Another Path to Healing: controlled exercise
- Created on Monday, 12 December 2011 09:25
- Last Updated on 17.05.2012
- Published Date
Doctors at the University at Buffalo have been treating athletes suffering from post-concussion syndrome (PCS) with a unique approach. Instead of laying on the couch for weeks or months, these patients are on the treadmill, following a carefully controlled and monitored exercise program. Not only are these athletes feeling better, they're glad to be doing something, especially if it brings them relief.
The benefits of exercise for those with physiologic post concussion disorders
by Barry Willer PhD and John Leddy MD; University at Buffalo, Concussion Management Clinic
Ray was known as Razor to his friends and teammates. After a concussion three months ago Ray hasn’t seen much of his teammates, or for that matter, much of anyone. He has improved somewhat. His headache is pretty much constant but low level. He still has light and noise sensitivity but his primary complaint was his inability to concentrate.
When he walked into our Concussion Management Clinic at the University at Buffalo he wore sunglasses and looked fairly depressed. His family doctor had heard about our program and liked the fact that we actively treat post concussion disorders and Ray was clearly not enjoying the more typical approach of rest and withdrawal from activity.
Ray saw Dr. John Leddy, the director of the clinic, and told how he was injured returning a punt for his varsity team. It was a helmet to helmet collision that Ray could describe only because he had seen it on film. He has no memory of the event otherwise.
After determining that Ray’s symptoms and physical health were such that an exercise stress test would be safe, Dr. Leddy instructed Ray to change into his running shoes and track pants. Ray then nervously stepped on the treadmill. Our Physical Therapist, Scott, has conducted hundreds of these tests and knows just how to help athletes relax. Scott reinforced what Dr. Leddy had already told Ray, that he must not work through any changes in symptoms. Ray was instructed to report everything he experiences. During the treadmill test Scott asks every two minutes about changes in how Ray is feeling.
Ray started out well on the treadmill. In fact, he quite enjoyed doing a little exercise after so many months on the couch. He did not know it but his heart rate and blood pressure were increasing faster than it should for an athlete, even an athlete that has begun to decondition. When his heart rate reached 152 beats per minute Ray suddenly felt strange and uncomfortable. Scott could see the change in Ray’s demeanor and immediately asked how he was feeling. Ray said his head was feeling like someone had just tightened a rubber band around it. Scott stopped the test immediately.
With the data from the exercise test in hand Dr. Leddy explained to Ray that indeed he was still suffering physiologic effects of his concussion. “However,” he said, “there is good news, as well. A heart rate of 152 means the recovery process is happening and we can speed that recovery process along.” Dr. Leddy then explained that Ray should exercise 20 minutes a day at a heart rate of 140 beats per minute and after a few weeks we will increase the level of exercise based on his progress. A big smile came across Ray’s face. He could not believe that he could exercise again, even if it was at this relatively low level.
A few weeks later when it was determined that Ray could exercise to a heart rate of 178 beats per minute without exacerbation of symptoms his exercise prescription was increased to 20 minutes at 160 beats per minute, two times a day. Ray could see the light at the end of the tunnel and it wasn’t far away.
Our research and treatment program has focused on individuals that experience long-term physiologic effects of concussion. We have published research on the reliability of the treadmill test and also published research on the effectiveness of controlled exercise in recovery from physiologic post concussion disorder. However, many family physicians are not like Ray’s doctor. Some doctors still follow the previous treatment model, which is actually a no-treatment model: rest and avoid exercise or mental tasks. The story of Razor is typical of the assessment and recovery process for elite athletes we have treated. Non-athletes recover more slowly but the outcome is much the same: full recovery. You can obtain more information about physiologic post concussion disorders by visiting our website: http://concussion.buffalo.edu/index.html. The website allows you to download recent publications on the treatment of physiologic post concussion disorders.
Questions/comments? Contact Jean Rickerson at This email address is being protected from spambots. You need JavaScript enabled to view it.
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