Updated June 27 2021
A concussion can be life-altering in many ways. Symptoms can include headaches, dizziness, trouble focusing, sensitivity to lights and sounds, sleep difficulties and numerous others.1 Symptoms typically last 5 to 10 days; however, in some cases these symptoms can drag on for weeks to months affecting school, work, and social life.
The good news is that these longer-standing symptoms are often due to issues other than concussion itself. The better news is that these issues can be easily treated by a trained concussion therapist. Unfortunately, these easily treatable causes are frequently overlooked as a potential cause of symptoms.
Concussion Management: Neck Dysfunction
This post will focus on the neck and how dysfunction in the neck can lead to the exact same symptoms as concussion. Part 2 of this post will focus on the evidence surrounding treatment of the neck in concussion patients.
Injury or dysfunction of the neck has been shown to cause symptoms such as headaches, dizziness, loss of balance, nausea, visual and auditory disturbances and even reduced cognitive function.2 These are also the most commonly reported symptoms in concussion.
In a study conducted in collaboration with the University of Buffalo (UB), we compared patients with chronic concussion injuries against patients with chronic whiplash injuries (both groups were between 1 month and 1 year since injury).
We had patients fill out two surveys at their first visit to the UB clinic; one survey asked them to rate the severity of a series of whiplash-related symptoms, the other survey asked them to rate the severity of a series of concussion-related symptoms. We then examined the data to determine if we could tell the two groups apart based on their reported symptoms.
We hypothesized initially that the concussion group would report more headaches, visual problems, memory problems and cognitive problems and that the whiplash group would report more neck pain. We were very surprised to find that there was absolutely no difference between symptoms reported between the two groups (Marshall, Vernon, Leddy, Triano – unpublished).
When we look at the mechanism of these two injuries, we see similarities that further cloud the diagnostic picture. A study examining junior hockey players in Canada, found that regardless if the injury mechanism was a blow to the body that appeared to cause a whiplash, or a blow to the head that appeared to cause a concussion, 100% of the time, players demonstrated signs and symptoms of both injuries.3
This is because both concussion and whiplash are due to acceleration and/or deceleration. Concussion is due to acceleration or deceleration of the brain, while whiplash is due to acceleration or deceleration of the neck.
Studies on high school and college football players (using instrumented helmets) have demonstrated that concussions occur between 60-120G of linear acceleration (where G = Force of Gravity).4 Studies examining whiplash injuries have shown that it only takes 4.5G of acceleration to result in strain injury to the neck.5 Based on these forces, we can easily see how every concussion likely has some degree of associated/concurrent neck injury!
It is conceivably impossible to have acceleration/deceleration of the brain after impact without having some degree of acceleration/deceleration of the neck and vice-versa. In fact, an animal study from way back in the 1940’s found that if the neck was stabilized and not allowed to move, impact to the head would not cause concussion even at very high velocities of impact.6 In other words, researchers have known about this link for a long time.
We have now established that sprain-strain injuries of the neck are likely involved, to some degree, in every concussion injury. Furthermore, symptom presentation and a history of a hit to the head cannot tell the difference between neck injury and concussion as the two injuries have the same mechanism and identical symptoms. It is therefore important that prudent clinicians suggest “concussion” patients undergo a thorough neck examination by a trained concussion therapist to address potential underlying neck dysfunction that may be contributing to their symptoms.
Sidney Crosby suffered with concussion symptoms for over a year before a practitioner finally discovered that neck dysfunction was the major cause of his lingering symptoms.
“Sidney Crosby’s latest concussion-related layoff may not be a concussion after all, but rather a more-treatable neck injury that went undiagnosed for weeks if not months.
After meeting with specialists on both U.S. coasts during the last week, the Pittsburgh Penguins captain was told Tuesday he has a soft tissue injury that is causing swelling in his top two vertebrae.”
— Paul Hunter, CBC 2012
Please be sure to read part 2 of this post which examines recovery timelines of each injury and the effectiveness of neck treatment in concussion patients.
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- McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvořák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine. 2013;47(5):250–8.
- Marshall CM, Vernon H, Leddy JJ, Baldwin BA. The role of the cervical spine in post-concussion syndrome. Phys Sportsmed. 2015;43(3):274–84.
- Hynes LM, Dickey JP. Is there a relationship between whiplash-associated disorders and concussion in hockey? A preliminary study. Brain Injury. 2009;20(2):179–88.
- Broglio SP, Surma T, Ashton-Miller JA. High School and Collegiate Football Athlete Concussions: A Biomechanical Review. Ann Biomed Eng. 2011;40(1):37–46.
- Spitzer WO, Skovron ML, Salmi LR, Cassidy JD, Duranceau J, Suissa S, et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine. 1995;20(8 Suppl):1S–73S.
- Denny-Brown D, Russell WR. Experimental cerebral concussion. Brain; 1941.