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In Episode 7 of Ask Concussion Doc with Dr. Cameron Marshall, we discuss neck spasms related to treating whiplash following concussion; how to manage tinnitus and dizziness caused by post-concussion syndrome (PCS); and a new study looking at the prevalence of lower extremity musculoskeletal injuries following concussion.
Whiplash following concussion
With the exception of your fingers, the neck has the most and highest density of muscle spindles and Golgi tendon organs in the body. The neck tells your brain a lot about where you are in space – which is known as your vestibular system.
There are three systems that make up your vestibular system: visual system; inner ear and semi-circular canals; and the others are the muscles and joint receptors of your neck.
Those three systems have to be congruent and telling the brain the same thing in order for a person to feel level and okay.
If the eyes and inner ear are working correctly, but there are issues with the neck, then this can cause symptoms. For example, people with spasms in the neck can experience dizziness – in this case, cervicogenic dizziness.
What causes spasms? Spams of the neck could be caused by the initial impact or injury and protective mechanisms, reactive actions that cause irritation or displaced joints, or tightness of muscles, for example. Dr. Marshall discusses the role of different muscles in the neck, and how a concussion injury could bring about certain cervicogenic type symptoms such as feeling off or balance issues.
He also discusses in detail some of the treatment approaches for these issues, which may include manual therapy, acupuncture, mobilizations of the joint, deep neck flexor work or joint positioning error, among others.
How to manage tinnitus and dizziness caused by post-concussion syndrom?
Firstly, a practitioner needs to make sure that tinnitus is not caused by an underlying issue. In some cases, it may be caused by other neurological findings, or could be completely benign and happen randomly.
When it’s coupled with dizziness, the approach to rehabilitation may include exercise therapy, vestibular rehabilitation, or management of cervical spine dysfunctions. Follow the link for more information about treatment and rehabilitation options for post-concussion syndrome.
In some cases, tinnitus may go away over time, but if is the primary complaint, referral to an ears, nose and throat specialist or an audiologist may be required. Dr. Marshall discusses this complaint in detail during the episode. If you are suffering from post-concussion syndrome, visit our website to find a clinic near you.
Study of the Week: Risk for Lower Extremity Injury After Concussion
In the last segment, Dr. Marshall discusses a recent study that looks at the rate of lower extremity injuries (in soldiers) within 2 years of a concussion. Published in the Journal of Orthopaedic & Sports Physical Therapy, the study concludes that the rate of lower extremity “musculoskeletal injury among this population of physically active adults is higher following concussion.” 
Watch or listen to Dr. Marshall’s analysis below.
Watch on YouTube:
Listen on Soundcloud:
 Kardouni, Joseph R. et al. Risk for Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers. J Orthop Sports Phys Ther. 2018 May 8:1-25. doi: 10.2519/jospt.2018.8053. Available at: www.jospt.org/doi/abs/10.2519/jospt.2018.8053