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POST CONCUSSION SYNDROME
Post Concussion Syndrome - Blair Certified Doctor of Chiropractic
Understanding Post Concussion Syndrome
Are you or a family member dealing with the challenges of post concussion syndrome? How severely has it been disrupting your daily life? You ability to concentrate? To focus? Even to think? What about your energy? You sleep? But perhaps most important of all, your mood? Since the injury, have you not been feeling yourself at all? And how has it shown up in your relationships with your spouse? Your children? Your friends? And your coworkers?
One of the most frustrating things about post concussion syndrome is that it takes so long to heal! And worse, it’s impossible to say exactly how long it may take. Some people seem to recover quickly. Others take so much longer. One way or another, if you’re feeling the frustration of just wanting to have your life back, you’re not alone. Have you googled “post concussion specialist near me,” and want to make sure that you leave no step left unturned in your recovery? If so, you’ve probably been to neurologists and physiotherapists, who have prescribed you a series of exercises to assist with your post concussion syndrome recovery.
But is there more that you can be doing at the same time? Let me ask you: since the injury, have you had any specific treatment for your neck? If you’re looking for natural, non-invasive solutions to help in your recovery we may be able to help you. Keep reading to find out more.
How to “Read” Post Concussion Syndrome Symptoms
The symptoms of post concussion syndrome are extremely variable, which is one of the reasons that many people don’t realise what is going on until they get a formal diagnosis.
Some of the most common symptoms of post concussion syndrome include headaches or even migraines, dizziness, blurry vision, “fogginess in the head,” inability to concentrate, memory problems, sleep problems with the paradox of feeling tired all the time, and mood disturbances where “you just don’t feel like yourself.” Depression and anxiety are two other common symptoms associated with post concussion syndrome.
The reason that symptoms are so varied is because a concussion is essentially a brain injury. In fact, many authorities describe a concussion as a “brain bruise” or “brain sprain” that occurs as the result of a sudden injury.
And the part of your brain that suffered the injury will be the part that creates the most symptoms.
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If it was the back of your brain, it could be your vision or balance (occipital lobe or cerebellum).
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If it was the base of your brain (brainstem), it could be your autonomic nerves, which control your vital organs and stress responses.
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If it was the front of your brain, it could be your mood or hormones (pre-frontal cortex or hypothalamus).
The list is potentially endless.
What Can Cause Post Concussion Syndrome
Pure and simple, it’s a physical injury that “bruises” or creates a sudden tug on the brain tissues. Now, here’s the thing: in years past, it was believed that you could only suffer a concussion if you suffered a direct head injury where you lost consciousness.
Not true. Here’s a personal story that illustrates the point.
When I was in college, I was playing backyard football (gridiron) with a bunch of friends. We were running the ball, and one of my buddies broke the line in for a score. He was so wide open that be decided to do a little showboating into the end zone and did a front flip … sort of. It was more of an awkward roll where he landed on the top of his shoulders, pulling his neck down and banging the back of his head on the ground.
It was not what you’d call a high-impact injury at all. He actually popped straight up, gave us high-fives, and then we continued the game.
About 5 minutes later between plays, he leaned over to us and asked, “How’d we get on defence?”
… My friend had no memory of scoring the touchdown! He never lost consciousness - and there was never a true head impact - but he definitely suffered a concussion!!
A grade I concussion happens when there is a head or neck injury that pulls on the brain, but to the point that you lose consciousness.
A grade II concussion happens when you do lose momentary consciousness and “see stars.”
A grade III concussion happens when there is more than a momentary blackout and that lasts from a few seconds to minutes.
The thing about it is that you can still suffer severe neurological consequences even following a grade I concussion. Moreover, the symptoms may not appear for days or sometimes weeks following the injury.
Some time ago, one of my chiropractic mentors was involved in a car crash where the airbags went off and smacked him in the face. Aside from a few bruises, he “felt fine” … until about a week later when he inexplicably couldn’t concentrate.
It seems that the initial shock of the injury masked the severity of his condition, which ultimately took several months to resolve.
So when it comes to post concussion syndrome, even a “small injury” can create an exponentially nasty collective of symptoms if just the wrong part of the brain is injured in just the wrong way.
Most Common Reasons Adults get Post Concussion Syndrome
Whiplash-type injuries.
Direct head trauma such as a sudden hard “smack” on the head that causes you to blackout or to experience post concussion symptoms as a result is definitely common. In my experience, however, it is whiplash-type injuries that are even more common.
A whiplash injury is any sudden snapping of the neck either backwards and forwards, or side-to-side. These types of injuries include car accidents - including low speed collisions < 40kph where the airbag never goes off - and sports injuries (e.g., tackling, falling, sliding or hitting a ball with your head).
The reason that whiplash can cause post concussion syndrome is because of the unique relationship between the upper neck and the brain. Picture a balloon with a string attached on the bottom. In effect, this is your brain (balloon) and your spinal cord (the string).
The ligaments of the upper neck (called myodural bridges) anchor your brainstem to the muscles and bones in your upper neck. The reason is to protect the opening of your spinal cord (because if it didn’t, every time you moved your head you would squish your nerves) and to facilitate the normal flow of cerebrospinal fluid (CSF).
So, if you suffer an injury that causes a sudden pulling of your neck - including these myodural bridges - it may also pull on your brain, effectively leading to a “brain sprain.” It may also explain why so many people who suffer post-concussion syndrome have “normal” MRIs of the head.
