Hey there,

I'm looking for some advice on following the buffalo protocol on exercise from those who have used it. I did a test run on a cross trainer a couple of months ago and kept upping the pace until I felt rather fatigued. The symptoms didn't return as I was using the cross trainer, but came a bit afterwards. I felt weak in my legs and somewhat foggy in my head.

So I used the heart rate at which I stopped as my symptom triggering heart rate and placed my goal at 80% of this heart rate - the goal ended up being ~137 bpm. Before university started again a month and a half ago, I did 7-10 minutes of training at between 120 and 137 bpm before I stopped. This made my legs feel wiggly and weak but my head was pretty clear even though I had some fogginess that I think was due to anxiety/expecting symptoms after exercising.

When university started, I had my plate full with reading which surprisingly went by more than allright (I stopped with the exercise and instead walked for a bit each day). It seems that I managed to get by my first course without excarbating any of my symptoms and I actually seem to be more resilient towards fatigue now, a month and a half later. However, as I'm slowly progressing (at least I think I am - conversations are less challenging than they were a couple of months ago but symptoms are hard to measure as I'm not pushing myself to the limit as often anymore), I feel like I could be doing more to improve my situation. I'm eating okay, sleeping okay and walking for a bit each day.

So I went back to using the cross trainer, but I'm left a bit confused over (what I believe is) anxiety-induced symptoms after the training. Am I below the symptom triggering threshold if I experience anxiety-induced symptoms after training? I have no way of knowing for sure that these symptoms are induced by anxiety, but the fogginess-symptom feels completely different from the fogginess I experience when I know that I've pushed myself too far cognitively. That fogginess is thick and impenetrable, this one feels more like a thin layer laid upon a pretty clear conciousness.

TL;DR - how do you feel after exercising and how do I know I'm not doing too much?


PS. I might just be impatient and restless because I feel like I'm not doing enough to get better. How do you approach being patient about recovery when you feel like things aren't moving forward?

Recovery for those who do not experience a spontaneous recovery within the first 6 weeks need to accept that recovery is usually a slow process. If you are able to get your class work done and accomplish the other tasks of a college student, why do you feel you need to push harder ?

The Buffalo Protocol and other return to play protocols have an objective of getting back on the field. The team usually needs them so there is extra pressure or the team needs to decide if they are going to be replaced for NCAA scholarship requirements. There is also a need to maintain conditioning for that time when the athlete can return to play so increasing exertion levels is important.

If you just continue without pushing yourself but still moving forward, you will be surprised when you have those light bulb moments of "I haven't had symptom xyz in ages." or other awareness of tasks accomplished that had been avoided previously.

Try to be grateful for your lack of symptoms and decreasing limitations.

I'm sure you are right, I'm unneccessarily impatient. I just miss being able to work out and hanging out with friends without being concerned about the environment being too noisy, aswell as having a couple of beers. As I've progressed to this point where I'm pretty functional in a uni environment (studying-wise), I guess I've become aware that I anticipated that once I'd be healthy enough to study again I'd be fully recovered. Even though I know I should be more grateful, I feel like the return to school was a tad anticlimactic because of those anticipations (of which I was unaware until I got here).

When practicing your rowing, at about what level of extortion/heart rate do you put yourself to be able to go for 20 minutes? I remember that you've mentioned that you could go for a bit until you felt uneasy - do you notice any feelings of weakness or dizzyness? Anxiety-induced or not.

You're right in your advice, I should relax and let recovery progress in its own pace. Now I'm just thinking that it'd be nice to have a way of providing the same level of physical stimulus as taking a walk (or just a bit more challenging - I feel like I could handle the step-up) even when it's raining and I don't feel very excited to go outside.

I row on a C2 (Concept 2) rower. I set the screen for 'Just Row' so it shows Watts, elapsed time, strokes per minute, distance traveled, and 30 minute pace. I row at 22-24 strokes per minute at 105 Watts or so at a 30 minute pace of 6000-6100 meters. I watch the distance traveled and time to maintain 500 meters per minute. I do 4000 meters in 20 minutes. My legs will feel wobbly and I know I have done a workout but I don't feel seriously winded. I have not checked my BP or pulse.

