Returning to Running after TBI or Post-Concussion Syndrome

Regularly I receive feedback from folks that say they would love to return to running after concussion/TBI, but have not yet been able.  By no means do I believe that every single person can  run after TBI, and perhaps time on a bike trainer or walking would be a better option for some folks. Every injury is different. However, if I had simply gone out to run, there is no way I would have been able to do it.  Returning to running involved A LOT of walking. That is why I decided to write out my “return to running” plan. Now I am not a trainer, or a doctor, or in any way qualified to tell you what to do…other than I am my mother’s daughter so perhaps I’ve always been on the bossy side.

The following is the plan I worked up for myself, and how I found my return to running. The most important part is adjusting it for your individual needs. If you go out one day, and your symptoms worsen, then back off. As much as running generally helps me, on some bad days I still go slower, cut it short, or skip my run altogether. Learning to listen to yourself and respect your body and brain is key to recovery.   Every “step” in this program was a week or more for me.  Returning to running, as recovery itself, will exercise your patience more than anything else. If you go too quickly, you can set yourself back weeks.

Sage Burner 25K trail race on May 21, 2016, in Gunnison, Colo. My first post-injury trail race, 8 months into recovery. Being in a race environment was way harder than I had anticipated. It is easier to run alone.

Step 1: Base miles – Walk.  I began by walking around the block, and this felt awful at first. Then I started increasing this to 10, 20, 30 minutes. For two months I would go several times a day…mostly because I felt if I stared at the walls of my house for one more second I was going to scream.  I had to look at the ground in front of me, but over time I slowly worked up to the point I could look at the houses or yards I passed. For me, it was MUCH easier to walk on a flat trail or bike path in natural settings. Plants and trees were easier to be around than the repetitive patterns of houses and landscaping. Treadmills or indoor tracks were too difficult for me.

Step 2: Running baby steps. During a walk, when I was feeling good, I ran 4 steps. That is it. And I use the term “ran” loosely. It was barely faster than I had been walking. “Wog” might be a more accurate term. After those few steps, I then walked a few minutes and then ran another 4 steps. I only did this two or three times, then I waited 24 hours to make sure my symptoms weren’t exacerbated. If my symptoms were stable, I repeated this every day for a week during my walks, and followed the 24 hour rule for every increase in distance/time. **For the record, at the beginning running felt very awkward and strange. That is okay. It is also okay if it makes you feel worse for an hour or two. Just make sure it doesn’t make you feel worse the the rest of the day or the following day.

A short winter run in Gunnison last month, where I ran that first post-injury trail race in spring of 2016. Even in the snow it was easier than that first race was.

Step 3: Running first down. Increase the run intervals to roughly 10 yards. Spot something in the distance, and imagine your first down marker there. Stop when you get there. You will not be the hero if you continue on to the end zone. I would only do two or three intervals in a 30 minute walk.

Step 4: Running one minute. From here, a watch is helpful. I used a Garmin with a heart rate strap, so I could monitor my effort. I set an alert to 130 bpm, and if it beeped, I walked. Make sure you are far enough out (usually at least 8 weeks post-injury) that your doctor clears you to have your heart rate above 120 bpm. Although I get my heart rate much higher these days, even now if I push myself too hard for too long during a workout I will become symptomatic. If you don’t have a heart rate monitor, I would recommend that if you find yourself breathing hard, slow down or walk.  After walking for 10 minutes, I ran 1 minute, then I walked 5 minutes and ran 1 minute. I repeated these 1:5 run-walk intervals 3 times, and then walked another 5 minutes.

Group run up Rattlesnake Gulch in Eldorado Canyon.

Step 5: Less rest.  When 1 minute run: 5 walk was comfortable, I didn’t increase the run time, but I shorted the rest time in between to 1:4 for a few sessions, and then 1:3. Always include a 10 minute walk to start the workout. This gives you time to access how you are feeling and decide if it is a good day to try the workout, or if you should stick to walking.

Step 6: Two minutes. Now I started increasing my time to two minutes, and went back up to 5 minutes rest. Then slowly decreased the rest periods as I did in Step 5. Once I was comfortable at 2 minutes run: 2 minutes walk, I moved on to measuring distance.

Step 7: A quarter mile. This is when I started getting excited. After a 10 minute walk, I ran 0.25 mile, then walked for 5 minutes. On the first day I did two intervals, then the next day 3 intervals, and then 4 intervals. Over the next few days I dropped the 5 minutes rest to 3 minutes, and then 2 minutes rest, then 1 minute rest.

Step 8: A half mile.  After a 10 minute walk I ran 0.5 miles, then walked 5 minutes. I repeated this interval once. Over the next few days I decreased the rest as I did in step 7.  At this point I allowed my heart rate to get up to 145 bpm. If it got much higher, I would feel horrible, so I kept my pace low.

Step 9: One mile!  After a 10 minute walk, I ran one full mile, and celebrated my victory!

