The "Bare Ass Minimum (BAM)" concept in concussion/PCS recovery. Does this make you lazy or smart?
Starting the New Year with the "bare ass minimum" sounds lazy. But when you turn it into an acronym, "BAM," and call it a "concept," is it that lazy? Let's chat about it.
Like Chef Emeril Lagasse says, "BAM!"
The BAM concept was first presented to me by Precision Nutrition when I was a client looking to experience their flavor of nutrition and exercise coaching firsthand. Stated simply:
The bare ass minimum (BAM) is your specific threshold for progression or regression. Anything less than your BAM, and you regress. Anything more than your BAM, and you progress. Maintain your BAM, and you maintain your baseline level. That's why it's called a "bare ass minimum."
So, in the context of nutrition and exercise coaching, if I want to gain 5-10lbs of lean mass, my BAMs may look something like:
Eat four meals a day (one meal can be a smoothie).
Eat at least two palms (~40g) of protein with each meal.
Eat at least two fists of veggies with each meal.
Perform resistance training at least three times per week.
Get to bed by 10pm every single night.
If I can do this "BAM plan" ("eat, train, sleep") for several weeks in a row, I can expect to gain some weight - hopefully with a large percentage of that weight being lean muscle.
Regulating your BAM.
Now that quick example BAM is quite involved (e.g., the BAM of a college kid who doesn't have much responsibility outside of their training plan). What about the rest of us with jobs, school, partners, children, and maybe even a brain injury that left us with some fun, persistent symptoms?
That's where we talk about two critical pieces about the BAM's fluidity:
Imagine a dial or a knob that you can turn up and down - like the dimmer switch to a lamp. Your BAM is the lowest the dial will go, but you can always crank it up.
Your BAM can and will change from week to week and month to month. Your BAM is not set in stone.
By establishing and working with a BAM, we can let go of "all or nothing" thinking. There is absolutely nothing "black or white" about concussion recovery.
So, let's set a concussion/PCS BAM. If you're anything like the typical patient that comes to me after months or years of PCS, we're going to have to start with (and maintain) the basics. While that sounds easy, loud traffic sounds outside, or a rough trip to the grocery store can set you back for a day or more. So, how do we navigate the BAM? We take that dial and crank it way down:
Breathe slowly and intentionally (e.g., 5:5) for anywhere from 2 to 20 minutes per day.
Drink 2-3L of water per day.
Circling back to the beginning, your BAM is your maintenance. It's not moving the needle forward, and it's keeping you from going backward. For many folks, concussion or not, that can be as simple as "breath slower and stay hydrated."
But, what about when you're feeling better and are having a good day? Well, on those days, your BAM may look like a typical day of recovery:
View the morning sunlight for 15-30min
Breathe (5:5) for 10-20min
Morning Yoga for 30min
Half of each meal is veggies
Drink 2-3L of water per day
Perform 20min of sub-symptom aerobic exercise
Perform 3-4 rounds of visual/vestibular rehab
Perform 15-30min of soft-tissue mobilizations
View the evening sunlight for 15-30min
Etc., etc., etc...
And your BAM can be more or less than anything I just typed.
Now, let's throw in some "boundary talk."
Wait, boundaries? Why? Believe it or not, even though it may be a minimum, having a BAM sets a boundary. And sometimes, that can be tricky, so it helps to flip the situation on its head.
Let's take it away from a concussion for a second and into work. You have decided that your current job is just "not it" - the pay, your co-workers, the commute. You've chosen to quit. But, also you have a family and bills. So, when do you do it? This is where you start to explore your unique boundaries:
Could I do it tomorrow? Hell no. I have nothing in place, and I'd need to give my two-week notice anyway. Well, what about in 2 weeks? Yuck, that still feels scary. I wouldn't have anything in place by then, and I only have enough saved for the next three months. Okay, what about a year? God no! I couldn't stand this job for another 12 months.
Boom! We've found some edges to our boundaries. We know that it's not as soon as two weeks or as far as a year. So, let's keep playing with these questions until we can settle on a range that sits well with us (e.g., three months).
How does this apply to a concussion recovery BAM? Well, we can get all fancy and goal-oriented and say, "My BAM has to be more than breathing and drinking water! I'm better than that." But, we've got to be realistic about our boundaries. In concussion/PCS, the boundaries can be "feely and intuitive," like knowing the magically appropriate time to quit your job. But, they can also be physical symptoms or signs that present when you've reached various limits.
For example, let's say your CO2 tolerance is garbage. So, asking you to breathe through your nose at a 5:5 pace for 10 minutes would feel miserable.
What about 1min? Yeah, I could do that. Okay, what about 6min? Mmm, nope. What about 3min? Yeah, I think I can do that comfortably.
And, remember, this is not set in stone. As you improve and your recovery progresses, this breathing BAM may be a personal conversation about finding your 5:5 breathing time between 10 minutes and 20 minutes.
Bringing it all together.
As we enter 2022, I don't want you to forget the mindset strategies I discussed as we welcomed 2021. Additionally, I'd like to expand our "mindset toolkit" with the BAM concept this year.
Your "bare ass minimum (BAM)" is unique to you.
Your BAM is your behavior or set of behaviors to help you maintain your current progress.
Anything more than your BAM should help lead to progression.
Anything less than your BAM should help lead to regression.
When setting your BAM, know your limits. Flip your BAMs on their heads - play with the extremes until you find a fit.
Remember, these BAMs will come and go and change as you progress and ride the rollercoaster of concussion/PCS recovery.
Happy New Year to you all!
Dr. Mark Heisig is a licensed naturopathic doctor with continuing mTBI education from The American Academy of Neurology (AAN), Complete Concussion. Management (CCMI) and The Carrick Institute. His office is located in Scottsdale, AZ.