Post-concussion syndrome exertion protocol

After a brain injury the metabolic processes in the brain are impacted negatively.  Exercise can regulate cerebral blood flow and stimulates the inherent healing mechanisms of the brain including BDNF (brain derived neurotrophic factor).  While the brain was thought to lack plasticity and healing potential in times past, we now know that the process of healing actually mimics the processes involved in normal brain development.  There is a growth and repair mechanism that takes time and is stimulated by sub-symptom threshold exertion programming.  Using a methodical approach including a symptoms journal and step wise increase in exertion, people suffering with post-concussion syndrome can recover faster.

The approach used at my practice includes heart rate monitoring using a wearable chest or wrist device.  Heart rate monitoring allows for control of exertion level, which should be at the light exertion level initially.  These can be found at a sporting goods store or at this link online.  Starting at 60% Heart Rate Maximum (estimated as 220-age x 60%) for a duration of ~ 10 minutes is usually well tolerated.  Stationary bike is the preferred method of exercise as this limits other stimuli such as change in head position, ocular coordination, vestibular challenge, and impact.  These other systems are needed in exercises including running, calisthenics and weight lifting. The exercise should be completed, journalized, and a symptoms severity completed with each session.  Increasing duration in small increments of 10-20% every 24 hours helps to build exercise tolerance and avoid symptoms exacerbation.  Of course this is a titration and a bit of trial and error is employed.  Advancing or withdrawing the amount of exercise based on tolerance or exacerbation of symptoms respectively is helpful.  Duration of exercise is titrated to 25 minutes at 60% HR maximum, and thereafter the intensity titration begins.  Each session increase HR maximum 2-5% for a duration of 25 minutes.  Once tolerating exertion at 80% HR maximum other sports specific and resistance exercises can be added.

PCS Exercise Log Example

PCS Exercise Log

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