I trained a client yesterday that was recovering from a concussion.
It has been some time since I had designed an exercise program for a client with a concussion. When I worked in a Medical Rehabilitation Program and Occupational Rehabilitation Program, it was a regular thing.
Let me highlight a few things you need to keep in mind when training a client with a concussion.
4 Tips to Training a Client with a Concussion
#1 – Monitor their Heart Rate
Monitor the individual’s heart rate to see what level of heart rate they can tolerate before they start to feel concussive symptoms.
At a higher intensity of exercise, the increase in heart rate can lead to greater circulation to the head, which can lead to an increase in concussive symptoms.
Make sure you monitor their heart rate with a heart rate monitor or with the electronic read out on the cardiovascular machine. Have them stay below a level of heart rate that brings on their concussive symptoms.
#2 – Length of time in the Gym
Start off with a short session and see how they feel after the session, later that evening and then the next morning.
Many times a concussive client’s symptoms will return later, after the exercise session. Sometimes it can be a few hours later.
Ask your client to monitor their symptoms after the session. This will give you a good idea if the amount of time in the gym is too much or too little for them. If their symptoms return, there is a good chance the length of time in the gym was too long. If the client does not experience symptoms, you can increase the time.
#3 – Minimal Head Movement
I focus on machines at the start because the body is supported and in many cases the head can be rested on a machine pad.
I avoid supine and prone machines and focus on seated machines. The act of getting from standing to supine or prone can be difficult for a concussive client. At the start avoid this movement, but in time, begin to add it in.
Using machine or seated exercises on a stability ball limits the head movement and decreases the risk of concussive symptoms.
#4 – Avoid the Treadmill
For someone that has a concussion, the treadmill may be way too much.
The mix of signals can bring on concussive symptoms.
I often start with the recumbent bike. It keeps the head in more of a neutral position compared to an upright bike.
Make sure to get them to look ahead, as looking at a TV high on the ceiling can put their head into extension and bring on their concussive symptoms.
I hope these tips will help you when you have your next client that is recovering from a concussion.
Let me know what your tips are for working with a client with a concussion. I know there are a number of readers that work with people who have been in motor vehicle accidents.
What are your tips?
Rick Kaselj, MS
I had a blog reader, David, who asked me to post his response to the blog. Here it is:
Concussion is but one cause of trauma. Trauma can be instantaneous and physical, as in concussion, or chronic and developed over time, as in emotional trauma. Either way, the deepest symptoms are the same. Apart from obvious bruising, as in concussion, and swelling in the brain, there are many other symptoms that may include: headaches, increasing accident proneness, balance problems, dizziness, tinnitus (ringing in the ears), sleep disturbance, difficulty concentrating, mood changes, anxiety, depression, tremors, musculoskeletal pain, peripheral neuropathy, postural distortions, fibromyalgia…etc. Not all these symptoms appear at the same time, and not everyone has all of them. The point here is that trauma, concussion included, is a central nervous system (CNS) event. Therefore, it cannot be treated in the conventional ways.
All contemporary forms of treatment–exercise, physical therapy, massage therapy, chiropractic, acupuncture, drug therapy–fail to treat the central cause which is in the brain and spinal cord (CNS). When the CNS is treated, the vast array of symptoms disappear. When the CNS is not treated–which is usual–only some of the symptoms disappear and they recur…year after year after year. Only when the cause is treated, the CNS, is there lasting healing.
There is one therapy that is specifically aimed at the CNS and which has no side effects (unlike drugs that affect the CNS) and a proven success rate of 85% over all in thousands of studies internationally. That therapy is NeuroKinetics.
Developed in the 1980s in the French aerospace industry to treat jet pilots and astronauts and later applied to everyone else, NeuroKinetics is not a drug nor manual therapy. It consists of hours of assessment in which is determined whether NeuroKinetics can help the individual. Only patients who can be helped are accepted. That is part of the reason for the unparalleled 85% success rate.
Treatment consists of sending a low-level “biophotonic” light pulse into the feet of the patient while he or she stands in front of an assessment grid. Instantly, this light beam communicates with the CNS, and the brain reactivates neural circuitry that has been dormant or partially inactivated by the trauma, or concussion in this instance. Symptoms like headache, balance difficulties, visual problems, muscle soreness and stiffness may begin abating in the very first few minutes of this treatment. I have watched it and had it done–it is amazing!
