Concussion and Neck Joint Position Sense in Rugby Players

Posted in Neck Pain Disorders on May 17, 2022

A recent study has found even more compelling evidence that there is a link between the joints and nerves in your neck and concussion. 

In this particular study that looked particularly at rugby players, the researchers found that players who had suffered a concussion were more likely to have what is known as a joint position error involving disruption of the proprioceptors in their neck.

What this means is that in your neck, you have three types of nerve receptors: 1) pain, 2) pressure (which detects movement), and 3) proprioception, which is about balance and muscle tone.

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A joint position error is a test that you can perform on your own where you close your eyes, then nod/turn your head in a few different directions, and then attempt to bring it back to the same position that you started. If you don’t bring your head back into pretty much the exact same position, it is a sign that even if you do not have neck pain that there is something wrong with your neck that is affecting your proprioceptors.

Going back to the research on the rugby players and concussions the real interesting thing was that the researchers did not find an increase in the neck joint position errors after the players suffered a concussion. No, what they found was that the neck joint position errors were present before the players suffered a concussion,

In other words, certain rugby players may have a preexisting condition in their neck that affects their nerve receptors and renders them susceptible to certain types of injuries that including concussions.

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Now, the researchers did not get into what causes a joint position error in their particular article, but here we will address one of the common neck and health problems that can disrupt proprioception in the neck, and what you can do about it!

Neck Health - A Risk Factor for Concussion in Rugby Players

Not just rugby players, but the implications from this research are that any person (especially women who are more susceptible to concussion than men due to genetic differences in ligament structure) IF they have a pre-existing problem with their cervical joints and proprioceptors is more likely to experience a concussion if they suffer a neck injury.

When it comes to beck injuries then, we have several types of possible injuries and levels of severity. On the most severe side, we have fractures, dislocations, ruptures, and lacerations. With these types of conditions, the signs and symptoms are usually quite evident, and treatment typically requires surgery, casting, and/or physiotherapy in the following weeks (or months) to rehabilitate the injury.

On the other side, we have the kinds of injuries that most people don’t really pay attention to micro-tearing of the muscles, ligaments, or connective tissue that support the vertebrae in your neck. While many of these injuries will heal on their own, there are particular types of injuries that can cause the vertebrae in your neck to shift and lock outside of their normal centre of gravity. These are called capsular entrapment injuries, or chiropractic subluxations (which are not the same as medical subluxations). 

Because so many of these injuries are relatively small (2-3mm), they often do not go reported on standard x-ray, CT, or MRI studies. Moreover, these types of injuries do not always produce immediate pain or even other symptoms. However, when these injuries are allowed to add up over weeks, months, or years, they can cause progressive degeneration and accumulate like unpaid compounding interest. As they relate to joint position errors and concussion, these types of injuries are also the very things that affect joint position, movement, proprioception, and muscle tone. 

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Of particular interest are the top two vertebrae in the neck, the atlas (C1) and axis (C2), which are supported by a series of suboccipital muscles that contain more proprioceptors than any other area of the spine. Therefore, should any of the joints in your upper neck be injured in any way (bump, fall, trip, etc … even if they don’t cause immediate pain), these bones can affect your overall joint position sense, proprioception and thus represent a risk factor for experiencing a concussion should you ever had another injury in the future. An important side note, from the asymptomatic standpoint, there is actually no distinction between a concussion and whiplash:

  • Blurry vision
  • Headaches or migraines
  • Nausea
  • Brain fog and poor memory
  • Dizziness or vertigo
  • Seeping difficulties
  • Neck, shoulder, and body pain 

If you are like us and believe that it is better to prevent disease than to treat it - and if you believe that it is better to treat the cause naturally and not just the effects with drugs or surgery - here is where a unique approach to healthcare known as Upper Cervical Chiropractic may be able to help.

The Blair Technique - A Different Approach to Neck Health and Concussion in Rugby Players

We would like to emphasise that when it comes to concussion and similar syndromes, it is important to work with a range of qualified health professionals who focus on different aspects of recovery: neurologists, physiotherapists, osteopaths, etc. So what upper cervical chiropractic represents is one important piece in that overall recovery strategy to help people with concussions. 

