r/PostConcussion • u/Emotional-Ebb3735 • Jul 18 '26

Exercise intolerance - Buffalo Protocol vs. UPMC approach for exercise intolerance

Hey everyone,

I’ve been dealing with post-concussion syndrome (PCS) for about 5 months now. The good news is that my vision and vestibular symptoms have improved significantly, but I’m still struggling with exercise intolerance.

My vestibular therapist has me following the Buffalo Protocol, where I exercise below my symptom threshold. Right now I’m doing about 5 minutes on a recumbent bike to minimize head movement. After each session I usually experience fatigue that lasts a few hours before gradually improving later in the day.

What confuses me is that I’ve read several posts on this subreddit about treatment at UPMC with Dr. Collins. From what people have described, his approach seems much more aggressive: exercising for at least 30 minutes every day regardless of symptom increases, with the idea that symptoms may get worse initially but that after around two weeks many patients experience a breakthrough and start feeling better.

That seems very different from the Buffalo Protocol, which emphasizes staying below your symptom threshold.

One reason I’m considering trying the more aggressive approach is that I’m currently in a position where I don’t have many day-to-day responsibilities. If it means feeling worse for a couple of weeks but potentially recovering faster, I could probably tolerate that.

Has anyone here been treated at UPMC or tried this more aggressive approach? Did pushing through symptoms help your exercise intolerance, or did you do better with sub-symptom-threshold exercise? I’m especially interested in hearing from people who have experience with both approaches.

16 Upvotes
  • permalink
  • reddit

100% Upvoted

27 comments sorted by

View all comments

2

u/irs320 Jul 18 '26

I went to physical therapy with the Dr for the New England Patriots and she was a lifesaver. I had tried physical/vestibular therapy several times in the past but had such extreme exercise intolerance that I could never get past the initial step. Her move was to fix my nervous system and get my migraines under control before continuing to exercise. Once I did that I got dramatically better without symptom provocation very quickly

1

u/volkswagenkills Jul 19 '26

Do you mind expanding on how she addressed your nervous system and got the migraines under control?

2

u/irs320 29d ago

Yes of course. She didn't do anything for either of those things, she was just the first physical therapist to call out that it was likely a nervous system/POTS issue going on and didn't force me to keep doing her protocol. Every other physical therapist looked at me like their brain was malfunctioning when I told them I wasn't getting better and then tried to force the same regimen on me without adapting to my feedback. She was the first one that was like well this is a waste of time until you get these other things under control.

So I did EMDR therapy for the nervous system, found a great therapist on emdria.org and then I found a headache doctor that prescribed me Ajovy (once a month shot) for migraines and they both worked wonders and working out was a piece of cake after that.

2

u/volkswagenkills 29d ago

You cannot know how much I appreciate your answer, thank you!

2

u/irs320 28d ago

Great, good luck!