Exercise Intolerance Since Concussions
 

I suffered two concussions from skiing in March of 2017. Didn't think much of it until I started experiencing strange headaches every time I exercised. So I went to a neurologist who started me on vestibular therapy. This didn't do much for me because even the toughest vestibular exercises didn't cause me any problems. Felt pretty lost because I was still getting headaches from exercise but nothing else! The "typical" PCS triggers didnt cause me any problems.

Found a more knowledgeable neurologist who got me doing a version of the Buffalo Protocol to help improve my tolerance for exercise. Have been trying to do this off and on the last 8 months but have really struggled to make any progress. My problem is that during my workout I don't experience concussive symptoms or headaches, but it is when I stop exercising I get the headache. It isnt immediate, but usually 30 minutes to an hour after I get hit by a headache. Headaches usually last for a few hours but can linger for days. The headaches are not "painful", but it feels like I have an intense throbbing pressure in my head. My eyes get pressure behind them. These headaches leave me exhausted, and put me in a fog. It makes it hard to follow the Buffalo protocol because I cant judge how hard to go in a workout, and I have found that even small increases in heart rate during exercise will still give me a headache later.

Sorry for all the text, but just posting on here to tell my story and to see if anyone has any advice or has experienced something similar. My doctor and therapist don't have any answers, and at this point they just keep telling me that it will take time and to be patient. I haven't seen any improvement in this last year and have been feeling lost lately on what to do. I get random headaches that come and go some days, but they are mild compared to what I get after I exercise. I feel sharp in school, but feel trapped not being able to exercise.

I know many people on here have it way worse than me, so I feel lucky that the only thing I struggle with is exercise, but I would love to be able to be active again.

The Buffalo Protocol does not mean exercise until your symptoms return. It allows for delayed symptoms. Try lesser levels of exercise to see if the delayed headache manifests.

It may help to get a wrist blood pressure kit and see if your BP relates to your headaches.

Have you tried any headache meds? ibuprofen, aspirin, etc?

What pulse rate have you been targeting?

I have tried ibuprofen and acetaminophen without much luck. They dont make a noticeable difference.

That is a good idea about blood pressure. I will look into getting one. I have been using pulse rate monitor when I work out. Lately I have been keeping it below 110 because I have been just trying to walk/spin at the gym, but I still get headaches after these workouts.

When I need additional headache relief, I take acetaminophen and aspirin at max dose of each. My doctor told me to combine them. They provide very good headache relief together.

Icing the back of my head and neck sometimes helps.

mate, I literally feel your pain it took me 6 months to even get a doctor take me seriously enough to refer me to a neurologist. And like you I am DESPERATE to get exercising again. My head ache sounds very similar to yours pounding pressure especially behind the eye and brought on badly by exercise. The only thing I can recommend trying is lions mane as per my previous post. at the moment I have been head ache freeish for a week, from about 7-10day of taking them. if you do try them its important you get high quality as some cheaper one made it worse.

Luigi,

It took me 1.5 years to get past only being able to walk 500’ and another 2 years to be able to suffer no ill effects from time at the gym.

I did ok at the gym if I carefully managed my heart rate....if I got it up on the higher aerobic end for sustained periods I had real after effects. I just did everything slower and easier and was quite happy to be able to do that after 1.5 years of laying around.

Missed 3 ski seasons.

Dude, same thing here. I do 130-150 BPM for 45 minutes. Immediately post-workout I feel pretty damn good. But for the next few days or even weeks I just regress significantly...dull pain in the lower skull, brain fog and general malaise.

It sucks because the exercise definitely helps my anxiety, however the regression of symptoms just leads to further anxiety and depression.

I've been going consistently for 2 months now...hoping I can overcome the threshold.

Pizzamanluigi I've been struggling with exercise intolerance ever since my concussion in 2012. The Buffalo protocol has helped me to get going, but it took over 3 years to get me to a point where I can do my favorite hikes and walks without the fear of regressing myself.

If you're getting headaches after the exercises, dial it back. What kind of exercises are you doing? Weight? Cardio?
I would start with cardio and go very light on any kind of weight training. Once you get your cardio to a point where you don't see any problems, start adding weights very slowly.
Unfortunately there's no sure way to tell you how long this will take, everyone is different. Like I said it took me over 3 years to get my cardio back and I'm still overdoing it sometimes.

I get those if I work too hard. Mostly when my brain gets jostled. Even chewing a stick of gum does it. So weird.

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QWERTY,

Maybe slow it down some.

My cousin gave me some good advice one time when I was complaining to him I wasn’t the same at the gym....he said, “You’re in recovery stage, treat yourself as such. If you had a broken bone you wouldn’t be worried about slowing down because of it.”

Bud

Perfect

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Sorry for the slow reply, work and school has had me too busy to even think about working out.

@HempHappy you still headache free?