From here I think you get the point. Getting to that first full mile took me 3 months of consistent work. While over the following two months I worked my way up to 5 miles, I did so with a LOT of walking breaks. And, I wasn’t doing 5 miles every time I went out. That 5 miles was my Saturday long run, and the other days I was doing a 2-3 mile run or going for a hike. None of those miles were fast, but I was out there and thankful to be running at all. Over time I was able to tolerate faster paces and a higher heart rate. I worked my way up to running on trails, where learning to run downhill and through rocks became my next challenge. Snow running can still be a challenge for me some days.

Running through deep unconsolidated snow is a lot of work, physically and mentally.

Returning to running will be a slow process. Other orthopedic injuries from the crash or fall that injured your brain can make it more difficult. Massage, acupuncture or dry needling, cranial-sacral therapy, and chiropractic work can all make a difference in dealing with those injuries to help keep you moving. Running ultramarathons is not for most people, but there are many forms of exercise and all of them can aid in recovery. So get out to start those baby steps, and celebrate all the little victories along the way. To all the folks that have shared their stories with me so far, thank you! Maybe we should start Team TBI to 100? That 100 miles could be in a year, a month, or even one race. Let me know what you think, and please share your return to running stories.

Do not let what you cannot do interfere with what you can do.

TBI to 100

My amazing crew at Olympian Hall for the Run Rabbit Run 100 miler – September 2016



2 thoughts on “Returning to Running after TBI or Post-Concussion Syndrome

  1. I really like this encouragement!!

    Five years, seven months ago, I picked up my third concussion in 18 months. On top of three other concussions I had in prior years, this last one was devastating. After several months of trying to recover on my own (no thanks to my Harvard Med School neurologist, who always seemed confused about concussions, and had zero helpful advice or information for me – ever), I found an article about the value of exercise in healing.

    Long story short, despite being “fluffy” and a slow walker in the best of circumstances – I bought the Zombies, Run! app on learning to run a 5K. This gamified way of learning to run was literally a life-saver for me. No longer was I condemned to spend my life in a dark room, in too much pain to listen to audio books – I was saving the world! You listen to the game, and just follow directions. You are an injured runner, living in a post-zombie apocalypse world; and the doctor is rehabbing you. Similar to Kristin’s ideas, you start really slowly – your first run is 15 seconds long, I believe. They cheer you on, and talk about how much progress you are making, and that feels great. And it’s an app; so if you are not feeling it one day, just walk or go back a week and repeat that version. You aren’t being graded; you are rehabbing.

    It took nearly two years after my 6th (final??!!) concussion to get past the never-ending migraine, and walking was so hard on my brain. But now I could run a little bit, and do the other leg-strengthening exercises, in the app. I looked like a doofus – but I’m a middle aged fluffy chick dressed in spandex doing knee lifts in the park, running for 15 seconds at a time, and randomly laughing at messages no one else could hear. Doofus-looking was okay with me: I was out of bed, and I was walking, and sorta even running. I kept reminding myself I was the best darn runner in the entire park – who was recovering from a massive head trauma!! 🙂 Oh yeah, in my own mind I was pretty darn cool.

    Objectively, I’m a lousy runner – too fluffy, too slow, and my feet get numb after about 40 minutes (walking breaks help!). But I still listen to the Zombies, Run! app – and have moved on to the regular version where I have all sorts of world-saving adventures! I’m never going to run 100 miles at a time, I’m never going to be fast, I didn’t lose a single pound running, and my face turns bright red when I’m hot – giving me the appearance of a wildly overheated stuffed pepper. But – who cares?? When I run two or three times a week, I’m not setting any records – but my brain is happy, my head doesn’t hurt, and everything feels good with the world. I run on trails when possible and that feels great for my brain; though the negative-numbered wind chills of Minnesota, where I now live, have introduced me to a new world of “treadmills” and that’s been okay too. As long as I’m running – I’m holding back my mtbi symptoms. When I stop, they return. It’s a pretty simple equation for me: save the world from zombies, or be an pain-wracked zombie myself.

    So yes. Your doctor may not know about running, or may think it’s bad to try. (Several horrified friends told me it was surely going to damage my brain further.) It’s okay to listen to that as you are deciding what is best for you. But, from the unscientific sample size of “one” in this population of brain-injured people – I’m here to tell you that it can absolutely help. You absolutely may feel so much better. Your recovery may speed up. And if you want to save the world from zombies – it’s all possible for you!!

    1. That is wonderful Mary! Good for you! Yes, I also had a few people tell me I shouldn’t run. A physical therapist at the time told me it would make me worse. But I had been cleared to do some spinning on my bike trainer and so I decided to try. Even those first few steps were exhilarating. I felt like me. Yes it felt weird, and I felt fuzzy, and slow, but I was so happy to be doing it. Keep chasing those zombies!

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