And it’s because it may actually be the neck - not the skull - that is the source of the brain trauma.
Most Common Reasons Children get Post Concussion Syndrome
For men and boys, the most common sport to cause post concussion syndrome is Australian rules football (AFL), which is followed up with rugby and then soccer. However, you’ve can’t forget skateboarding or surfing (getting dumped off waves).
For women and girls, the most common sport to cause post concussion syndrome is soccer … but not necessarily for the reason you might think. It isn’t from head butting the ball, but from sliding during a tackle!
Researchers believe that as a general rule, women have greater flexibility of the ligaments in their neck than men. The result is that it takes less force in a collision to cause injury. So for all the “Tom-boys” out there, proper care of the neck following a sports injury may be all the more important.
So if you suspect that you, your son or your daughter may have suffered the type of injury that we are describing, make sure that you get the head/brain cleared with the first responders. But then after that, make sure that you also get your neck properly assessed too.
What to do about Post Concussion Syndrome
The first thing to do if you believe you may be experiencing post concussion syndrome is to have a proper assessment at the hospital to make sure that you didn’t break anything in your skull or your neck. That will include x-rays, a CT scan and an MRI.
With post concussion syndrome, many of these common tests show “normal.” In other words, there’s no overt signs of fracture, dislocation or bleeding. Good.
However, the thing about post concussion syndrome is that it is a functional disorder, which means that the nerves aren’t quite firing the way that they were before. It’s like a computer infected with malware and isn’t able to process information the same. The computer slows down, starts to behave erratically, and crashes if pushed too far.
In essence, post concussion syndrome is a brain-processing disorder. The solution then requires a three-pronged approach: 1) making sure that there is no residual tension or irritation that could be preventing the brain from being able to heal, 2) rehab activities that improve the brain’s ability to process information and 3) the time and committed persistence to do whatever it takes to allow your brain to heal.
I’ll address #3 first. “There is no process that does not take time.” Healing is no exception. As much as we all wish there was a magic fix for post concussion syndrome, to the best of my knowledge there isn’t. Whatever form of care you require, you must accept that your healing will take time. There are no shortcuts.
Now #2. Exercises that challenge your brain to re-wire itself are very important in overcoming the challenges of post concussion syndrome. For these, you will need to work with a specialist who prescribes eye-tracking exercises and other rehab activities that will activate your brain. Often, this person will be a neurologist, physiotherapist, physiologist or chiropractor.
And then, the foundation for it all: #1. Don’t forget the role of whiplash and the structure of your neck in health. Even if you haven’t broken or dislocated anything, an injury affecting the alignment or motion of the bones in your neck may still be producing tension that is interfering with your body’s ability to heal.
Chiropractic and Post Concussion Syndrome
In addition to working with your neurologist and your physiotherapist, if you are wanting to make sure that you do everything possible to help with post concussion syndrome, have you thought of seeing an upper cervical chiropractor?
Foremost - just to get it out of the way - upper cervical care is not the same as general chiropractic. There is no twisting, popping or “cracking” the neck.
Okay, so what is it then? The focus of upper cervical care is on the alignment of the top two bones in your neck - the atlas (c1) and the axis (C2) - and the impact that they have on the function and health of your nervous system.
The process involves a personalised assessment of your condition, which includes a series of neurological tests that identify if there is a problem with the nerves in your upper neck and then precise, customised x-ray views that show the alignment of the individual bones in your neck. So even if you have had CTs, MRI or other neck x-rays before, these tests allow us to see additional angles that help us to identify the problem in ways that you may not have had tested before.
As a result, we may be able to offer a unique and natural solution to help with post concussion syndrome that works by helping to improve brain function.
Chiropractic Treatment for Post Concussion Syndrome
Researchers from New Zealand have published a number of studies demonstrating how restoring proper mobility through the neck helps to improve the processing ability of the brain. It is this precise mechanism that may also be able to assist the body to heal from the symptoms of post concussion syndrome.
In addition, researchers from the USA also publish a number of cases of people showing how specific correction to the alignment of the upper neck improves the flow of CSF and in turn the symptoms of post concussion syndrome.
That said, it is imperative that I explain what upper cervical care is and is not.
Blair upper cervical care IS a unique and specific method for aligning the vertebrae in the top of the neck as a method of improving the function of the nervous system. So the reality is that it is NOT a direct treatment for post concussion syndrome, but is a natural treatment for the body so that your own body may have a better opportunity to heal from whatever you may have going on.
If this concept makes sense to you - that we are not treating you for post concussion, but that we are treating your neck in order to help you be healthier. Then, as a team working with your neurologist and physiotherapist, we have the full anticipation that these activities will help you overcome the challenges of post concussion syndrome.
If you have any questions or would like to book an appointment with one of our doctors to find out if Blair upper cervical chiropractic may be right for you, please contact our office at 07 3188 9329, or send us an email.
References
Caccese JB, Buckley TA, Tierney RT, et al. Sex and age differences in head acceleration during purposeful soccer heading. Res Sports Med. 2017 Oct 25:1-11. doi: 10.1080/15438627.2017.1393756.
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.
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.
Haavik-Taylor H and Murphy B. Altered sensorimotor integration with cervical spine manipulation. J Manipulative Physiol Therap, 31(2);2008:115-126.
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.
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.
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).
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.
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