Priorities during the first 2 weeks post concussion (blunting the inflammatory response):
Light Grade Exercises – Daily
- Increase caloric intake by 100-200 calories – primarily Carbohydrates and Fats
- Double your Water intake – add salt
- Breathwork – Daily
- Proper rest and sleep – not doom scrolling or binging TV, but breathing, moving, and grounding along with proper relaxation and good sleep
Take these supplements:
- Omega 3 (DHA dominant) – 2,000mg/day
- BCAAs
- Magnesium Glycinate and L-Threonate – 600mg each/day
- B-Vitamins- 1 standard dose/ day
- Creatine Monohydrate- 10g/day
- Glutathione Liposomal or NAC- 600mg/day
- Glutashield (GI support) – 1 scoop/day
- NeuroOptimizer (Jarrow Formulas) – 4 caps/day
- Bonus Supps: CardioPerformance (Quicksilver), HistaAid (Quicksilver), HeroProtocol, and or UltraBinder (Quicksilver)
Follow these Steps on a day to day basis – 1 step per day, if symptoms present day of or next, repeat the same step. Do something EVERY SINGLE DAY.
Step 1. Move
Purpose: Recover
- Walk for 10 minutes, remain in Level 1 HR.
- Read a book, (preferably larger font words) 5-10 minutes.
- 10 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- Photobiomodulation/ Low level laser therapy (consult medical advisor for course of action)
- Journal all progression or regression throughout the entire process (mental clarity, mood changes, dietary changes, water intake, activities, sx, stress, anxiety, etc.)
- If sx reoccur, halt, repeat in 24 hours.
Step 2. Light Aerobic
Purpose: Increase Heart Rate (increase Cerebral perfusion)
- 20-30 minutes of Level 1 HR with subtle rises into Level 2 HR.
- Continue reading progression, increase time as Sx allows.
- McGill Big 3 Core exercises (Lateral Plank, McGill Curl Up, BirdDog) to tolerance.
- Basic eye movement training.
- 20 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, repeat in 24 hours.
Step 3. Moderate Aerobic + Light Resistance
Purpose: Increase Heart Rate and Conditioning (increase cerebral perfusion)
- 30 minutes of Level 2 HR, Fast walk, slow jog or slow bike.
- 1 set of 10 repetitions; Body weight squats and pushups
- McGill Big 3 Core exercises
- Basic eye movement training + vestibular training
- 20 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, repeat in 24 hours.
Step 4. Sport Specific Movements
Purpose: Implement sport movements with increased heart rate and conditioning. Maximize aerobic activity, accelerate to full speed with change of directions, introduce stationary head rotations. Monitor symptoms.
- 30-40 minutes of Level 3 HR (~70% Max HR)
- Sport Specific Drills and Exercises (ie. bear crawls, QB drop backs, tires, ladders, jump cuts, back pedal, dribbling cones, passing, stationary shooting, 3 man weave, lay up drills, suicides, cradling, change of direction, fielding ground balls, pop flys, running bases, etc.)
- “Helmets and gloves”
- 2-3 sets of 10 repetitions of Resistance band movements (External rotation pull aparts, monster walks, squats, pushups, pull ups, dips, pallof press, chops and lifts, external rotation overhead press)
- 2-3 sets of 10 repetitions of Plyometrics (Box jumps, jump lunges, burpees, etc)
- McGill Big 3 Core exercises
- Moderate eye movement training + vestibular training + sensorimotor integration
- 20 minutes Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, repeat in 24 hours.
Step 5. Real- World Drills/ Non-Contact Return to Practice
Purpose: Sport movements, coordination, increased heart rate with cognitive load, add deceleration/ rotational forces in controlled settings. Monitor for symptoms.
- Up to 90 minutes of practice drills, Level 4 HR
- Full Speed drills, change of direction drills with rotational head movements. 80-100% RPE. (ie. hit/push pads then sleds (focus on heads up, square up, stay low), leverage drill, full speed play out, passing and route running/ coverage, ball tossed headers, full speed shots, goal-keeper dives, tackling drills, 1v1 scramble, pick and roll, hitting off pitching machine, live batting practice, etc)
- Full pads
- Begin Strength training program to 80% RPE. Monitor Sx
- McGill Big 3 Core exercises
- Rigorous eye movement training + vestibular therapy + sensorimotor integration
- 20 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, repeat in 24 hours.
Step 6. Full Contact- Return to Practice (Requires medical clearance, No; autonomic dysfunctions, GI disruptions, brain fog, headache, recreation of sx, cleared bloodwork biomarkers)
Purpose: Reassess sx every 30 minutes throughout practice. Build confidence and functional skills to return to full game play. Increased coordination and cognitive load in the sport setting.
- Normal Training activities
- Strength training program to 100% RPE
- McGill Big 3 Core exercises
- Rigorous eye movement training + vestibular therapy + sensorimotor integration
- 20 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, consult medical advisor.
Step 7. Released, Full Return to Play
- Reassess with medical advisor, 1x/week for 4 weeks, 2x/month for 4 months.
- Continue: Normal Training activities, Strength training program to 100% RPE, McGill Big 3 Core exercises, Rigorous eye movement training + vestibular therapy + sensorimotor integration, 20 minutes of Breath Work (Ujayi, box breathing, wim hof, etc)
- If sx reoccur, halt, consult medical advisor.
| Level | Target Heart Rate (HR) |
| 1 | Level 2 – 10% |
| 2 | Level 3 – 10% |
| 3 | Original Sx Recreation HR (~70% Max) |
| 4 | Level 3 + 20% |
| Max | 220-Age +- 10 beats per minute |
Target Heart Rate (HR) Table
*Progress to the next stage may occur every 24-48 hours as long as symptoms do not return.
*If symptoms appear 2-3 days post stage, wait 72-96 hours before trying again
*It is recommended that you seek further medical attention if you fail more than 3 attempts to pass a stage.
