Originally Posted by Canadoc

Hi everyone,
This is the first time posting a "thread" as well as the first time I've ever been part of an on-line forum, let alone any forum for that matter. I'm a family physician in Canada, and like most Canadians, enjoy playing hockey. Unfortunately, in 2006, I suffered a concussion during a hockey game which resulted in a prolonged recovery. After about a year, I was finally able to tolerate and enjoy sports again without inducing a headache. As you can imagine, I was forbidden by my wife to lace up my skates again (no argument).

In retrospect, I now realize I made 2 errors in recovery (wish I knew then what I know now). First, I quickly returned to work without much cognitive rest and pushed my way through long clinic hours. Second, I lifted a heavy article on day 2 post mTBI which quickly brought significant and instant head pain.

What has now become a permanent disability is an inability to strain or lift articles more than ~10 lbs without feeling a discomfort in my head. This discomfort eventually becomes pain if I persist with the strain or lift. The more intense the pain, the longer it takes to dissipate. With new head trauma (such as loghtly bumping my head on a shelf, running in my squash opponent....ie sudden deceleration), this intolerance to strain is magnified for a few weeks. Eventually it settles back to a baseline but never goes away. Essentially I am extremely sensitive to any increase in intra-cranial pressure(ICP) (physical strain--->increase venous pressure--->increase ICP. The problem is that it is now taking less force to temporarily magnify this phenomenon. I've recently had a second MRI specifically to rule out a head trauma induced Chiari-type CSF obstruction. Thankfully everything was normal. I've consulted local "concussion specialists" who can only come up with theories of meningeal hypersensitivity post injury with the consideration for medication dampen the pain during effort (which I'm reluctant to do).

The other phenomenon that now follows any head bump (and I mean just a bump), is a decline in cognitive stamina that slowly improves over 2-3 weeks. It's difficult to cancel patients who have been waiting so long to see you. So, against better judgement, I often will push myself cognitively through a days work. I now can appreciate that these changes (following repeat minor injuries) are both structural (at a cellular level) but also biochemichal (increased neuron vulnerabilty and cell dysfunction). What puzzles me is why the worsening trend over time.

Once I'm 3-4 weeks past a "head bump", I feel cognitively great again. I'm able to enjoy aerobic sports that don't increase venous pressure much or for long. In other words, I have no problems tolerating an increase in arterial pressure when I'm "well" (I can ride my bike but just can't lift it!).

I wonder if anyone else has been experiencing similar post-concussive symptoms and whether investigations have shed any light.