You should not be pushing into symptoms or trying to push through symptoms. Your exercise should never cause an increase in symptoms. Your exercise should be very low intensity until you have been free of dizziness for a straight week. If you increase your activity level and symptoms return, stop and wait for more clear time.

If your concussion specialist is focused on return to play, she sounds like she may be a weekend ImPACT seminar trained specialist. They tend to focus on pushing for return to play at the expense of depth of recovery. Coaches want players back on the field as soon as possible so the specialists try to push.

You should not be trying to evaluate progress more than every 7 days or so. No daily assessment. They are worthless.

Days after poor sleep are bad because of the poor sleep. Accept that.

Do you use screens at work each day ? Have you tried reducing the brightness of the screen ? F-Lux.com works for some. Avoid fast moving screens like video games.

Learn to recognize the early signs of fatigue. Needing to reread a line of text, struggling to focus, any sense of 'What did I just do/read?' Take a break. Change activities when you start to fatigue.

Reading can be a problem if the lines of text are too long or the writing is too complex/descriptive. Think of activities like juggling. You can only juggle 2 or 3 balls. Reading with background noise/voices or other stressors is more than 3 balls. Multitasking is 5 balls. Expect to fail if you try to juggle too many balls.

You should not go to bed until you are ready to fall asleep. You should be able to get comfortable and fall asleep within minutes. If you start to toss, get up. Distract yourself and wait for that sleepy feeling and go to bed again.

You should start slowing down with activities at least an hour before your usual bed time. No conversations or heavy reading. Start dimming lights. Take care of anything that needs to be ready in the morning, especially by making notes so you can 'let go' of those thoughts.

You can find the specific ways for you to recover best. Don't expect others to find the solutions. The doctors and therapists who have never experienced prolonged PCS rarely get it.

My best to you.

I think that I was misleading using the term return to play. I just meant to say that we are employing a method of slowly returning to various forms of activity.
I'm actually not attempting to return to sports of any kind at the moment and the only physical exercise that I'm doing is short 5ish minute walks every hour or so. It's the mental activities like reading, playing piano, having conversations and using screens that I'm trying to slowly build up.

The concussion therapist has suggested what you said, of not increasing the time on the various activities until I am symptom free at the current amount of time spent on any activity. She had me do a bunch of self evaluation at first in order to determine how much I felt each type of activity affected me. I gave "points" to each activity and the idea is to limit the total number of points in a day so that I don't have any more symptoms at the end of the day than I did at the beginning.


The bulk of my days are made up of "0 point" activities like listening to podcasts, light stretching or organising, and mindfulness. I try to take a short walk and do a quick 5 minutes of sitting eyes closed rest at the end of every hour. Then every other hour or so I do a short bit of an activity that costs some points. For example, maybe easy reading for 10 minutes costs 1 point at the moment and if progress was being made then 12 minutes would cost 1 point in a couple of days.

I asked about pushing a bit more into the symptoms because I haven't noticed much progress and somebody told me that they felt an increase in their recovery when they started "going to a 5 out of 10" in terms of the onset of symptoms with various activities instead of a 1 or 2 out of 10. This went contrary to what my therapist said and that's why I was curious for another opinion.

Yes I've reduced the brightness on all my screens and I've experimented with different colored plastic dividers over my computer screen but I still have the very beginning of symptoms come on after 5-10 minutes or less in some cases.

Thanks again

It sounds like the Becky Moran points system from London. That is too 'one size fits all' for my taste and many others. Learning to recognize the early signs of nearing your limits so you can switch tasks is another system. The point system does not have adjustments for individual issues. Your bad sleep vs good sleep days will have different applications of points. Learning to recognize the early signs works whether you have had good sleep or not. It also works with those tasks and activities that do not fit the points system.

That makes a lot of sense. I'm putting your recommendations into practice.

Another big thanks.

What does this mean if you have these? I definitely do and my headache pain gets replicated if I pinch my neck muscles on both sides. I've been doing acupuncture with electric shock to try to loosen them. I've also done trigger point injections and 5 weeks of physical therapy. Nothing has worked.

I don't trust chiropractors so does that mean that there's nothing else left for me to try?

