No screen time for two days after concussion, says doctor with Philly sports radio pedigree

A Philly guy named Macnow is drawing attention lately for his expertise on concussions and screen time.

No, not the SportsRadio 94.1 WIP host, but his son Theodore Macnow — a pediatric emergency physician at UMass Memorial Children’s Medical Center, in Worcester, Mass.

The younger Macnow (still a Philly guy at heart, maintaining his allegiance to the Eagles in hostile Patriots territory) just published research that should help injured athletes no matter where they play.

In a study published in September in JAMA Pediatrics, he and colleagues reported that concussion patients recovered more quickly if they avoided screen time for the first two days after injury, compared with those who had no such restriction.

Father Glen Macnow, who mentioned the study on his show, acknowledged that his interest in the subject went beyond familial pride.

“Two things that definitely play into my line of work are concussions and screen time,” he said in a phone interview.

» READ MORE: Teen athletes with concussion: How soon should they be cleared to play?

The NFL’s 2015 concussion settlement was a hot topic on the airwaves, along with football rules changes designed to reduce the risk of brain injury. Public awareness and precautionary measures have increased in other sports as well, both for professional athletes and those of school age.

Physicians have welcomed the widespread attention for this serious health issue, once dismissed in the sports world as something to “shake off.” But the best strategies for treating the injury are still a work in progress.

Until recently, people with a concussion were urged to cut way back on physical and mental activity until symptoms resolved — dubbed the “cocoon” approach.

Then in 2015, a study found that youths who rested for four days following concussion took longer to recover than those who rested for just two days. In response, physicians have adopted a more intermediate approach: prescribing rest for a day or two, followed by a gradual return to activities so long as symptoms do not grow worse.

But what types of rest, and what types of activity? The advice can vary from doctor to doctor, said Theodore Macnow, an assistant professor of pediatrics at the UMass Chan Medical School.

Some physicians say it is OK to look at smartphones and other screens, provided the app in question does not feature flashing lights. Others have counseled limiting screen time to less than an hour, or none at all, Macnow said.

In search of answers, he and colleagues conducted a study among 125 patients who went to the UMass emergency department with a concussion between June 2018 and February 2020.

The patients, aged 12 to 25, were randomly assigned to one of two groups. Some were told they could engage in screen time right away, while the others were asked to abstain for 48 hours. Patients reported their level of severity for 22 symptoms, including headache, nausea, dizziness, and difficulty in concentrating.

Staying away from screens seemed to help, said Macnow, who collaborated with Boston Children’s physician Rebekah Mannix, the study’s senior author.

In the group that was allowed to look at screens of any kind — most opted for TV or smartphones — the median recovery time was eight days. Those asked to stay away from screens felt better after a median of just 3.5 days, though they did not abstain entirely.

Some in the abstinence group acknowledged spending an hour or two looking at their phones or other devices. Those in the group with no restrictions, on the other hand, reported that they used screens for a median of 10.5 hours over the two-day period.

The research will be a valuable guidepost in helping those with injury return to normal, said Christina Lin Master, a Children’s Hospital of Philadelphia sports medicine physician and concussion researcher, who was not involved in the study.

The results are consistent with other evidence that the most important time to rest is the first day or two after a concussion, Master said. And while gazing at a screen may seem like a restful, passive activity, it is not.

“Screen time is a workload for your brain,” she said. “The critical thing is the timing.”

Still unclear is whether some types of screen use might be worse than others. Is it the electronic glow that poses a problem? The rapid movement of images in, say, a video game, placing strain on eye muscles and the neurons that control them?

Another possibility is that screen time could impede recovery because it interferes with sleep, though the two groups in the UMass study reported no difference in sleep duration, Macnow said.

Also unclear: How much difference will screen restrictions make over the long term? (Study participants were followed for just 10 days.) Macnow said he plans to explore these topics in follow-up studies.

In the meantime, he and Master agreed that a sensible alternative to screen time would be an activity that involves simply listening, such as an audiobook or the radio.

Macnow’s father, an author and former Inquirer sportswriter who has been at WIP since 1993, would take that.

He jokes that he knows “nothing about medicine,” yet ended up with not one, but two sons as physicians. His younger son, Alexander Macnow, works at the Foundation for Advancement of International Medical Education and Research (FAIMER), a Philadelphia-based nonprofit.

The elder Macnow said the smarts come from his wife, Judith, a former nutritionist.

“I’m the idiot of the family,” he said.

But smart enough to pay attention when a family member brings science into his domain of sports.

Theodore Macnow also did that in 2017, measuring the health impacts of carbon monoxide emitted by ice-resurfacing machines at youth hockey rinks. The elder Macnow tagged along with his son as he studied the devices — commonly called Zambonis, though some are made by other manufacturers.

While he defers to his boys on medicine, Glen Macnow sets the tone on sports, making sure that the Boston-area Macnows are not swayed by their New England surroundings.

“I send my two grandsons Eagles sweatshirts and hats on a regular basis,” he said. “Let there be no doubt.”