If you don't have either problem, physiological problems may develop along with PCS. Cognitive problems alter movement, make you more cautious, more physically tense, more cautious. You won't run because you're concerned about getting lost. You avoid your weights because you keep dropping them and exertion gives you headaches. Or you don't feel comfortable driving to the gym; your reaction times make tennis embarrassing. No one would think you sailing solo anything but madness.
But without PT, after 3 or 6 or 9 weeks of this altered "moving within your world," it's hard to go back. This is why athletes are monitored so closely after a concussion--going back too quickly worsens symptoms, and going back too slowly limits recovery potential. By 12 or 16 weeks the neural pathways are laid down for "take it easy there, what's the hurry?"
This isn't unique to PCS; it happens with acute back injuries and other orthopedic injuries too. No one in a leg cast gets it off and isn't shocked by muscle atrophy and the limb's general patheticness.
But confidence and energy level and response times are often altered with PCS, so that getting back into a "normal" routine of physical activity can take a really long time. That extended period of "fragile" behavior can convince your brain that it's safe to be still, and dangerous to charge into the world full-speed.
This perceived fragility can then severely limit your world and recovery.
So whether you're in PT or not, the DOCC framework has you in the gym, working out for 3-5 hours a week (without weights at this point), both as a way to manage mood and anxiety and--especially--to retrain your brain that your body is healing, and needs exercise to fully recover. Maximizing treatment of soft tissue damage though education and PT, plus a self-directed physical conditioning program for 6 months is about what it takes to "rewire" the brain into thinking it's competent again.
Well, this plus the writing assignments. More about those tomorrow.
This of course did not work for me. I hate the noise of the gym, and am a nut case in terms of adding ridiculous amounts of weight onto every machine. I'd have to be well past Step Five (we're at the end of Step One here) to have my inner challenge junkie calm enough to work out without pushing myself too far.
So I borrowed my father's recumbent bike and did the back stretching and strengthening exercises from PT, daily yoga stretches in the kitchen when I was alone (no one to impress) and walked my 10k steps a day (or more), which is about 50 miles/week, even when it was cold and snowy.
It was still better for me than the gym, and my just dessert for being so vain I can't just hit a treadmill at 2 miles an hour at the Y and then do a little therapy ball stretching. But you can totally do this low-level workout 3-5 times a week without re-injuring yourself.
Or not. In that case you're banished to solo workouts and strengthening. I try to do some of the strengthening exercises like these everyday. Squats suck but they help my butt. I can get up to 200 seconds if I plank every day for 3 weeks and that really tightens my abs. But I keep changing the exercises to keep my brain flexible, and wondering what we'll be up to next.
Whatever you're doing, have fun. You'll be doing it for the rest of your life ;).