see this dynamic form of exertion testing emerging in the research.  It is possible for patients to feel symptom free before they are fully physiologically healed after a concussion. Exertion testing therefore can play an important role in making sure we stress these systems to mimic the demands of sport to ensure symptom free and safe return to play.  

Here at Next Level we use a combination of testing depending on the severity of your symptoms.  We may perform the BCTT which can be extremely helpful in establishing a target heart rate for beginning aerobic training.  As vestibular therapy progresses, we monitor for when it is appropriate to begin dynamically challenging the systems with more intensive exertion testing and training.  We have utilized very similar testing to the GGT and incorporate coordination and reactive drills that are sport specific as needed. 

When working with your doctor to obtain clearance for full return to play exertion testing and training are one useful part of the evaluation and treatment process.  We will be keeping an eye on the future for further research supporting exertion training!  And in the meantime we will keep the heart rates up and the sweat going as we help athletes recover and return to sport. 

11.)    Marshall CM, Chan N, Tran N, DeMatteo C. The use of an intensive physical exertion test as a final return to play measure in concussed athletes: A prospective cohort. Phys Sportsmed.2018;1-9.