Exercise
 

I am a newbie, I injured my head in a horse riding accident. I was wearing a helmet but have done some damage to my head. I am 9 weeks post concussion and still have a constant headache. I am on meds for pain control.

I was 3 weeks away from my first international competition with this horse and I want to stay as fit as possible so that my return to the showring doesnt take as long. My dr has said that if I take a high enough dose of the pain killers and cant feel the pain I can go back to riding.

I have sent my horse away to a trainer until the neurologist ok's me to ride again. I attempted walking yesterday and I am ok on the flat but walked up a long flight of stairs and it got my heart rate up and left my head feeling worse. As per my Dr who says I can go riding this is ok but I just thought I would ask what you all think while I wait the next two weeks to see the neuo.

How much exercise can/do you do? Is there something that is better than the other to stay in shape? Yoga?

Im no expert, but the thought of being on a horse and bouncing up and down sends pain straight into my head! Im assuming you also possibly injured your neck with the fall, have you had your neck checked out by a cervical specialist or chiropractor? i would think getting back up on a horse so soon would give you a massive headache, mess with your vision, create a lot of dizziness, and possibly nauseous. If you havent done much exercise in the past 9 weeks....which not many of us have that soon after, pushing yourself to get ready for a show will most likely set you further back in your recovery. Im 7 weeks out and attempted to do an hour of exercise a few weeks after my accident every day, and by the end of the week, i was so unbelievably fatigued and headaches were so bad, i could barely move and set myself back. Sadly, the prescription is rest. Take care of yourself and wishing you a speedy recovery.

I have no desire to get on a horse right now which is why he has been sent away for training. But I do want to get back on again at some point. I feel gross and lethargic and out of shape and wanted to know what others are able to do without too much harm.

Sorry I don't know how to answer because you must be past me already on the scale of vigorous exercise. I would think yoga would be a good one to do. Obviously exercises that don't jar your head are the better choices. I talked with my doctor about choosing walking and swimming over running, etc. Good luck to you!!

what about a stationary bike? Very little head movement or risk of falling. I completely understand what you mean about feeling gross and lethargic. Its hard when you are an athlete and used to being so active. I also do exercises at home with resistance bands, a big ball, and foam roller. I use the bike or elliptical in my complex gym. Its not much, but it keeps my muscles moving. I get dizzy from all the stimulation at my real gym, so keeping it at home, i can rest immediately if i need to or if i need my headache meds.

I would be more concerned about your next concussion than any attempt at exercising and getting back into shape. This accident changed your life to one that is still liveable. The next could leave you in misery for a lifetime. From what I can tell, your doctor does not have any idea about concussions or Multiple Concussion Syndrome.

Some years back, my dog broke his leg. The doctor who fixed it surgically gave us some Fentanyl to give him for the pain. The dose was so strong that he was running around the back yard like nothing had happened. Then, he stopped running and just wanted to lay down. He had felt so little pain that he had shredded the repaired femur. He ended up needing a second surgery by a specialist and ended up with a one inch shorter leg for the rest of his life. The second surgery was successful and the Fentanyl was much less so he spent adequate time resting until his leg was stronger.

What I am trying to say is your head hurts for a reason. It is telling you to take it easy. Pain killers may over-ride the message but they won't over-ride the reason for the message.

You need a serious evaluation by a concussion specialist ( not a generic neurologist) and even a neuro-psych assessment to determine how you function with reaction times and cognitive skills.

Your brain does not heal like a broken bone. It cannot make scar tissue. The damaged cells either recover completely or die completely. No in between. The stretched axons (connections between brain cells) remain weakened for a long time if not forever.

The most liberal athletic trainers and sport medicine doctors require a complete lack of symptoms before allowing athletes back onto the field. The conservative ones require normal mini neuro-psych tests before a return to activity.

You are risking the rest of your life. Be careful and think about your choices.

My best to you.

Good post and good advice Mark. This is, as you may have deduced, the part that I am struggling with understanding for my particular case.

Thanks Mark

That is they type of information I need. Since my Dr hasnt set limitations I think I have been pretty good in not doing much. I just needed to know what my risks are by pushing back since my dr seems to think there is no risk at all. If going for walks puts me further at risk I can continue to twiddle my thumbs.

I am thankful for the internet as much as Dr's are against it.

The risk of mild exercise/exertion is not high. It can slow your recovery but will not likely have long term consequences.

My concern is the long term and likely permanent risk you run by getting back on your horse and falling on your head again. If you were wearing a helmet and suffered such an injury as you already suffered, it shows that your brain is not tolerant of impacts. Some brains have more tolerance to impacts that others. It appears you have a sensitive brain.

Was this your first fall with a concussion? Or have you had other falls that did not appear to be concussions?

All falls with or without impacts to your head need to be considered part of your medical history. You would be wise to try to chart the falls you have suffered during your riding career.