As I said previously, taking your year slower will give you a better chance of not riding the roller coaster of PCS.

The Buffalo protocol has not shown to help with reducing sound sensitivity. Nothing really helps with that other than slowly increasing exposure. That is done by learning the early signs of over-stimulation and removing oneself from the environment when those signs manifest.

In my experience, the louder and more chaotic the sound, the shorter my tolerance is. I can go to a noisy restaurant and sit in a quiet area (usually the bar) near an exterior wall (less echos) and sometimes use my foam earplugs and last for a meal. If I am over-stimulated, at first, I will notice the sounds as a tolerable struggle. I can try to ignore the sounds by focusing on my meal and talking with my wife. Then, I might start to notice early signs of anxiousness or confusion. Some mild disorientation may manifest. Time to change environments. I can get outside and my brain settled down quickly.

In the past, if I pushed to the anxiousness point, I would take a hour or two to get settled.

The worst sound environment for many is either chaotic music, multiple voices speaking at the same time, and echoing ambient noise. It takes a lot of brain processing power to make sense of these stimulations and we don't have that brain power available for long.

I struggle to understand the current culture of college having a big entertainment. social and fun value that must be experienced. For me, it was go to class and go to work at McDonalds flipping burgers and try to find time to study, eat and maintain a household. I barely had time to fit in meeting with a church college group midweek and Sunday church for some social interaction. A couple weekend ski trips with the ski club

Today, college appears to be all about the 'college experience' with studies a distant second. The PCS interruption of the college experience seems to be quite a stressor. For me, my PCS cognitive and memory struggles were enough stress. Accumulating college credits and keeping the bills paid was enough of a goal.

But, I had been dealing with PCS for 8 years and had been instructed by a neuro to slow down and stay away from alcohol so I had no affinity for partying, only light socializing. I had no clue as to what over-stimulation triggers were so I did not understand how to moderate stimulation. There was no concussion recovery industry like there is today.

I'll try to put my exercise level at around the level that you describe, as of now I can feel a little too much in my head for comfort after a workout, even if it's only caused by anxiety.

I really recognize what you say about the way sensory overload is percieved - I experience the very same sensation of suddently noticing ambient sounds when I've been in the environment for a while and the very same sensation of slight confusion if I stay in the same room even after struggling a bit with focusing on the conversation. It's most noticeable when I notice that I have to struggle a little bit to find the words that I want to say.

I understand what you are saying about current college culture, I feel like there's a lot of different subgroups with different cultures about partying and hanging out. I'm part of one of those which doesn't party even every other week, but I've been very involved in club culture due to my interest in music and DJ:ing. What I feel like I'm missing is the contrast between doing something active in the weekend which isn't just a soothing interest (like watching a movie, reading a book or listening to music). I do a lot of reading and hanging out at my room in the week during which I do course reading, so the thing that I miss most about going out with a couple of friends is letting go of cultivating another culminative, calm interest and changing environment.

The course work during the week is pretty challenging but I've structured it so that I can relax when I get home from the library and right now relaxing in my room isn't that different to reading course litterature. I suppose I could try to change that somehow.

Tonight there is a dinner (and later on a party) for my dorm, I'm going to try to join in on the dinner and see how I do. If I get by okay tonight I know that I'm going to be able to hang out with friends in more calm environments in the future.

"I've been very involved in club culture due to my interest in music and DJ'ing."

This presents the same challenge as athletics is for injured athletes. One needs to find the medium between staying connected to athletics or club culture and not delaying or exacerbating symptoms.

"I experience the very same sensation of suddently noticing ambient sounds when I've been in the environment for a while and the very same sensation of slight confusion if I stay in the same room even after struggling a bit with focusing on the conversation."

This is when you need to find your tolerance levels. The sudden noticing of ambient sounds is the brain kicking into the first stage of fight, flight, or freeze. Pushing to far into this can manifest into increasing struggles.

For me, I had to be concerned with three issues.
1. Could I endure the stimulation without a mental meltdown?
2. Would pushing to hard cause me to have a need for an extended recovery period?
3. Would an extended recovery period interfere with other responsibilities.

