Disclaimer: The following should in no way, shape, or form be construed as medical advice. I am not a doctor or neurologist and do not play one on the Internet. If you have suffered a concussion, or believe you may have a concussion, seek medical attention first. Once you are cleared to exercise, this may be a useful strategy to return to full function.

Concussions, or mild traumatic brain injuries, can be phenomenally destructive and disruptive events. If you’ve ever had one, you know how awful the effects can be, and if you’ve never had one you should continue doing your best not to hit your head.

All of the reasons concussions cause ill effects are not only unknown, but well beyond the scope of this article. However, one of the systems that can be significantly negatively impacted is the visual system. Symptoms of visual dysfunction following head trauma can include “headache, eye pain, difficulty reading, dizziness, focusing issues, and double vision.”

In my own words, here is what I believe goes on after a concussion, and what we can do to improve it. Following an injury, much like a muscular injury, there is a rigidity and a loss of function in the visual system. It can become so stressful to use an impaired function that it’s actually distress to utilize it. Because we use our visual system extensively in day-to-day life, if there are distressful functions then we are unknowingly piling on the distress just by doing normal tasks.

Imagine injuring your shoulder but absent any obvious pain or indication that you shouldn’t be doing some things you keep using it to pick things up, put them overhead, push, and pull. Eventually you’re going to do even more damage.

It’s been my experience at the gym that we can use biofeedback and simple movement to address these visual dysfunctions and re-train the abilities that are impaired or missing. The best part is that it’s totally non-invasive, often can be done in concert with your normal training, and often works extraordinarily quickly.

The Framework

There are two parts to using biofeedback to improve eye tracking after a concussion. The first is understanding the different “modes” that place different demands on the visual system. The second is that each motion and position of the eye is different, and some will test well while some will not. The goal is to find the functions that test well, and move towards the ones that currently do not.

There are 7 distinct “modes” in which demands are placed on the visual system, approximately in order of how much stress they place on the visual system.

• Body not moving with eyes tracking an object, non-moving background
• Body not moving with eyes at fixed point, moving background
• Body not moving with eyes tracking object on non-moving background
• Body not moving with eyes tracking object on moving background
• Body moving with eyes at fixed point, non-moving background
• Body moving with eyes at fixed point, moving background
• Body moving with eyes tracking object on non-moving background
• Body moving with eyes tracking object on moving background

It’s my experience that the body staying at a fixed place and demanding that the eyes track either a specific object, or a background of moving objects is the least visually demanding or stressful task on the spectrum. The most demanding is the body moving, while tracking a specific object against a moving background. In a gym context, this means you’d want to start with someone facing a blank wall, with nothing moving in their visual field and move from there.

If this hierarchy proves to be true, it’s easy to see why people who have had concussions can find daily life excruciatingly hard to get through – seemingly simple tasks like driving a car or moving around a busy office are taxing at the highest level.

How to Implement

The testing procedure is the same as you would use with any exercise. Check the range of motion to determine a baseline. Move into a position, or perform a movement. Re-check range of motion to determine better or worse.

The goal, then, is to use biofeedback testing to determine where the person currently is able to move and function.

For example, the first thing to test would be, does it test well to stand facing an empty room with eyes fixated on a certain point?

If so, test looking at a point to the far right of the person, as well as a point to the far left of the person. In this way, you can establish the “boundaries” of the visual system in this least stressful task.

Keep in mind that you can, and should, also test the up and down limits of the eyes.

Next, you would test various directions of tracking movement against a solid, non-moving background such as an empty room. You will probably need a partner for this, to hold up a finger, or an object and move it in the various directions for you to track it.

For example, testing tracking an object moving from the far right of the visual field to the center. Moving from the far left of the visual field to the center. And then moving from center out to the extremes of the visual field.

Again, you can test vectors in 360 degrees including up and down, and the far corners.

While it seems like this could be virtually endless, you’ll find that very quickly you can start to understand where the limitations in function are, and it’s only necessary to test a few regions or vectors to confirm your hypothesis.

What you’re looking for are things that test really badly – for areas to avoid moving and to work towards, and things that test really well so that you can move more in those positions.

Next you would incorporate a moving or changing background into the same series of tests. Some people with concussion symptoms absolutely can not handle anything in this configuration when first starting out. If so, you would regress to the non-moving or empty room background and start working there.

To determine the limitations and boundaries of the visual system you’d continue through all of the different modes until you find where the person’s function falls off. In a highly functional individual who is perhaps only experiencing very mild symptoms, they may only have problems with the most complex task – moving and tracking an object against a moving background.

