If you’ve recently suffered a concussion, you might be confused about when and how to return to exercise. Traditionally, many healthcare professionals have recommended mental and physical rest until concussion symptoms resolve, but unfortunately these symptoms sometimes last months or even years. The isolation and the lack of physical and mental activity can lead to deconditioning, depression, anxiety, and can actually slow down the recovery time.
Concussions affect the autonomic nervous system (ANS) which regulates blood pressure, cerebral blood flow and heart rate. It is quite common to get ANS dysregulation after traumatic brain injury or concussion. This is why any uncontrolled activity or physical exercise after concussion can exacerbate symptoms.
Recent research suggests that complete rest lasting longer than 2 days can actually lead to worse outcomes post-concussion. Moderate physical activity within the first week of a concussion, even on the first or second day, actually speeds recovery time and lessens the chances of developing post-concussion syndrome. Exercise is often the only way to retrain your ANS and to get back to your pre-concussion life. This is similar to when you have surgery for a given condition. If you simply rest the muscles after surgery, the muscles may not fully recover, putting you at risk when you try to resume pre-surgery activities. Likewise, if you immediately try to do everything you did prior to surgery, then you could also damage these weakened muscles. These principles apply to exercise after a head injury as well. Post-concussion there are many principles that we must follow, but simply stated we start at sub-symptom thresholds and gradually increase the intensity.
We all are aware of the general benefits of aerobic exercise: it helps prevent or manage major health problems such as heart disease, diabetes, and obesity. It lowers blood pressure and improves mental health. Aerobic exercise also helps brain function by increasing blood flow to the brain, which gives the brain the oxygen it needs to function properly. It also causes the brain to produce chemicals that stimulate cell growth and improve neuroplasticity. For example, the brain derived neurotrophic factor (BDNF) is a protein that promotes the growth of neurons and increases synaptic plasticity, which improves communication between cells in the brain. Studies show that every time you exercise, your body produces this protein. This post-exercise cognitive boost continues for hours after exercise and is an important factor in healing from brain trauma and in improving cognitive abilities. In a nutshell, you need to exercise so that your brain can obtain and use these chemicals to heal.
How do I exercise after concussion?
You need to use some common sense when you first return to exercise after a concussion. It should be a step wise process and you shouldn’t do anything that puts you at risk for another concussion. Avoid activities that cause your head or body to jolt, such as contact sports, running, and jumping.
So, what can you do?
You can start with mild exercise that increases your heart rate without drastically increasing your symptoms. Riding a stationary exercise bike or working out in a pool are often good options. Walking at a moderate pace is another good activity. Although you don’t have to be symptom free to exercise, if you find you’ve pushed yourself too far and you experience drastically worse symptoms, back off a little next time. The important thing is to keep exercising. You can gradually increase the intensity (how hard you push yourself) and duration (the amount of time) you are exercising if you do not have symptoms during exercise or the next day.
In order to ensure that you are performing appropriate exercise and at the appropriate intensity, speak to your health care provider. Properly trained professionals can custom tailor an exercise program giving you parameters such as appropriate heart rates, levels of exertion etc. to ensure that your training is safe and beneficial. If return to sport is your ultimate goal, a qualified health professional can also help determine when it is safe to do so.
The best and safest way to overcome post-concussion syndrome is to find qualified concussion trained healthcare professionals to assess your condition and to guide you through the process with an individualized, detailed treatment plan. We, at South Simcoe Physiotherapy, will review all of your symptoms post-concussion and perform a detailed assessment and develop a thorough, personalized treatment plan. Treatment involves exercise, manual therapy, acupuncture, cognitive rest and referral to multidisciplinary therapies if needed. Contact us today!