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the neck-concussion connection: when a 'brain problem' is actually cervical
the symptoms of whiplash and concussion overlap, making it sometimes difficult to distinguish between a brain injury or a cervical injury that causes brain symptoms.
4 minute read
is it a cervical injury or a concussion? sometimes it's hard to tell.
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headaches. dizziness. brain fog. poor balance. many people assume these must be signs of ongoing brain injury after a concussion. what many are unaware of is that the neck can cause these same symptoms. the neck contains joints, muscles, and sensors that constantly talk to your eyes, inner ears, and brain. when the neck is tight or irritated, your head can hurt, your balance can feel off, and your eyes can feel slow or sore. treating the neck has been shown to help many patients resolve post-concussion symptoms. 1,2,3,4
your eyes and neck move as a team. when you move your eyes, neck muscles fire to help you turn your head quickly if needed. if those muscles are tight or not working well, even simple visual tasks like reading, scrolling, or driving can trigger head pain. that is why many screen headaches are actually neck-driven. the visual system is working, the neck joins in as designed, and if the neck is dysfunctional, you may get headaches, visual symptoms, dizziness, or even eye pain. 1,2
research shows a large overlap between whiplash and concussion symptoms. in contact sports and traffic injuries, acceleration and deceleration to the head and neck can produce both presentations, and the symptom sets often look so similar that you cannot separate them on symptoms alone. 5,6
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impacts strong enough to concuss the brain almost always load the cervical spine at the same time, so a whiplash-type neck injury commonly co-occurs.7-9 in a prospective hockey cohort, 100% of injured players evaluated showed both whiplash symptoms and concussion symptoms, which underscores how often these injuries happen together.5 because whiplash and concussion share nearly identical symptom profiles, persistent headaches, dizziness, and brain fog are often attributed to the brain when, in many cases, ongoing neck dysfunction is a major driver that can be missed if not assessed properly.5,6
the good news is that addressing the neck can help. in athletes with lingering post-concussion symptoms, adding targeted cervicovestibular rehabilitation that includes cervical manual therapy leads to faster medical clearance than usual care.3 in cervicogenic dizziness, cervical manual therapy improves neck range of motion, head repositioning accuracy, and balance.4 for cervicogenic headache, the weight of evidence favours manual therapy as the primary intervention, and randomized trials and meta-analyses show that adding rehabilitative exercise to manual therapy further enhances and sustains the benefits compared with exercise alone or either approach in isolation.10,11 in practice, a staged plan starts with targeted manual therapy to calm irritated joints and muscles and restore mobility, then layers in sensorimotor training and progressive strength and stability work to hold the gains.3,4,10,11
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so ask your clinician to screen your neck after a concussion. modern consensus and canadian practice guidelines recommend evaluating neck contributions and combining neck care with vision and vestibular rehabilitation when indicated. the aim is simple. help you stand taller, see steadier, and think clearer.12,13
dr. cameron marshall, dc, frccss(c) is a sport-specialist chiropractor and founder of complete concussions, as well as a co-founder of concussion fix.
references
- treleaven j. sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. man ther. 2008;13(1):2-11.
- treleaven j. dizziness, unsteadiness, visual disturbances, and sensorimotor control in neck pain. j orthop sports phys ther. 2017;47(7):492-502.
- schneider kj, meeuwisse wh, nettel-aguirre a, et al. cervicovestibular rehabilitation in sport-related concussion: a randomized controlled trial. br j sports med. 2014;48(17):1294-1298.
- reid sa, callister r, katekar mg, rivett da. effects of cervical spine manual therapy on range of motion, head repositioning, and balance in cervicogenic dizziness: a randomized controlled trial. arch phys med rehabil. 2014;95(9):1603-1614.
- hynes lm, dickey jp. is there a relationship between whiplash-associated disorders and concussion in hockey? a preliminary study. brain inj. 2006;20(2):179-188.
- alsalaheen ba, mucha a, morris lo, et al. physical examination of dizziness in athletes after a concussion: a descriptive study. musculoskelet sci pract. 2018;35:13-19.
- pellman ej, viano dc, tucker am, casson ir, waeckerle jf. concussion in professional football: reconstruction of game impacts and injuries. neurosurgery. 2003;53(4):799-812.
- mcconnell we, howard rp, van poppel j, et al. human head and neck kinematics after low-velocity rear-end impacts. sae technical paper 952724; 1995.
- spitzer wo, skovron ml, salmi lr, 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.
- jull g, trott p, potter h, et al. a randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. spine. 2002;27(17):1835-1843.
- fernández-de-las-peñas c, florencio ll, plaza-manzano g, et al. effectiveness of manual and exercise therapy on cervicogenic headache: systematic review and meta-analysis. chiropr man therap. 2022;30:47.
- patricios j, ardern cl, schneider kj, et al. consensus statement on concussion in sport: the 6th international conference on concussion in sport, amsterdam 2022. br j sports med. 2023;57(11):695-711.
- ontario neurotrauma foundation. guideline for concussion/mild traumatic brain injury & persistent symptoms (3rd ed.). toronto: onf; 2018.
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