Cardio

I always liked running to things. Up and down stairwells, coming back from grocery shopping, going from the train stop to a friend's party. But after the concussion, I couldn't jog more than ten seconds without triggering a headache.

My first neurologist a few weeks after impact just told me to 'try to get active again.' Telling this to a type-A former varsity athlete was the wrong idea. For the first few months, every few weeks I would try to go to the gym and do my normal workout, often triggering 9 or 10 headaches and once nearly fainting. I didn't want to accept that I couldn't run as hard or squat the same weight. At first, it wasn't my muscles atrophying, but rather the neurological strain of firing muscles overwhelming my system. 

Thankfully I came across a new neurologist and PT team at NYU who had a better approach. The best research on proper return to cardio is the Buffalo Protocol developed by Dr. Leddy at U of Buffalo. If you encounter a trainer who isn't aware of this study, they're not worth your time. The way it works is you walk on a treadmill at 3.6mph with a heart rate monitor on, and increase the incline every minute until your symptoms or heart rate spikes up. Once you hit that point, you then do 80% of that limit for 20 minutes a day, 5x a week, for two weeks, and then bump the ceiling up by 5 or 10 bpm. 

A youtube explanation:

I started at 90bpm, barely above walking. Combining some training from heart rate variability I was able to settle my heart rate down through slow breathing when it spiked from the anxiety of anticipating pain.

About a month in I overreached. After two weeks of increasing by 10bpm each week, I got overconfident/stopped paying attention and spent about a few minutes up near 140bpm. For the next week I was bedridden. I'd recommend setting up your heart rate monitor to beep loudly whenever you go out of your target zone. Also, be sure to use one you strap to your chest as wrist-based heart rate monitors aren't as precise as you need them to be for the protocol.

It took another six weeks to make it back up to 125bpm, a range where I finally started sweating. That first endorphin rush after eight months of near sedentary living was better than sex. The positive impact both symptomatically and emotionally from getting active again were key to my recovery. 

Today, 'bouncing' activities still cause issues. Jumping up and down playing basketball or running can trigger symptoms and make my head feel really heavy. But pushing myself with HIIT workouts on a bike a few times a week is such a joy.