Physical therapy can be good or worthless depending on the skills and therapy done. Traditional PT protocols are range of motion focused and/or strengthening focused and not much help with many subtle neck injuries. As Jo*Mar said, If your PT does not know how to identify trigger points and such, find a different PT.

Just as there are good and worthless PTs, there are also great and useless chiros. It is hard to find the good ones. In my experience, only one in five have been worthwhile. Same as my experience with PTs.

Some DOs, Osteopaths, are good with neck issues. Again, you have to find the good ones.

In my experience, any treatment will show at least a temporary improvement after just a few treatments if not the first. More treatments may be needed for lasting results but the treatments should be spaced apart with self-treatment/postural discipline used to help the treatment last.

Therapists of all types tend to want to keep their calendars full and use up the patient's insurance and financial resources doing so. The "I want to see you twice a week for 5 weeks" at the first appointment is bogus in my experience. Been there. Had to deal with that type of treatment.

The good ones might say, "I want to see you twice this week then next Monday, we will re-evaluate."

I spent $8000 in the first year and a half trying to find worthwhile care. I found a PT who did myofacial release (sort of trigger point therapy) and some other protocols and I started improving.

Upper cervical chiropractic helped and is not like the twist the head and pop the neck form.

I'm going to Mayo Clinic tomorrow for 5-7 day stay. Will see what they say about it.

The proletherapy treatment I looked up seems interesting and Mayo Clinic released statement in 05 saying it may be beneficial. The quote I got for that treatment was $3,400 for 4 doses. Reviews from the provider are controversial with some people saying they are way worse after doing procedure.

If I'm going to pay a lot of $, I feel HBOT has best chance at making a meaningful difference. Just my instinct for all that I've read and the science behind it. That and Keto diet which I'll be trying after I get back from Mayo.

HBOT will not help if you have a neck issue. KETO will not either. The Prolo treatment cost sounds very high.

With all the treatments you have undergone, what have you done to help your neck heal ?

If you just treat the symptom but not the cause, you will forever be stuck treating the symptom.

I don't think it's just a neck issue but it is part of the equation.

I think I likely have diffuse axonal injury. I was in Tbone car accident. Car was prob going 60mph+ and my SUV went airborne and landed on its side.

The fact I have convergent insufficiency makes me think it has to be more than just my neck. There have been times where my neck didn't bother me but it got a lot worse after I had kids and hold to them a lot in awkward positions.

Massage has always given me some temporarily relief but I've felt like a completely different person ever since the accident.

I have constant head pressure/tension headaches and brain fog with sensitivity to light and sounds.

I try to use flat pillow to not put pressure on my neck muscles. I saw a dentist who said I had TMJ and I use orthodontic device that is suppose to fix that + help with neck muscles.

I went to certified atlas chiro for a month then I stopped going after it was apparent to me it was a scam.

Brain carrick doctors tried to adjust my jaw as they said that was out of alignment. My symptoms got worse after he did his adjustment.

You likely have two injuries. You have a brain injury and you have an orthopedic injury, neck etc. If the neck is symptomatic, it interferes with blood flow to the brain. This reduced blood flow makes any brain injury much worse.

Until I resolved my neck, my brain was always bad. Once my neck started to improve, my brain issues started to get better. If I allowed my neck to get strained, my brain issues would come roaring back. My wife could tell how my days were going to be by looking at my facial composure while I was still asleep and she had just gotten up from bed. If my face had a calm look, I would have a good day. If my face had a strained look, I would have a bad day. Usually, if my face had a strained look, I was sleeping with bad posture.

I have a much improved neck today but I know that if I mess up with sleep posture, I will mess up my day. I will be foggy brained and may get headaches.

It took me two years to get my neck in a reliably stable condition. A chiro and a PT helped me along the way by helping release muscle spasms or misalignment. But, most of the healing was from strict self-discipline.

I have had sensitivity to sound for 20 years. I've been sensitive to light for over 50 years. That is easy to deal with compared to my memory dysfunction and cognitive processing issues. The foggy brain is the biggest problem but getting proper sleep in proper posture is the best solution for that.

If you still have neck symptoms, I suggest you focus on resolving them and see how you brain issues are with a stable neck.

There have been many studies that discuss the issues of blood flow to the brain and brain stem being challenged by neck issues.