People come from all over Canada and the world to NeuroKinetics Traumatology and Concussion Clinic at 16th and Granville in Vancouver, BC.
The clinic has seen several thousand patients–including hockey players, other sports injured people, some mis- diagnosed with Parkinson’s and MS (who now have no symptoms!), Attention Deficit Disorder, brain dysfunction, fibromyalgia and long-term depression, all sorts of musculoskeletal pain including sciatica. Again, when these conditions are related to the CNS–which most are–the results are on the order of 85% successful.
I highly recommend NeuroKinetics to anyone who has had a concussion–before symptoms progress beyond what seems to be a simple head injury at first.
For contact information: http://www.neurokinetics.com
David D
[Reply]
Rick Kaselj Reply:
December 29th, 2009 at 8:54 am
David,
Thank you so much for the detailed reply and the great resource.
I know it your response and resource will be of value to many fitness professionals.
Rick Kaselj
http://www.EffectiveRotatorCuffExercises.com
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[Reply]
I have not read much stuff on concussions and exercise. The info is very helpful.
The facility that David is talking about sounds interesting, I am interested in hearing more.
Michelle
[Reply]
Interesting post. Never head of an exercise program for a client with a concussion.
Jen
[Reply]
Hello everyone;
I found David’s post very interesting and useful especially for individuals like myself who work very closely with young hockey players.
I often find that muscle tightness in the scalenes, massetors and paraspinals is overlooked after a concussion. If not assessed headaches and other concussion like symptoms can be present longer as these muscles decrease the amount of blood going up to the brain. I spend a lot of time with my athletes teaching them how to stretch these muscles when symptoms of concussion occur and I also show them how to strengthen the extensors of the neck as these tend to be weak.
Lastly I wanted to mention the importance of confidence of going back to work/play after a concussion. Individuals often are anxious about symptoms returning or being seen as weak for taking time off for a concussion. I incorporate confidence boosting exercises during the rehabilitation phase to help with this problem.
Hope this information is useful
Urszula
[Reply]
Urszula,
Thank you so much for adding to the discussion.
Great information.
Rick Kaselj
http://www.ExercisesForInjuries.com
[Reply]
Hi everyone,
David has had difficulty posting to the blog.
He has sent me more information for people.
Rick Kaselj
http://www.ExercisesForInjuries.com
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Thank you, Rick, I think it will be.
Also, let’s not forget a segment of the population who struggle to get fit and stay fit, those over their 50s. One of the recurrent sources of injury–which may indeed result in concussion as well as broken bones and other traumatic injuries–is falling.
I am talking about falling going down or up stairs, on an icy strip of sidewalk, or just anywhere anytime, sometimes for no apparent reason. Older adults can fall a lot. And a fall is traumatic. Even if there are no physical injuries–bruises, cuts, sprains, broken bones, concussion–there is psychological trauma. You suddenly realize you can’t trust your body! You become afraid to take the next step. You can even dread going outside again. This anxiety can become chronic. Obviously, if you cut back on walking, or if you walk scared, this will impact your cardiovascular and muscular health, socializing and general independence. Falling has an impact on one’s entire life. Just ask your older clients. They may be embarrassed to talk about their falling, or they may actually be relieved. Approach the subject delicately. It is worth knowing the answer, as you will see in a moment.
A little-known fact is that falling is “cumulative.” By that I mean, when falling is caused by dysfunction in the CNS (as I mentioned earlier), when the bruises go away, you are still prone to fall. In fact, you become fall-prone (accident prone). The more you fall,…the more you fall. We are talking fall-proneness, not falling.
This means that the individual has to not only strengthen his body, work on the balance board, perhaps, maybe get glasses, all the peripheral remedies to lessen the tendency to fall. More than these things, one has to address the CNS, or falling will continue (fall-proneness), as statistics do show.
