Training with post concussion syndrome

Hi there,

As the title says I've been training with post concussion syndrome and am wondering if anyone has done the same or worked/trained someone with the same health challenge(s). I searched the forums and found a post talking about it but it's thread focused on getting a proper diagnosis vs. post diagnosis & training with it. First post in the forums so thanks for taking the time to read this / apologies it's a bit of a book.

I'm thirty five years old, 5'8, 205lb and my most recent numbers are I've had to make adjustments, I'm using a safety squat bar with low box vs low bar squat; squat 385 x 5, press 165x5, deadlift 450 x5, bench press 225x5. I only bench 1-2 monthly as I find it really spikes my symptoms, the same for power cleans.

I've had CT of my brain about 2 months after the PCS symptoms started, it took 4 different ERS but I got one - they noticed a dried bleed at the base of my brain (back left). The neurologist I was working with said it was dried and stable, recommended that I take a low dose asprin 81mg daily.

While doing my training sessions 2-3 times weekly I'm going to physiotherapy sessions 4-5 times per week, we focus on strength and mobility work for my upper back + neck. I've had post concussion syndrome for the past 18 months. The accident happened in the spring of 2017. I fractured c5,6,7 vertebrates in my c-spine, occipital ridge of my skull, concussion and some ribs. Unrelated to the injuries above I've had periacetabular osteotomies to both of my hips at age 30-31 (hip dysplasia) and have had extensive reconstructions to my right leg+ankle (car accident when I was a kid) along with a transplanted achilles tendon that ruptured rehabbing said ankle - this round of operations happened from age 25-29. I use lifting shoes and that helps make up for my limited range of motion in my right ankle as I have about 3-4* degrees total flexion. My body definitely has some miles on it but am trying to make the best out of my new normal.

That being said I'm usually feeling the effects of post concussion syndrome and find it make lifting pretty challenging at times. One of the most difficult bits is to keep momentum going forward and making positive weekly gains, When I feel like garbage (headache+pressure, neurofatigue, tinnitus etc) I find myself dropping the weights to more manageable numbers so I don't make the symptoms worse than they are at that time and or not doing exercises and doing them the next session.

I'm not sure if I'm at an impasse or just carry on with my training as is or do less volume, more rest, keep the heavy days limited? I'm resting 5-7 minutes between most sets, sometimes more if needed. Just not sure what to do, most training sessions I feel like I'm maintaining and unable to add weight weekly. Any advice or thoughts would be greatly appreciated. I take a multivitamin, omega 3's, magnesium, asprin daily - I eat 3-4 solid meals of meat and vegetables. My sleep patterns are messed up insomnia+light sleeping is one of the challenges with PCS. I know that the lack of sleep impacts my training / daily life.

My weekly training plan has been

Monday:
Squat 3x5
Press 3x5
Rows 3x5
Chinup 3x5 (weighted)

Weds:
Bench 3x5 (usually sub in weighted dips)
Romanian Deadlifts 3x5
Chinup 3xmax - sometimes I move this to Friday.

Fri:
Squat- 70% of Monday 3x5
Press- 3x5
Deadlift- 1x5

Thanks for your time,

I would focus first on fixing your sleep. If you can improve the amount and consistency of sleep, everything else will get at least somewhat better, and maybe a whole lot better. Do whatever you need to do to improve that, then move on to focus on the next pressing issue. When you have so many things going on at once, it’s easy to get distracted and not follow through with a definitive plan for any one thing.

While medications are not the best solution most of the time, if you are at the point where that makes sense, there are some things like tricyclic antidepressants that will help with sleep and headache (at doses much lower than used for depression, interestingly). You may have already been down this path but I would suggest seeing a neurologist or maybe physiatrist experienced in TBI recovery.

I had a TBI in July 2016 and dealt with the PCS symptoms (very similar to yours) for about 2.5 years. I'm sorry, man, it really sucks. But, at least for me, it eventually got better, to the point where I don't think about it much today.

Specific to training: For the first year especially, any really hard exertion tended to flare up the PCS pretty bad. I got back into running in 2017, and started doing barbell lifts in the summer of '18, I think (not doing the SS program though). The thing I found was that a longer workout, even at lower intensity, was worse than a shorter, more intense one. And accumulated stress (like two hard workouts on consecutive days) made it worse. Now, I didn't start actually doing the SS program until February of 19, when my PCS symptoms were mostly gone. So I can't really apply my personal experience to that, unfortunately.

I think managing recovery is going to be really critical. jfsully's advice is solid: getting your sleep straightened out should be your first priority (and trust me, I understand the challenge there). Definitely worth talking to a specialist about and trying to find an approach that works. With regards to programming, something you might consider would be going to a two-day rest rotation. So M-Th-Su-W-Sa-Tu-F over the course of three weeks. On the other hand, outside your PCS, you may simply be reaching the end of NLP based on your numbers, so you may want to explore transitioning to intermediate programming. I wouldn't even begin to suggest what that would look like for you, but I can tell you this: a 5x5 volume day would have been the kind of stress that absolutely wrecked me when I was still having PCS-- so I would avoid a Texas Method-based approach, at least until you recover more fully.