@Bud I missed this ski season and it tore me up inside, few things in life feel better than being on the mountain. How are your workouts now? Do you still manage your heart rate?

@QWERTY02 same here, I have gone from working out everyday to sitting around doing nothing. That is recipe for depression and anxiety. I just want to be active again.

@russiarules I have been doing just cardio right now. Lifting weights seems to cause headaches quicker, but sometimes it is hard to tell.

Pizza Man,

Things are much better now, i can work much harder this winter with for the most part few after effects but there are still days when stuff reminds me something happened 4 years ago.

This winter when it finally snowed at Tahoe I was able to ski full bore, felt good to not have to protect myself so to speak.

Bud

exercise intolerance
 

I seem to have the same problem as all of you. Did any of you figure out any remedy to this. I've tried the Buffalo protocol but I can barely slow walk for 10 min without getting a headache.

Unfortunately I have not found a remedy for my exercise intolerance. I seem to be in a similar place as you. Just go for a walk can give me a headache as well, it really ****ing sucks. I believe that some of my issues are coming from my neck, but I have been to two different physical therapist and they don't see anything wrong with it. Really at a lost on what to do next. I have also tried Buffalo protocol, and actually had some success early on with it but after I relapsed I have been extremely sensitive to headaches. I want to get back on a exercise program (extremely light of course) that follows Buffalo Protocol, but I cant risk getting a headache for hours with my current schedule of school and work.

The neck issue is not something that common PT or other diagnostics will find. It is more of a treat it and be disciplined to not aggravate it. PTs do range of motion and maybe palpations to find problems. Range of motion does nothing to diagnose these subtle injuries.

The problem is a subtle instability that allows inflammation triggering movement. The inflammation then triggers other symptoms due to reduced nerve flow and reduced blood flow.

The PT can do some gentle traction and mobilization but the patient needs to live with postural discipline. Straight head and neck position when sleeping and resting is important, for months if not years. It took me a long time to regain the stability in my neck so I can sleep in less than idea posture.

Learning to walk with less impacting foot plants can help. Using foam ear plugs can help one hear the foot plant as it impacts the head. The vertical pounding can be the hardest issue to resolve.

I do feel that instability in my neck. What methods did you use to help your neck stability? Luckily I sleep on my back and don't move much at night, so I think my neck stays pretty straight. I know I should have better postural discipline but it is easy for me to forget/get lazy with my posture. I will need to test out the ear plugs when I walk. Thanks for all your help. I really do appreciate you taking the time to assist people on this forum.

I could not tell I had neck instability except for the symptoms I experienced after I slept in poor posture, especially if I fell asleep in the car or a chair.

The worst was trying to sleep during an EEG with sleep session. The rolled up towel pillow under my head forced by chin to my chest. The inflammation interrupted my breathing, even when I was wide awake. This event caused me to consider my symptoms after other bad posture periods.

When I tried sleeping with straight head and neck position, the quality of my sleep and the days after those good nights of sleep improved dramatically. If I rolled to a bad position, I would have stressful dreams and have a stressed look on my face.

I spent a lot of nights getting a good night sleep in a recliner chair.

High doses of acetaminophen and aspirin, together, give me stomach ulcers, so that isn't helpful.

Aspirin in enteric coated form will not dissolve in the stomach. They are a bit slower acting but without the stomach upset. I've been taking 975 mgs of aspirin (enteric) twice a day for over 20 years for arthritis.

Hi all! I just saw this thread and though this doesn't sound like everybody in this thread's situation I just wanted to bring it to attention! I had very bad exercise intolerance after my concussion and my symptoms were taking a lot longer to diminish than we felt they should. I also started passing out after standing for too long so we knew something else was going on besides just a concussion. We found out that I have POTS (postural orthostatic tachycardia syndrome) which isn't a very well known condition which is why I was not diagnosed sooner. They are not sure what causes POTS but it often follows a concussion so it is lead to believe concussions may cause it! It is a disfunction of the autonomic nervous system and it causes a vast amount of symptoms such as head aches, brain fog, dizziness (things that are also concussion symptoms) but it's main symptom is exercise intolerance. It's worth looking into because once I began being treated for the POTS more than half of my symptoms diminished and my main focus is now on treating my POTS. Hope you all start to feel better! Definitely look into POTS!

I had a bad case of postural bradycardia for about 3 weeks 15 years ago. It came on after I rode home from a trip to California and fell asleep for a hour or more with my head tipped forward with my chin on my chest. I could barely stand up during the first week or two. My pulse was staying below 50. I just slept or dozed most of the time.

This was before I discovered that my upper neck was getting inflamed and interrupting my autonomic nervous system every time I had a head forward posture for an extended period (10 minutes or more).

My chiro and PT helped reduced the poor alignment but the most important part was being disciplined to no sleep or rest with bad posture.