I finally decided that some environments were not worth the cost to the rest of my day. I could use ear plugs and endure a church service but be wasted for the day. I even tried avoiding the loud music portion of the service and just listen to the sermon. The echos in the auditorium required so much focus to overcome that I would still be wasted. I would need to close my eyes to focus on the sermon.

If you are in a situation where you are struggling to focus on a conversation but closing your eyes helps you focus, that suggests you are pushing your brain's limits of processing auditory and visual stimuli.

The brain has an ability to share processing resources. As an simple inexact example, let's say you have 50 points of auditory processing power and 50 points of visual processing power. A non-PCS brain may have 100 points of each. If the PCS brain tries to focus on auditory processing, those 50 points may not be enough. If the visual processing is using all 50 points, the brain is maxed. But, the brain can switch processing power.

One can close their eyes and the brain can use visual processing power to enhance auditory processing. The blind use unused visual processing in their tactile and auditory processing. One can quickly learn to abandon visual processing and put that power to the auditory system. It is like learning to relax. It takes a bit of time to learn to do it. The same thing can help cognitive issues like trying to do complex thought. Reducing auditory stimuli can enhance visual or cognitive processing.

You need to experiment to see what stimuli get in the way of needed processing tasks.

Mark,

You are so spot on!....but what I want to communicate to the poster is, The information people are trying to help you with, you might not even understand?

I like to call it cause and effect, it took me years to figure that out?....

I do have brain damage on top of my TBI, Im not stupid, but I am slow...

Dealing with this for 11 years I take what I know that kills me for granted, and like you said do X and expect Z outcome!....

To all, take it easy....make notes before and after a event/melt down...Find the pattern and have a strategy! dont mean to preach, but reach out.

Mark,

Your advice on extended recovery after being in a challenging environment is helpful. I felt challenged during the dinner (I experienced what we discussed earlier, the noticing of ambient noise and feeling like you have to actively focus in order to be able to follow what is being said) but went through it without getting particularly close to the point of breakdown. I was much more tired than I usually am yesterday though, and a little bit of this feeling lingers on even today.

Regarding what you said about finding a balance in the interest for music and club culture, I agree. During these last 6 months I haven't been able to do much of anything, but I'm getting closer to a point where I can introduce aspects of these interests again without experiencing symptoms. A goal of mine is to be able to perform short and low-paced sessions of DJ:ing by myself in my room, which I think I will be able to do in a month or two. Being able to do this would make me feel like I'm not being forced to abandon the interest even though it probably will take a long time before I could even think of performing in clubs again.

On a aside note - I read about BCAAs in the vitamin regimen, but I'm not sure about the dosage and frequency of intake. I read a study on rats where an intake of 100 mM a day (I think) was linked to cognitive improvement, but not 50 mM a day. This lead me to reason that it'd be great to know that I get enough of this stuff to improve my recovery, and that I'd like to know more. Would you mind sharing your thoughts on dosage and frequency of intake? (If you have any studies on BCAAs and TBI that discuss dosage lying around, I'd love to read them too.)


daVOD, I'm not sure I follow you quite right, could you elaborate? If you are saying that I should slow down and appreciate my progress, I hear you. I'm trying to stay away from situations that might make me feel compelled to push beyond my limits. Apart from the setback after the dinner this weekend, I haven't had a breakdown in improvement for a couple of months now, so the strategy you suggest really does work. Thank you for your advice.

I have not looked at BCAAs as a dose or amount issue. It is just something to be aware of and try to increase in one's diet. Food sources for BCAA's are: whey, and milk proteins, beef, chicken, pork, fish, soy proteins, eggs, baked beans, whole wheat, brown rice, almonds, brazil nuts, pumpkins seeds, lima beans, chick peas, cashew nuts, lentils, and corn. I'd limit the soy, especially fermented soy. It has negatives for the brain. (free glutamate).

When I am in a over-stimulating environment and start to notice the ambient sounds, I put my foam ear plugs in. They cut out much of the ambient sound so I can extend the time in the environment. I can still converse with them in.

Mark,

Cheers. I have been slacking off on my diet lately, mostly due to wanting to save money and being lazy. I'm going to step it up again, starting this week, and perhaps even buying a BCAA supplement to make sure that I'm getting enough (for when feeling uninspired food-wise).

The plugs are a great idea. I'll bring mine to the next event.