Concussion/Mild TBI/Post-Concussion

MTBI (mild traumatic brain injury) is also known as a concussion. Sustained persistent symptoms due to MTBI is known as post-concussion syndrome. A mild concussion can be caused by direct or indirect blows to the head or body and should still be viewed as a serious concern. In other words, you do not have to become unconscious or directly hit your head to suffer from a concussion. The management of concussions is of utmost importance and should be taken seriously no matter the degree of injury. Symptoms are not always present immediately after an injury and may take up to 24-48 hours to manifest. It is important to note that recent studies have been advocating looking to the neck when an individual experiences a concussion.

“Assessment and care of the cervical spine and vestibular system in the presence of persistent dizziness, neck pain, and/or headaches may facilitate functional and symptomatic improvements and shorten recovery in post-mTBI subjects.” (1)

“There is a strong association between whiplash induced neck injuries and the symptoms of concussion in hockey injuries. Both should be evaluated when dealing with athletes/patients suffering from either injury.” (2)

“The hypothesis of cervical spine involvement in post-mTBI symptoms and in PCS (post concussion syndrome) is supported by increasing evidence and is widely accepted clinically.” (1)

The researchers in this study show a connection of upper cervical instability and post concussion syndrome being more often due to neck injury rather than brain injury. They “discuss a short case-series of five patients with diagnosed PCS [post concussion syndrome] having very favorable outcomes following various care and rehabilitative techniques aimed at restoring cervical spine function.” (3)

“As upper cervical joint dysfunction is a feature of cervicogenic causes of headache, the results of this study support the inclusion of a precise physical examination of the cervical region in differential diagnosis of patients suffering persistent headache following concussion.” (4)

The VA/DOD Clinical Practice Guideline for the management of concussion-mild traumatic brain injury states:

“The inclusion of neck trauma is important to acknowledge because the most frequent forms of civilian head trauma also cause injury to the cervical spinal column, spinal cord and neck musculature. Individuals who sustain head and neck injury can have headaches in which the pain originates from both the head and the neck.” (5)

Research shows that in mild traumatic brain injuries the cervical spine is involved and unfortunately, many protocols to manage this condition have still not incorporated care of the upper cervical region into the recovery process.

Upper cervical care should play a vital role in the recovery of these conditions due to the possibility and high likelihood of there being a misalignment in your upper neck. When a misalignment occurs in the region of the cervical spine, it can put pressure or tension on the brainstem and decrease the ability for the brain and body to communicate as effectively as it should. When this communication is restored after a precise upper cervical correction, the body will be better able to adapt and heal itself naturally due to humans being self-healing and self-regulating organisms. If you have ever experienced a head or neck injury or other trauma that may have caused issues relating to a concussion, it is worth having an upper cervical chiropractor perform an examination to see if one of the top two bones in your neck are misaligned. Contact us today to schedule a consultation to find out if upper cervical care is right for you.

1. Morin M, Langevin P, Fait P, Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review. J Sports Med (Hindawi Publ Corp). 2016;2016:1590161. doi: 10.1155/2016/1590161. Epub 2016 Jul 26.
2. Hynes LM, Dickey JP, Is there a relationship between whiplash-associated disorders and concusion in hockey? A preliminary study. Brain Inj. 2006 Feb;20(2):179-88.
3. Marshall CM, Vernon H, Leddy JJ, Baldwin BA, The role of the cervical spine in post-concussion syndrome. Phys Sportsmed. 2015 Jul;43(3):274-84. doi: 10.1080/00913847.2015.1064301. Epub 2015 Jul 3.
4. Treleaven J, Jull G, Atkinson L, Cervical musculoskeletal dysfunction in post-concussional headache. Cephalgia. 1994 Aug; 14(4):273-9; discussion 257.
5. VA/DoD Clinical Practice Guideline for The Management Of Concussion-Mild Traumatic Brain Injury: www.healthquality.va.gov/guidelines/Rehab/mtbi/mTBICPGFullCPG50821816.pdf