Exercise intolerance and PCS
 

Hi everyone, longtime stalker, first time poster. Thanks to the forum for providing some guidance about symptoms and recovery.

First real concussion was in May 2018. I was kicked in the back of the head in a freak accident during sports. No lost consciousness, but but after a few days had to take a few weeks off work.

My biggest symptoms had to do with 'sensory filtering'. Scrolling screens were tough. Sitting outside and seeing traffic move in the background was tough. I could have a conversation with a single person, but in a loud place where I had to separate their words from the background was tough.

After a few weeks, I returned to work feeling mentally normal, but physically a bit off. After 3 months, I started returning to physical activity, and after a few weeks had my first setback after a tough workout on a hot day. Since then, I've had a few more setbacks, all related to exercise, with my threshold for symptom-free exercise decreasing. My symptoms come back usually that night or the next day, and consist of general and mental fatigue. I've also noticed a few times where I'll have a fight or flight response to absolutely nothing.

My neurologist just prescribed Zoloft (sertraline), not for depression (which I do not have) or cognitive issues, but to try to get my brain to relearn how to regulate itself during exertion.

No questions for me yet, just putting this out there in case someone has a similar experience.

Waffles,

You have posted a subject I'm intimately familiar with.

I am 60 now and had been running for 40 years prior to my accident 5 years ago. I couldn't walk 500' without a flood of symptoms early in my recovery and 2 years before I could return to a gym at a very low level of exertion that produced symptoms I was capable of dealing with.

For me, I had to closely monitor my heart rate in order to control symptoms on return to the gym. The longer I sustained aerobic levels the more uncomfortable it became that evening and the following day. Now it's no big deal again.

Be patient, things will return to where you will achieve satisfaction with your fitness level again. I chose to do mine med free, might have been slower but for me it has provided a level of pride in my persistence and determination I possibly wouldn't have attained otherwise. It's a personal decision, there's usually more than one way to your destination if that makes sense.


Any questions PM me.

Take Care,
Bud

Hi Bud,

Thanks - PM coming your way.

Actually, I...can't figure out how to PM, so I'll just post it here.

To some extent, I'm glad I'm not the only one with this particular affliction, and all the articles suggesting exercise to help recover aren't ironic to only me.

If I can ask, did you notice your symptoms getting worse before the got better? The worrying thing for me is my threshold has decreased over the past 8 months.

Hello!

I highly recommend looking into to Buffalo protocol where you monitor your heart rate as you return to exercise. After my injury in March 2018 I was unable to walk more than a block without a spike of symptoms.

After 4 months I got a heart rate monitor and began monitoring. At first I could walk for 20 minutes at 120BPM. this was VERY frustrating as I was walking so slowly (less than 1km in 20 min). But over the months I have increased. Everytime I found that I feel no increase of symptoms I would increase my heart rate threshold. For to 125bpm then to 130bpm and so on.
When I got to 140bpm I also started to increase the time that I could workout. They recommend for this protocol you either walk or use a stationary bike at first as it's a consistent way to keep in control of your heart rate. And this doesn't move your head a lot so you don't get vision symptoms. Also during this time if your symptoms spike rapidly more than 2 pain points (so for example you headache goes from a 4/10 to a 6/10) stop and try again another time maybe at a lower heart rate.

Now (11 months on) i am able to life light weights for 1 hour with a heart rate max of 150. Somedays I still have symptoms after exercise, but if I don't push it I generally don't. Weights are less predictable heart rate rise, however because I was an athlete before my injury I find the emotionally boost I get from weight lifting is worth a small setback for the next day.

The theory behind this protocol as I understand it is that after a tbi when you work out the increase of blood to your brain is seen as a threat and your brain doesn't know how to deal so it increases symptoms to protect itself. Slowly retraining it that exercise is safe in this gradual method helps it realize exercise is not a threat.

I really hope this helps you, it's the only method that has helped overcome my exercise intolerance. It's a long, but worthwhile, process.

Waffles,

My symptoms started escalating ferociously around the 6 month post accident period and continued downhill for another year. They stayed bottomed out for another year after that.

I made it back to the gym at 2 years but it was 2.5 before I could do anything beyond minimal exertion. My cousin told me something that resonated with me, he told me I was in rehab, not the Olympics which allowed me to stop looking at the level of fitness I was at pre accident as something I needed to recover immediately and use it as a goal to keep me driving forward.

Swimming was a Godsend for me as running was beyond intolerable for my head.

Bud

Hi Kate2 and Bud,

Thanks for your responses. For me, Zoloft was the absolute worst, and I lost a few weeks dealing with the symptoms. I actually got another concussion in January (about a month ago), and I think the Zoloft impeded my recovery.

Kate2 - I ordered a wrist HR monitor that was laughably bad, and upgraded to a chest monitor, and am now going on a few walks a day. Unfortunate, because I was doing sub-7 mile runs run beforehand, and now I'm sore the day after walking for 12 minutes. Baby steps!

Bud - oddly, I'm glad I'm not the only one who deteriorated for no reason after initial concussion. I'll be seeing a concussion specialist next week, and we'll see what else they identify. Although the exercise was the only thing that exacerbated my symptoms, I never felt quite right, so maybe there was some vestibular or visual stuff going on as well, and everything might be tied together.

It's taken me a year to go from barely being able to do anything (100 bpm) to being able to do 130-135 bpm for 45 mins (about 75% of age predicted max heart rate) without too much ill effect. 20 mins at 145 bpm will still mess me up for a couple of days. I've been back at work, so that's slowed my progress lately... (partly due to time constraints, partly because there's times where I can't risk being messed up for a day or two if I were to push myself too hard).

Zoloft has been great for me (75 mg). But of course, everyone's different. I had minimal side effects going from 0-50mg. When I went from 50-75mg, I felt a little too chill and a bit sedated for a couple of weeks, but that subsided. The biggest benefit is that it's made me less stressed out about my symptoms.

A week after my concussion when the symptoms kicked in I could only just walk around the block before collapsing in the armchair exhausted. I built my fitness back up gradually by increasing distance until I could walk for 40 mins then increased my pace, it takes time but gets easier as you recover. I remember trying to run early on but got a jabbing pain in my head so I stopped and went back to building slowly. Can't rush PCS recovery.

Hey Waffles,

Was curious to any update on your progress?