Have you done any swiming or can you? I started doing this after one of my concussion because it has no impact but is still a good exercise. Just start slow if you don't want to get your heart rate up and if it goes well you can start swimming longer and faster. I still do mostly light swimming since I still can't run because of the impact or ride a bike because of balance issues. It might not work but why not give it a shot and see what happens.

-Soccer14

I have to second Mark in all he has said! I have had multiple impacts throughout the past 3 years, (2 work related and most recent a car accident). Each time it has been a harder, longer, more painful recovery.

I'm sure you have a great love for horses and for ridding. However, is it worth the risk of a lifetime of PCS? It's an individual decision that only you can make. However, you should know that doing so, even when you feel healed, makes a lifetime with this a possiblity.

As for trying to find milder exercises for now, consider your symptoms. If balance and vestibular problems are an issue, chose wisely! You don't want to accidently fall and hurt yourself more. The trick for me seems to be finding activities that don't up my heart rate. (Increase in heart rate for me= immediate return of symptoms, disabling me for the rest of the day). I have been mostly taking walks. (I used to do cardio and weights 45 minutes a day, and hate how lethargic and gross I feel... however pushing it is SO not worth how it makes me feel after!).

I think I may give swimming a try, just have to find a pool.

The best advice is to listen to your body. If the activity you chose makes you feel worse afterwards, you are slowing down your recovery and need to step back. This is NOT a situation of no pain, no gain...

Hope you can find something that works for you :)

Just wanted to add a note for everyone to be careful with swimming. I am a triathlete and swimming is by far one of the most intense exercises of the three I do. Sometimes while doing it, you can feel it's easier than you feel it was when you get out of the pool. Just a comment. Take it slow.

Swimming as alternative to walking?
 

Freezer (or anyone else),

I was thinking of trying some light exercise in the pool as an alternative to walking - maybe just walking in the pool, doing a couple of easygoing lengths of breast stroke, etc. Have you found even light pool activities to be as intense as walking? I'm really just looking for low-impact (ideally no impact) ways to move my body and get a bit of blood circulation going. While I have been mostly symptom-free at rest over the last week, I find that even short walks can still cause or contribute to symptoms, or at least the "fringe" of my earlier symptoms, coming back (mild intermittent headache, sleep disturbance, a bit of wooziness or feeling "off").

Any thoughts? The only alternatives I can think of are (1) to continue going for daily short + slow walks in the hope that the benefits of some light exercise outweigh the annoying but usually mild symptoms that result, and (2) to avoid walking or swimming altogether for 2-3 weeks, in the hope that having some sustained time with minimal or no symptoms will make light exercise easier down the road (I now seem to be OK with light household activities).

exercises in the pool
 

Hello Greenfrog,

I have been exercising in the pool for over a year now and have found it so helpful for my sanity and health.

At first I would just walk very slowly in the shallow end next to the wall in case of dizziness. At times I would have to hold on.

This is a better alternative to going on regular walks because of the resistance.

Once I was able to move a bit more, I added front lunges and side lunges along the length of the pool.

I also added some sculling,both front and back, and would hold on the wall for kicking.

I would recommend just holding onto the wall before you progress to a kickboard because the strain on the neck and upper shoulder muscles.

I would do one minute of kicking hard and one minute of rest. And the good thing is you can just put your head down on your folded arms to rest.

I held off on the strokes for a long time. It was months before I would swim freestyle and I would only do 25 yards at a time. I would try not to breathe so as to not turn my head.

Never any flip turns at all! Still haven't done one in 1.5 years.

Also, I found breaststroke to really bring on the symptoms... If I do it I don't put my head under.

Backstroke can be scary and forget about butterfly:)



Just take it really slow.. At first I would just go for 15 minutes because the dizziness can come on quickly and be quite scary. Its amazing how being the least bit hypoxic can make you feel like you will pass out.

Leg lifts holding on to the wall are great too. Stretches are so nice to do in the pool. I found that I was able to stretch better in the pool than at home.

About 1.5 years after my concussion my workout at the pool is pretty simple.
I try to break it up 10 minutes walking, 10 minutes lunges, 10 kicking and try to repeat. I probably swim only about 10 minutes tops.

As a swimmer for 10 years it can be discouraging to not even be able to enter the older ladies aerobics class:)

Just don't expect much, and I agree with the other poster about how you can easily over exert yourself swimming.

Just stick to walking and resistance and toning exercises, maybe there will even be a belt at your pool you can wear if you need to go in the deep end.

Good luck and one more thing. Have someone go with you at first, I was dizzy a lot in the beginning. I would be walking halfway across the pool and would feel it coming on and would hustle to the wall. Sounds comical now but it was terrifying.

Also, I had a seizure and about 11 months and all my tests were negative for them so you never know. I don't want to scare anyone but just please don't swim alone. Not worth it.

fellow horse rider (well, ex, actually)
 

Hi, my original head injury was after a fall from a horse, and I initially had every intention of riding again. However it took me at least 18 months to recover, and by that time I had seriously gone off the idea!

Everyone is different, and you may heal much quicker, but my personal view was that horses were too unpredictable and carried too much risk of another head injury.......so I moved onto to other hobbies which I have enjoyed just as much.

