BLOG: Study shows that flying after concussion has little impact on recovery
Athletic trainers, coaches and doctors have often expressed concern about whether it is safe for a recently concussed athlete to fly, given that elite athletes frequently travel for games or matches and would then need to return home.
Flying in an airplane with a pressurized cabin is known to reduce oxygen saturation levels. One might expect that this reduced oxygen level could be detrimental to a healing brain or might cause worsening symptoms in someone who has recently suffered a mild traumatic brain injury (TBI). Animal studies have shown some worrisome trends. When mice or rats with an induced TBI have been exposed to hypobaric conditions to simulate the experience of air travel, they showed alterations in cerebral blood flow, increased neuroinflammatory responses and neurocognitive deficits like slower reflexes. But until recently, little was known about the clinical impact of flying on TBI in humans.
What we found in a recent analysis should be reassuring. There were no differences in symptom severity or recovery time between athletes who flew within 72 hours of a TBI and those who didn’t fly (Sharma et al).
The study comprised a large prospective cohort of National Collegiate Athletic Association athletes and military cadets from 29 universities and military service academies participating in the Concussion Assessment, Research & Education Consortium. During a 4-year period from 2014 to 2018, 3,480 of these athletes experienced a concussion. Of these, approximately 100 are known to have flown in an airplane within 72 hours of sustaining their concussion. The athletes’ concussions were rigorously evaluated and characterized, and patients were followed closely until they returned to baseline, so this consortium database is a rich source of information.
My colleagues and I compared those who flew and those who did not in terms of the time required to start a return to play (RTP) protocol, time to return to learning (RTL) and time to full symptom resolution (SR), as well as symptom severity score on the Sports Concussion Assessment Tool (SCAT3). We found no associations between flying (or duration or timing of the flight) on RTP, RTL, SR or symptom severity, including headache severity.
There are a few limitations to our study. For example, it is possible that the people we studied, who tended to be healthier and more physically fit than average, recover better and are more resistant to the effects of flying than non-athletes. The athletes were evaluated a day or two after their flights, so it is also possible that some of them experienced acute symptoms during or immediately after the flights that then resolved. Finally, most of the athletes in the cohort had short flights of less than 3 hours, so we can’t say for sure whether long-haul flights may have more effect.
More studies of patients in the general population are needed, but this analysis provides good reassurance that it can generally be considered safe to fly shortly after a concussion. Of course, it is still a good idea to get enough sleep and hydrate well before flying to prevent severe symptoms and to maximize the chance of a speedy recovery.
Reference:
- Sharma TL, et al. JAMA Network Open. 2020;doi:10.1001/jamanetworkopen.2020.25082.
For more information:
Tara L. Sharma, DO, is a clinical assistant professor of neurology at the University of Washington Medical Center in Seattle. Her clinical interests include sports-related concussion, post-traumatic headache and TBI. Her research interests include investigating factors that may influence concussion recovery such as air travel, hormonal fluctuations in females and substance use.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
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