My initial concussion which triggered my PCS was in August of 2018. Until two days ago, I had not had any "setbacks" or major events that triggered symptoms since October of 2019. So I had been mostly symptom free and improving every day for a year and a half.

Then, two days ago, it was a beautiful day so I decided to go on a bike ride on a trail that I rode many times last summer. Unfortunately, there had been some recent construction on the trail, and it was torn up by construction vehicle tire tracks which had hardened in the mud. I did not realize this until I made it some way into the trail. I decided to tough it out, as I have a full-suspension mountain bike and I rode several fairly bumpy trails last summer with no issues.

I ended up spending 30+ minutes grinding across the hardened tire tracks, sustaining nearly continuous vibrations that my bike's shocks failed to fully absorb. Eventually I got off my bike and walked with it most of the way back to my car.

The rest of the day I felt a little off but mostly okay. Yesterday I felt a little off, but went on my usual jog and had no headache afterwards. Today I have felt worse. Symptoms are slightly blurry vision, slight light sensitivity, fatigue, brain fog, depression, and a general malaise feeling that seems to intensify the more I wonder about whether that bike ride did any physical damage to my brain.

My question is, under these circumstances, how much should I rest? My symptoms are vague and I cannot nail down whether they are concussion symptoms or the result of general anxiety/stress. When in doubt, what should I do? I have tried doing nothing today, aside from some video games and a short walk, but I seem to feel worse because I'm sitting around worrying about how much I should rest!

I am a student and luckily I have a light week ahead of me, but starting next week I am moving into a final exam period which will last several weeks and will be very intense. Sticking to my routine is crucial to my managing of stress and general depression/anxiety that I have apart from PCS.

So, does it sound like I had another concussion and should I fully rest as much as possible or should I push through and stick to my routine (which includes coffee, ice cold showers every morning, jogging every other day, other light exercise whenever I can fit it in, and studying/reading/writing 8-10 hours a day 6 days a week)?

Stress is more likely to cause a relapse than a rough ride. Worrying about a rough ride that obviously stressed your body and especially your neck is the king of stress. Rest is not video games......They are stressors.

I bet your body was surging in lactic acid from your beat up muscles.

You do not need to be resting at all. Let symptoms be your guide. If symptoms increase, stop the activity. Jogging is rough on the neck and can put vertical loads on C-1 and C-2 causing inflammation, just like your bike ride. Avoid all stressors until after exams.

Caffeine should be avoided.

Studies show that people 80% of people who suffer long term PCS have a pre-existing struggle with depression and anxiety. Resolving that will be a great improvement.

The vitamins regimen in the sticky above helps many tolerate stress. Adding 5-HTP and L-Theanine also improves anxiety and depression symptoms without drugs.

Hey Alaska 89,

I would say that your symptoms have nothing to do with concussion and everything to do with pushing yourself hard on a lot of fronts.

Your student work load is enormous. You should congratulate yourself on extraordinary discipline. However are you studying effectively? It's important to take frequent rest breaks between study sessions to actually speed learning. There's a lot of information out there on study techniques/ simple memory training that make studying more effective and fun.

I think your body/mind is crying out for rest and you attributing natural fatigue to an old concussion. Naturally it is making you anxious. and stressed. If your body/mind is telling you to cut back then listen to it.

Best wishes,

Atty

Leaning forward on a bike & adding in very bumpy ride is a big factor in neck /arm tension/stressors..
Consider how much your head weighs, then add in the factor of how it hangs out in front of the body on our neck..
There are calculations on the added weight & stress to our neck muscles, shoulders , even upper back adds in to it..
A web search can find that info..
Plus you naturally would tense up from the bumpy ride, so that stifles the free flow of good blood/oxygen to the areas involved..

Cyclist's Neck - Physiopedia
more...
how much head weight is added to spine when riding a bike - Google Search

I appreciate everyone's responses. As Mark and Jomar suggest, I have long suspected that I have a subtle neck injury, which I apologize for not mentioning in my original post. Stress is also a factor that I try my best to reduce.

The "concussion clinic" I went to in 2019 referred me to a physical therapist who prescribed various neck stretches, which I used to do daily until recently. I'm not sure if they help, but I figure they can't hurt. Also, I'm not sure what else can be done if it is a neck injury.

Today I studied most of the day, and seemed pretty good until later afternoon when I stopped for the Chauvin verdict (I live near the twin cities). At that point I realized I had an inordinate amount of brain fog that continued to accumulate when I tried to keep working.

Is it normal for brain fog to increase during cognitive work and staring at a computer screen with a neck injury? Also this may be a stupid question, but is it possible to make a neck injury worse by "pushing through" symptoms?

I do notice a very subtle tender/sore spot at the base of my skull on my right side, kind of where the C1/C2 vertebrae that Mark mentioned are located. What other indicators might there be to know for sure that I have a neck injury?

Thanks everyone.

Subtle neck injuries may manifest as a tender spot at the bone behind the ear.

Neck stretches are not therapeutic. Neck strengthening with minimal movements can improve the muscles but the ligaments take a long time of no stress to improve.

Good sleep posture and good head and neck posture while looking at a computer is important. Texting neck posture is the worst. Do not look down at your phone and text with your head tipped forward.

Staring at a computer screen is not helpful to recovering from brain fog.