Be gentle with yourself, don't make any rash decisions at the mo, you are very early in your recovery. and most importantly, do not do anything to hamper your recovery. Your health is the most important thing......

greenfrog - sorry, i don't have any specifics for you becasue I haven't been in the pool since my concussion, but walking in the pool would be good. I woudl thinik it would get your heartrate up more than just walking in the air though. But yes, low impact it is!

Thanks - I actually just got back from a short walk in the pool in my parents' condo. I'm just going to keep experimenting to see if I can find something that works. I think exercise / physical movement is so important, and I miss the de-stressing benefits that go along with it. I'm hoping to find some level of activity that I can sustain, even if it's an extremely gentle one to start.

When I first got injured, I was such a mess I could not even do yoga. I started going to a senior yoga class at our community center (and I am in my 30s!!) where they do very very gentle stretches while seated in a chair, so you don't have to get up and down off the floor or lower your head below heart level. That was all I could do for several weeks. I can do regular yoga now but have to avoid very intense poses.

Then I progressed to walking VERY slowly around a track. At first I could only do 15-20 minutes at a time. I just did as much as I could every day and stopped when my head started hurting. Now, after several months, I'm able to go several miles at a totally reasonable [human] pace! I still walk almost every day.

If I had a stationary bike, I would try that, but regular bicycling makes me nervous about hitting my head now...

Whatever exercise you pick, just do a little at a time and listen to your body. Stop when it hurts, but try again in a few days.

Good luck!

Eowyn

Hi and welcome, this is a great site for support! Mark said it all.

I too have PCS from a horse accident, it's been 15 months for me and no riding in sight yet. Because I did not have the proper guidance in the beginning, I have to back track now and see what helps. With that in mind, I would suggest the following:

See a neurologist (if you haven't already) to rule out any other possible issues (vestibular, etc)

Call your Brain Injury Association asap (don't wait any longer), they are amazingly helpful and will assign a case manager free of charge to help your particular situation. They send you articles and info, including the best Dr's near you to see. I was finally referred for NeuroPsych testing and that person referred me to the sports medicine Dr I am seeing now. Plus they are just incredibly supportive.

Find a respected sports med Dr (perhaps from BIA), they are more helpful than a regular primary Dr. That person will help guide you as to what exercise (if any right now) you should be doing. They will monitor your condition as you progress and can advise you.

It is true that first you should be symptom free before starting back on an exercise program, so start with staying in your healing process (I like Mark's example of his dog) before worrying about more. I know it is frustrating...I am only allowed to do leisurely walks, no exercise while I get my symptoms back down. It feels disgusting...but it doesn't pay to push it. It will set you back even more.

There is a report on the protocol for returing to a sport and the first step is NO SYMPTOMS for at least 24 hrs before you can begin Step 2 which is LIGHT exercise 10 min per day and only if you remain symptom free, etc. So it is a potentially slow process, just to prepare you.

Riding a horse on pain meds is not a good idea (even without a concussion) and could create worse symptoms that you may not feel right away. It isn't just about not feeling pain.

You may not be clear on your judgement and awareness right now either, so your movements on the horse may not be the same (your horse will feel you being off too). It was wise to send your horse off, so you are not tempted. My horses are here at home and I still don't feel ok enough to work them on the ground let alone get on.

Though I am getting better, my reaction time is slower and that leaves me vulnerable, and my boys are well behaved. Just to prove that point, when standing next to my horse, he spooked (very unusual for him) in place and slammed his hoof into my foot. Now my foot has slight nerve damage because of the way he hit it. The funny thing was, at that moment I was thinking how perhaps I was feeling up to starting some ground work with him....guess he knew I wasn't ready yet and said so! haha!

Bottom line is: don't guess on the exercise, get reliable info from someone who actually understands concussions and can guide you properly. Then healing will take place faster.

Hope this is helpful in some way!

Jeni

Wait to ride.
 

I have ridden horse for 10 years. My concussion was caused by a riding accident over a year ago. Most people have no understanding of how a concussion causes serious or subtle damage to numerous parts of your brain. They so often do not comprehend how even small changes to the functioning of different parts of your brain can interact and create big problems. For myself, I know that an important competition would be potentially disastrous. Here's why:
high stakes = stress = impaired and slowed thinking
loud noises = stress = more of same
bright overhead lights = stress = more
small changes in coordination of left and right hands = could mis-cue horse = dangerous
small changes in balance = very dangerous when riding a horse
stress + stress + stress = slowed reaction time = very dangerous in some situations
get tired much more quickly which causes all of the above to get much worse at an alarmingly fast rate

Don't listen to people who don't understand concussions. They can give you bad advice. "Get back up on the horse" is a classic one and some of the worse advice someone could give you. This is the time for caution. Riding requires excellent balance, coordination and timing. Any problem in these areas could put you at serious risk of another concussion. A second concussion is very, very dangerous! When it comes to recovery, think in terms of months or even a year or two, not weeks.