Let me explain what fall proneness is. It is not, as I said, weak or unstable muscles and joints. It may or may not include these physical problems, yes, but that is not why people fall usually. It is not because they don’t see something in their path and trip over it. That happens, but that is not why, usually, people fall. What happens in fall-proneness is a chronic lack of coordination between incoming stimuli and the brain followed by a poorly timed body response as a consequence. The eyes, the receptors in the feet that give a sense of pressure on the ground, the balance mechanism in the ears (the occular-motor, vestibular-motor, and other systems) are not coordinating properly in the brain itself and the brain cannot interpret incoming stimuli in such a way as to maintain body balance. So the body falls. This poor coordination may not be obvious until there is a need to have an almost instantaneous engagement of all these systems to maintain the vertical position of the body, at which time the subtle lack of coordination becomes crucial. So, the person is prone to fall all the time,…and then falls from time to time. And will fall again, unless the CNS is brought “in tune” within itself and the external world.
And that is what NeuroKinetics does: addresses dysfunction in the brain and spinal cord (CNS) that expresses itself as falling.
Trainers, much more than doctors, are in an excellent position to help “fallers” because of the one-on-one time spent interviewing their clients and the history they take. It would only add a couple of minutes in a first visit, for example, to ask if the older person–or younger person for that matter–you would be surprised at how many there are–have incidents of falling. Ask if the frequency seems to be increasing. Ask also about such symptoms as:
*Dizziness
*Nausea (even mild)
*Changes in vision (need glasses changed or other)
*Sleep problems
*Increasing need for chiropractic or physical therapy manipulation, yet without apparent cause
*Forgetting (perhaps forgetting familiar names)
*Lack of concentration
*Shakiness in a limb or limbs, even mild
*Hormonal changes
*Accident proneness (dropping things, small hand-eye miscoordinations, increasingly “off” in a sport, serial MVAs)
You do not need to go into depth or detail with your client. Just note any of these symptoms. If your client has one, and certainly several of them, it would be a service to him or her to recommend NeuroKinetics. You might also want to drop by NeuroKinetics Traumatology and Concussion Clinic at 16th and Granville and speak with the people there to learn more about this really revolutionary form of therapy.
Think of NeuroKinetics as re-establishing clear and precise communication between the brain and the external world, and a whole lot of related symptoms disappearing when the brain is “connected” to the world properly. Imagine not only fall proneness disappearing but body mastery improving spontaneously and sport performance increasing. It’s great when you catch the ball with your hand instead of it bouncing off your fingertips! Great when your foot meets the ground instead of your face. But, this really is no joke.
http://www.neurokinetics.com
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[Reply]
I got an email from Kathryn from Washington State. She is a strength & conditioning coach. She had some great information when it comes to working with athletes. I thought it may benefit some of you.
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Hi Rick,
With Washington State being one of the first to pass a law controlling the return of athletes to activity following a concussion, the start of your post was good. There are more details that should be included such as training should not begin until all signs and symptoms are gone while at rest for at least 24 hours, then a graduated return to play (GRP) protocol should be followed.
I’ve attached the recommended assessment form – the SCAT2, and the International consensus report that includes the GRP.
I think it also imperative to mention that only qualified individuals should be making these assessments. Furthermore, it should be noted that clients will often receive clearance following an MRI or such, which are not shown to be definitive for the resolution of concussions. All in the article.
Happy Holidays!
Your’s in Health……
Kathryn
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These are the links of the resources she sent:
SCAT2
http://www.mshsl.org/mshsl/news/ConcussionTool.pdf
Consensus Statement on Cuoncussion in Sport: the 3rd International Conference on Concussion in Sport held in Zuich, November 2008
http://bjsm.bmj.com/content/43/Suppl_1/i76.full
[Reply]
Kathryn,
Thank you so much for the great information.
I do not do work with many athletes but like yourself and Urzula, I know there are many people that read the blog that do.
Thank you so much.
Rick Kaselj
http://www.ExercisesForInjuries.com
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[Reply]
Rick,
Your post on concussion will be very helpful for me in designing an exercise program for my clients. Keep up the good work.
Albert
[Reply]
Thanks for the great tips, Rick.
It’s truly helpful for my friend who just suffered concussion from falling on ice & hitting his head.
I’m sure will get him & all my friends to read your blog, you always provided us the great information.
Keep it coming!
Regards,
Tannis
[Reply]
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