Note: This blog was generated with the assistance of AI and meticulously reviewed, edited, and updated by Dr. Mark Heisig to ensure accuracy, relevance, and a human touch.

When it comes to managing post-concussion symptoms, focusing on isolated symptom generators—such as visual or vestibular dysfunction—may limit recovery potential. For athletes, the interconnected nature of the visual, vestibular, and cervical (proprioceptive) systems is crucial for optimal performance. These systems do not operate in silos, and neither should their treatment.

In this article, we’ll explore how these systems overlap, why addressing them together is critical, and how this approach optimizes recovery trajectories for athletes.

The Visual, Vestibular, and Cervical Systems: A Delicate Balance.

The brain relies on continuous input from the visual, vestibular, and cervical systems to maintain balance, spatial awareness, and visual stability. Here’s how they interact:

  • Visual System: Provides environmental information, including movement, depth perception, and orientation (Gallaway et al., 2017).
  • Vestibular System: Processes signals from the inner ear to detect head motion and maintain balance (Master et al., 2018).
  • Cervical System: Delivers proprioceptive feedback from neck muscles and joints, contributing to spatial awareness and head-eye coordination (Gard et al., 2022).

These systems work together seamlessly to help the brain interpret movement and maintain stability, relying on areas like the parieto-insular vestibular cortex to combine information into a clear sense of balance and orientation. When one system is disrupted—common after a concussion—it often affects the others, leading to symptoms like dizziness, vertigo, blurred vision, and neck pain (Berthoz & Viaud-Delmon, 1999; Leddy et al., 2021).

By thinking of these systems as pieces of a larger puzzle, it’s easier to understand why treating them together often leads to better recovery outcomes.

Breaking Down Symptom Overlap.

Post-concussion symptoms rarely fit neatly into a single category. For example:

  • Visual and Vestibular Systems: Dysfunction in these systems can manifest as blurred vision, vertigo, or visual motion sensitivity. Tasks like reading or navigating a busy environment may become overwhelming (Master et al., 2018).
  • Vestibular and Cervical Systems: Imbalance or dizziness might originate from the inner ear but could be compounded by proprioceptive deficits in the neck (Gard et al., 2022).
  • Visual and Cervical Systems: Difficulty stabilizing gaze during head movements often stems from both visual disturbances and impaired neck proprioception (Leddy et al., 2021).

Treating one system in isolation risks overlooking underlying contributors or creating compensatory dysfunctions.

Clinician Tip: I often explain this to patients using the analogy of determining what is “smoke vs. fire.” Is a symptom the root problem (fire) or a consequence of another dysfunction (smoke)?

Why an Integrative Approach Matters.

Athletes—such as those in hockey, football, or soccer—require seamless integration of their visual, vestibular, and cervical systems for peak performance. As such, these athletes face unique challenges in concussion recovery:

  1. Complex Symptom Patterns: Concussions in sports often involve simultaneous disruption of multiple systems, given the dynamic and high-velocity nature of gameplay (Master et al., 2018).
  2. Demanding Environments: Rapid decision-making and spatial awareness are critical in-game requirements, underscoring the need to restore full system integration.

A combined rehabilitation approach addresses these challenges head-on:

  • Visual-Vestibular Therapy: Exercises such as gaze stabilization or visual tracking retrain the brain to process sensory input effectively.
  • Vestibular-Cervical Therapy: Manual therapy and proprioceptive exercises improve neck mobility and balance.
  • Integrated Balance Training: Combining visual, vestibular, and cervical stimuli in exercises helps athletes regain coordination and stability in dynamic environments.

Innovative Tools for Integrative Concussion Recovery.

At Complete Concussions, we partner with industry leaders to provide cutting-edge tools for concussion rehabilitation:

  • NeckCare: Offers innovative tools for assessing and rehabilitating cervical function, restoring proper neck mobility and proprioception.
  • FitLight: Uses a system of lights to improve reaction time, visual tracking, and hand-eye coordination, critical for athletes post-concussion.
  • Concussion Lab: Delivers evidence-based solutions for assessing and treating multi-system dysfunctions, empowering clinicians to create targeted treatment plans.

These tools complement our integrative approach, ensuring athletes receive tailored, effective care.

Practical Tips for Clinicians.

  1. Sub-Type the Concussion: Use tools like the Vestibular Ocular Motor Screen (VOMS) to identify deficits in visual, vestibular, and cervical systems.
  2. Tailor Treatment Plans: Customize therapy to target overlapping dysfunctions, integrating vision therapy, vestibular rehabilitation, and cervical exercises.
  3. Monitor Progress: Track improvements across all systems, ensuring gains in one area don’t mask deficits in another (Leddy et al., 2021).

Conclusion: A Unified Path to Recovery.

For athletes and others managing concussion symptoms, the visual, vestibular, and cervical systems are inextricably linked—both in function and dysfunction. Treating these systems synergistically unlocks the full potential for recovery, ensuring athletes can return to their sport safely and confidently.

At Complete Concussions, we emphasize an integrative approach to rehabilitation. By addressing the whole picture—not just isolated symptoms—we help patients achieve lasting recovery and peak performance.

References
  1. Gallaway, M., Scheiman, M., & Mitchell, G. L. (2017). Vision therapy for post-concussion vision disorders. Optometry and Vision Science, 94(1), 68-73.
  2. Leddy, J. J., Haider, M. N., Noble, J. M., Rieger, B., Flanagan, S., McPherson, J. I., & Willer, B. (2021). Clinical assessment of concussion and persistent post-concussive symptoms for neurologists. Current Neurology and Neuroscience Reports, 21(12), 1-14.
  3. Gard, A., Al-Husseini, A., Kornaropoulos, E. N., De Maio, A., Tegner, Y., Björkman-Burtscher, I., & Marklund, N. (2022). Post-concussive vestibular dysfunction is related to injury to the inferior vestibular nerve. Journal of Neurotrauma, 39(11-12), 829-840.
  4. Master, C. L., Master, S. R., Wiebe, D. J., Storey, E. P., Lockyer, J. E., Podolak, O. E., & Grady, M. F. (2018). Vision and vestibular system dysfunction predicts prolonged concussion recovery in children. Clinical Journal of Sport Medicine, 28(2), 139-145.
  5. Berthoz, A., & Viaud-Delmon, I. (1999). Multisensory integration in spatial orientation. Current opinion in neurobiology, 9(6), 708-712.