Concussions aka mild traumatic brain injuries (mTBI) are a common, but unfortunate, occurrence that effects people of all ages. Sport activities, car accidents, falls, or getting knocked in the head by an object are all possible situations that can cause a concussion. In Denver, Colorado, common causes of concussions are slipping on ice, mountain bike accidents, and downhill ski crashes. Luckily, for most people, concussion symptoms resolve in 10-14 days. But about 30% of people may still experience symptoms 6 or more months after suffering from a concussion; this is categorized as Post Concussion Syndrome (PCS). PCS as defined by the World Health Organization (https://www.who.int/) includes having a history of a traumatic brain injury and 3 or more of the following symptoms: Headache, Dizziness, Fatigue, Irritability, Insomnia, Difficulty in memory or concentration, and/or Intolerance of stress, emotion, or alcohol. Although the W.H.O. does not specifically list exercise intolerance as a defining symptom of PCS, it is extremely common.
Exercise intolerance due to PCS is defined as an increase in symptoms with exertion or an increase in heart rate and/or the onset of new symptoms during exertion. Common symptoms include dizziness, lightheadedness, and headache. These symptoms not only discomfort, they can also cause risk for falling and possibly sustaining another concussion. It is important to recognize exercise intolerance symptoms and adjust accordingly. But how to adjust and progress can be confusing - keep reading for helpful tips!
Possible physiologic causes of exercise intolerance with PCS:
Disruption of the Autonomic Nervous System (ANS) and the cardiovascular system: Elevated cerebral blood flow and arterial carbon dioxide contributing to onset of symptom exacerbation during exercise
Vestibular and/or Vision problem: Difficult and varied sensory input with exercise activities
Cerebral autoregulation: The inability of the cerebral vasculature to maintain stable blood flow with changes in blood pressure during exercise
Inflammatory processes: Changes in how the cells function due to injury
Axonal disruption: Mechanical disruption of cellular communication due to injury
Determining the possible cause of exercise intolerance can be done by a trained physical therapist. A comprehensive exam will include cervical spine screen, vestibular testing, visual processing testing, balance, reflexes, and The Buffalo Concussion Treadmill Test (BCTT). The BCTT is a graded exercise test that provides objective information (heart rate based) on exercise intolerance for PCS. The results help guide how to resume and progress exercise while minimizing symptom exacerbation. Read more about BCTT here: https://www.frontiersin.org/articles/10.3389/fneur.2019.00395/full
Exercise is an important component of general health and wellness, even for people not suffering from PCS! But it is especially important following a concussion; exercise is a key part of the healing process. Ideally, light exercise is initiated at 3-5 days post concussion. Components of resuming exercise include:
Choose an exercise activity that minimizes risk for a second impact event
Initial exercise intensity is very low compared to pre-concussion level
It’s never too late to start exercising! Exercise helps bring blood flow (and therefore oxygen) to the brain to help the healing process
Benefits of Exercise:
Decrease in post-concussion symptoms sooner
Improvements in mental health, including reducing anxiety and depression
Improvement in academics and cognitive performance
Read more about exercise recommendations from the American Academy of Pediatrics: https://www.aappublications.org/news/2018/11/12/concussion111218
Watch Day 1 (of an 8 day course) on returning to exercise after suffering from a concussion: https://www.youtube.com/watch?v=ICOYec3f8wY
For personalized, one-on-one care and advice to help you return to your desired exercise level and activities, book an appointment today!
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