On the other hand, a person with a severe concussion or a history of head injuries may not be able to do a simple exercise such as a squat or deadlift while facing in towards a room full of moving people such as in a busy gym. Fortunately, it’s pretty easy to simply turn them around and have them face a wall to do their movements.

Using the information gathered in this testing session, you can begin to determine an action plan for moving where they can, so they can move where they can’t.

For example, I recently worked with one of my Movement Minneapolis clients, Maggie, after she slipped and fell on some Minnesota ice and hit her head. We started working on visual variations and drills because she was unable to find any movements that tested well, and hadn’t worked out in several weeks.

After working through the protocol above we discovered that  Maggie had no trouble moving her body through space while keeping her eyes in a relatively fixed position, but ONLY if she was looking up and to the right. Looking straight forward or to the left not only tested badly, but actually made her feel bad instantly – exactly what she had been experiencing when trying to exercise before working on these visual drills. In fact, she was able to discover that if she had the left side of her body facing towards a wall – in other words, so there were no distractions coming from that direction – she did the best of all.

Eventually the progression was from up and to the right, to just to the right, to straight ahead. By the time the ability to look straight ahead was regained, looking to the left was no longer a problem and Maggie no longer had to test any visual modifications and was back to functioning totally normally.

One thing to point out is that once you’ve determined the limits of the visual system most of what you’ll be doing is applying variations to your existing training and movements. For example, if you’re working within any of the modes of the body moving, with eyes on a fixed point, you’re really just describing exercising while keeping a particular focus. Only in the eye tracking modes would you need to specifically work on a drill such as following an object that a partner is moving, or something like catching a ball tossed from a particular direction.

It’s All The Same

Regular readers of my writing in biofeedback will recognize this approach as familiar. Besides the fact that the eyes are directly mediated by muscles and can be trained as such, the reality is that most of the functions of the body can be trainer in the same manner.

What can I do?
What can’t I do?
How can I get closer to what I can’t do, by doing what I can do?

One of the simplest and most effective things you can do to improve the success of your training is to keep a journal or notebook. Unless you have nothing in your life going on other than training, it’s almost impossible to remember what you do in a session from one training session to the next, much less when a week or month goes by. Did you do three sets, or four? Was it 50lbs, or 55lbs? What if something is “off” one day, how can you remember if it’s a pattern or a random fluke?

If you’ve ever seen the movie Free Solo you’ll know what I’m talking about, but in it the filmmaker does a great job of dispelling the idea that Alex Honnold is just a crazy thrill seeker. His training journal plays a prominent role of demonstrating how intricately Honnold prepared for the climb, taking detailed notes on every section of the route. At one point his climbing buddy asks if he ever writes down non-climbing notes like, “I saw the biggest Juniper tree” or “I miss my girlfriend” and Alex responds, emotionless, “No, no, no.”

It’s been my experience as a coach that two things stop most people from keeping a training journal: they don’t know what the value is, and they don’t know how to keep one that makes it useful.

The value of a training journal is to have an accurate accounting of what you did, as well as a way to write notes to future you, so that you know what to do in the future. For example it’s good to know what weight you lifted last week on a particular exercise, but it’s even better to know that with the benefit of having just done it you could assess that it was too easy, or too hard. That gives you guidance for the next week to up the weight or to drop it down a bit.  This is a blunt and obvious example, but the more you take ownership of and start paying attention to your training the more you’ll get out of taking notes.

Over time you may develop your own system, but use mine as a starting point. Here’s a couple examples and then I’ll talk about the parts:

Deadlift
355 x 3, 3, 4, 3, 3   10:31

Kettlebell Press
24kg x 6/6, 7/6, 6/6     5:55

My format is always the same. I write down the movement, then the weight, then each set followed by a comma. I don’t always do the same number of reps each set, and then in the future I can easily see if for example my first few sets are better than the first few sets of a previous workout. If it’s a unilateral exercise, I write each side separately because those aren’t always identical either. Finally, I log the total time including rest.

In addition, I might scrawl some notes about what felt especially notable or different on that day – something that might be useful in the future to guide me or explain why some numbers were “off”. The beauty of the simplicity, quickness, and unstructured format of a pen and paper makes it easy to leave yourself free-form notes to future you.

If you’ve never kept a training log before, start. Do it diligently for six to eight weeks. When you do that, and you review your progress over the previous two months or so, you’ll find that you’ve made the best progress you’ve made in a long time – if not ever.