The upper cervical is a special division of general chiropractic that focuses on the health and function of the top two vertebrae in the neck (C1 and C2) because of their profound impact on your spine and brainstem, which is the master control centre for your entire body. There are many varieties of upper cervical chiropractors (including the Atlas Orthogonal and NUCCA techniques), and while we have studied (and practiced) many of them, the approach that we have come to prefer through our own research and experience is known as the Blair Technique.

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The Blair Technique was developed in the USA as a method to recognise the unique differences in every human being, that we are not the same on the outside or on the inside. Thus, it is only by taking these differences into account with a proper assessment including specialised diagnostic imagining that we are able to identify the exact location, direction, and degree of particular neck injuries (i.e., joint position errors), and thus the most appropriate way to correct them.

Rather than using stretches, exercises, or spinal manipulation, the Blair Technique uses a precise and light impulse directed through the neck in order to release the locking point that is effectively holding the vertebrae outside of its normal neutral position. By doing so, we are not attempting to force bones back into place, and there is no twisting or cracking at all. What we are doing is providing just the right amount of force so that your own body is able to do the healing work the way that it is designed to do: from the inside out.

The Blair Technique (and upper cervical chiropractic in general) are still widely unknown here in Australia and yet has been shown in many cases to have a profound effect in being able to help improve people’s quality of living after concussion injuries, plus a host of other syndromes. Atlas Health is the premier Blair Upper Cervical chiropractic centre in Australia. Located in North Lakes (north Brisbane), we work with clients from across southeast Queensland and even interstate to help them find long-term solutions so that they can get back to enjoying the things in life that matter most to them.

With concussions especially, the road can often be a long one. But every step forwards is a road that can make a profoundly positive difference. We hope that this article has been both informative and valuable. To discuss your particular condition and to find out if the Blair Technique may be right for you, we offer a complementary 15-minute phone consultation. Click the contact us link on this page or call us direct at 07 3188 9329, and we will be happy to assist you.

References

Daligadu J, Haavik H., Yielder PC, et al. Alterations in cortical and cerebellar motor processing in subclinical neck pain patients following spinal manipulation. Manipulative Physiol Therap. 36(8); 2013:527-537. https://www.ncbi.nlm.nih.gov/pubmed/24035521

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What is an Upper Neck Subluxation?

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Gouttebarge V, Aoki H, Lambert M et al. A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports. Phys Sportsmed. 2017 Sep 13:1-7. doi: 10.1080/00913847.2017.1376572. https://www.ncbi.nlm.nih.gov/pubmed/28870119

Haavik-Taylor H and Murphy B. The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study. J Manipulative Physiol Therap. 33(4);2010:261-272. https://www.ncbi.nlm.nih.gov/pubmed/20534312

Haavik H and Murphy B. The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. J Electromyography Kinesiology, 22(5);2012:768-776. https://www.ncbi.nlm.nih.gov/pubmed/17137836

Lelic D, Niazi IK, Holt K, et al. Manipulation of Dysfunctional Spinal Joints Affects Sensorimotor Integration in the Prefrontal Cortex: A Brain Source Localization Study. Neural Plast. 2016;2016:3704964. doi:10.1155/2016/3704964. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800094/

Ogura T, Tashiro M, Masud M, et al. Cerebral metabolic changes in men after chiropractic spinal manipulation for neck pain. Altern Ther Health Med. 2011 Nov-Dec;17(6):12-7. https://www.ncbi.nlm.nih.gov/pubmed/22314714

Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).

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Rosa S, Baird JW, Harshfield D, Chehrenama M. Craniocervical Junction Syndrome: Anatomy of the Craniocervical and Atlantoaxial Junctions and the Effect of Misalignment on Cerebrospinal Fluid Flow, Hydrocephalus Bora Gürer, IntechOpen, DOI: 10.5772/intechopen.72890. A

Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015. DOI:10.1159/000365463.

Wong JJ, Shearer HM, Mior S, et al. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. Spine J. 2016 Dec;16(12):1598-1630. doi: 10.1016/j.spinee.2015.08.024. Epub 2015 Dec 17. https://www.ncbi.nlm.nih.gov/pubmed/26707074

Farley T, Barry E, Bester K, et al. Poor cervical proprioception as a risk factor for concussion in professional male rugby union players [published online ahead of print, 2022 Apr 4]. Phys Ther Sport. 2022;55:211-217. doi:10.1016/j.ptsp.2022.03.010. https://pubmed.ncbi.nlm.nih.gov/35526515/

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