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The Neck Connection in Concussion/Mild Traumatic Brain Injury (mTBI)

Women with neck pain

You may be asking yourself, “What do my neck and spine have to do with my concussion symptoms, especially since I am not experiencing neck or back pain?” Or another question you may be wondering is, “I have had neck and back pain following my concussion but imaging came back “negative” and my
doctor said everything looked “fine” so how can the spine still be involved?” Many times, patients come
to me asking these exact questions, not fully understanding the correlation between the injury
(concussion) and the effect it has on the brain and spinal cord (nervous system) which consequently can
cause symptoms such as headache, brain fog, balance problems, decreased energy, vertigo, along with
hearing and visual issues.

The neck is a vital part 

Generally, we tend to equate pain with a problem or rely on available testing whose purpose is to rule
out serious pathology such as a fracture, spinal cord injury, herniated disc, or a bleed after a traumatic
event. When no pain or pathology is present, we overlook the function of that particular area as the
source and yet wonder why symptoms persist. The neck (cervical spine) is an extremely vital part our
bodies. In fact, this is the area that connects the brainstem (lower most part of the brain) to the rest of
the spinal cord which houses and protects not only spinal nerves, but also some cranial nerves that exit
from the base of the skull. The cervical spinal nerves, contribute to strength and sensation of our head
and upper extremity; whereas the cranial nerves that exit from this area, play a role in face and head
pain/headaches, chewing, along with integrating vision, hearing and balance. In short, the information
between the brain and the body must pass through the neck. If there is an injury to the neck, the
connection between the brain and body (via the spinal cord) can be affected causing improper
communication of the nervous system leading to symptoms.

Whiplash which also can occur with or
without a concussion

Concussion, defined as, “A subtype of mild Traumatic Brain Injury (mTBI)…A reversible neurological
dysfunction…may be caused by either a direct blow to the head, face, neck or elsewhere on the body with
an impulsive force transmitted to the head…which may result in neuropathological changes, but the
acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury
and, as such, no abnormality is seen on standard structural neuroimaging studies.” (1) It is a metabolic,
physiological, and microstructural injury to the brain where the force of the head and neck being jarred
forward and back (and in some incidences which also include rotational forces) cause a shearing of the
white and gray matter in the brain (which are different densities) and can lead to injury of the axons and
nerve transmission pathways. This causes functional disruption of the pathways in the brain, or
“messaging highways” that allow the brain and body to coordinate certain functions such as balance,
vision, hearing, movement, and so forth, leaving you to feel symptoms either physically, emotionally,
cognitively, or even affecting sleep and wake cycles. When a “neck injury occurs due to forceful, rapid
back and forth movement of the neck” (the definition of “Whiplash” which also can occur with or
without a concussion), (2) muscles, ligaments, and mechanoreceptors can be damaged in that area. So,
in other words structural injury to the axons in the brain, and possibly to the ligaments, muscles, and
mechanoreceptors surrounding the spine (which pick up movement and joint position sense), are all
unable to be detected and the damage causes a disruption in the function. That is why concussions are
often referred to as the “invisible injury”. However, the good news is, as stated in the definition, these
injuries are reversible with appropriate identification and care.

The neck has a very delicate proprioceptive system

In the brain, many systems integrate into common areas and communicate with each other such as the
visual system, auditory system, vestibular system, and proprioceptive system. The proprioceptive
system encompasses the whole body up to the neck including the limbs and torso, and is responsible for
letting the brain know where you and your body parts are in space (ie. joint position sense). Since the
neck (cervical spine) “has a very delicate proprioceptive system that plays a crucial role in helping
maintain posture and balance” (3) , a concussion or whiplash may cause the brain to develop a mismatch
of where it believes the body actually is in space, to where it actually is in space. As a result, the brain
may compensate by tilting or rotating the head and neck to accommodate for the mismatch. This
compensation trickles down the rest of the spine causing compensations in other areas. Have you ever
seen someone walk into a wall and totally miss the opening of a door? Well, that’s because even though
their visual system saw the appropriate opening of the door to comfortably pass through, the
proprioceptive system was providing inaccurate information to the brain and the brain misidentified
their physical position from where it should have been. Since injury to the neck (cervical spine) causes
distortions in transmitting information to the brain (4) , by treating the neck (cervical spine) and rest of
the spine, appropriate integration of neurological systems is established and mismatches are eliminated
giving appropriate awareness of where you are in space.

The brain and body are viewed as an entire integrated system

Often, in traditional medicine, providers specialize in treating particular symptoms and individual
systems. For example, patients will see an eye doctor for their vision complaints and an ear doctor for
auditory concerns. Even though it is prudent to visit these specialists and rule out serious pathology,
should test results come back negative, the likely cause of those symptoms of headache, visual and
auditory issues, etc. could be coming from the brain and spinal cord. Many times, improving neck and
spinal function will naturally improve the other associated symptoms of both concussion and whiplash.
In Chiropractic Neurology, the brain and body are viewed as an entire integrated system and a thorough
evaluation of all systems is performed. Personalized treatments consisting of specific adjustments to the
affected spinal joints can provide appropriate input into the nervous system along with brain stimulation
exercises and rehabilitation modalities. This brain-based approach is essential to re-integrate
functioning of the nervous system and correct dysfunctions due to concussion or whiplash. If you have
tried other therapies in your healing journey and are working with great providers but not finding a
complete resolution of your symptoms, you may want to consider having an evaluation with a Board-
Certified Chiropractic Neurologist.

1. Consensus Statement on Concussion in Sport- the 5th International Conference on Concussion in sport
held in Berlin, October 2016. McCrory P, et al. April 26, 2017, British Journal of Sports Medicine, pp. 1-10.
2. Whiplash Symptoms and Causes. s.l. : Mayo Clinic.
3. Cervical Proprioceptive Impairment in Neck Pain Pathophysiology, Clinical Evaluation, and Management: A Narrative Review. Peng B, Yang L, Li Y, Liu T, Liu Y. 1, s.l. : Pain Therapy, June 2021, Pain Therapy, Vol. 10, pp. 143-164

4. The implications of cervical spine degenerative and traumatic diseases in the pathogenesis of cervical vertigo and hearing loss. Cobzeanu MD, Rusu D, Moraru R, et al. 3, s.l. : Rev Med Chir Soc Med Nat lasi, 2009, Vol. 113, pp. 814-818.

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