Post-concussion syndrome | Neck injury or head injury? What is causing post-concussion like symptoms?August 5, 2017
A study in the July 2017 edition of The Journal of orthopedic and sports physical therapy says there is considerable evidence to support the importance of cervical afferent dysfunction (damage to the neck vertebrae and weakness in neck stability) in the development of dizziness, unsteadiness, visual disturbances, altered balance, and altered eye and head movement control following neck trauma or sports injury, especially in those with persistent symptoms.
The study’s author, Julia Treleaven of the University of Queensland says an understanding the nature of these symptoms and differential diagnosis of their potential origin is important for rehabilitation. In addition to symptoms, the evaluation of potential impairments (altered cervical joint position and movement sense, static and dynamic balance, and ocular mobility and coordination) should become an essential part of the routine assessment of those with traumatic neck pain, including those with concomitant injuries such as concussion.1
Dr. Treleaven’s assessment continues new research findings that is trying to determine the cause of post-concussion syndrome and the suggest best treatment recommendations.
What Exactly Is Post-Concussion Syndrome?
Doctors and patients know that Post-concussion syndrome (PCS) is a complex disorder in which various symptoms- such as brain fog, headaches, and dizziness- continue for weeks, months, or even years after a concussion. Among sports-related injuries, post-concussion syndrome is one of the most elusive and challenging problems to treat. While many patients will recover from their concussion, just as many will not.
Among sports-related injuries, post-concussion syndrome is one of the most elusive and challenging problems to treat. While many patients will recover from their concussion, just as many will not. As an athlete sustains repeat concussions, the chance of recovery becomes less likely.
What Does PCS Look Like?
Most patients who suffer from post-concussion syndrome will have normal blood work, normal MRI examinations, and normal vital signs. Since we cannot “see” an apparent cause of their symptoms by these traditional tests, a conventional treatment for post-concussion syndrome does not exist. Those that suffer from this disorder are asked to rest and possibly undergo physical and occupational therapy until symptoms resolve.
Even these recommendations have been called into question.
A recent study presented at the Pediatric Academic Societies 2016 Meeting found that youth who exercised within seven days of head injury had nearly half the rate of persistent post-concussive symptoms a month later.2
Putting It Into Perspective
While my personal quest to solve my own head injury began with an automobile accident rather than a sports injury, my symptoms were quite similar to those who suffer from post-concussion syndrome. After exhausting the realm of traditional medical treatment including examination by neurologists, therapists, and surgeons – my headaches, inability to concentrate, and lack of energy continued for over 10 years. Out of desperation, I began to take matters into my own hands. I determined that most of my issues were likely caused not by damage to my brain, but by something entirely different.
What Does Treatment Look Like?
One may ask, how could injections into the neck and head possibly cure the problems of concussion and head injury? The answer has to do with a complete understanding of what happens during a head injury. I have studied films of the hits that have caused devastating concussions and observed that trauma to the skull does not just damage the brain, it also creates a significant whiplash injury to the neck and the base of the skull.
Within these areas lies the brainstem, an area of the brain that controls our balance and coordination, and supplies nerves to the muscles that control the eyes, ears, face, and portions of our autonomic nervous system (ANS). Injury to the cervical and skull base changes the relationship between the brainstem, base of the skull, and cervical canal, causing increased pressure on the nerve control that I have described above. This leads to many of the symptoms of post-concussion syndrome. Fortunately, our regenerative medicine injections (stem cells and platelet rich plasma) into these damaged areas can normalize the relationship between the skull base and cervical canal, and relieve excessive pressure on the nerve. Once this happens, symptoms of post-concussion syndrome resolve.
Connected To Neck Injury
This connection between neck injury and post-concussion syndrome has been confirmed in a number of new research studies.
In the June 2017 edition of the medical journal Musculoskeletal science & practice, doctors suggest:
“Concussion is typically defined as a mild brain injury, and yet the brain is unlikely to be the only source of persistent post-concussion symptoms. Concurrent injury to the cervical spine in particular is acknowledged as a potential source of common persistent symptoms such as headache, dizziness, and neck pain. . . (These} The clinical characteristics described give preliminary support to the idea that the cervical spine may contribute to persistent post-concussion symptoms, and highlight the value of physiotherapy assessment and treatment of the cervical spine following a concussive injury.”3
Prolotherapy and PRP Injections
The above confirms my own research into how the body fights pain, naturally. This is when I discovered prolotherapy, a holistic procedure that involves a series of injections into damaged ligaments, tendons, and joints that produces a healing response within the damaged tissue, ultimately leading to repair of the damage. The mechanism for this non-surgical repair is mediated through immune system modulators which cause the concentration of cells known as macrophages and monocytes along with chemicals known as chemokines, to remove microscopic debris and fix damaged tissues.
Agents used for Prolotherapy restoration include lidocaine, dextrose, phenol, glycerin, and more recently growth factors derived from the patient’s own body known as platelet rich plasma (PRP). The exact mixture or substance used in prolotherapy is not nearly as important as the precise diagnosis and treatment into the area of damage that is causing the symptoms of post-concussion syndrome.
I began to treat administer injections into the base of my skull and localized areas of my neck and head. While performing this procedure on myself was somewhat risky, it was my last and only hope. Simply put, suffering in chronic pain for a decade needed to end. Fortunately, within a few treatments, my pain was drastically reduced and eventually disappeared.
Since my initial use of prolotherapy, many patients suffering from post-concussion syndrome entered my office – like me, with nowhere to turn. These patients ranged from professional athletes, to recreational athletes to people who sustained head injuries due to trauma, but our symptoms and examination results were all markedly similar. We all suffered soft-tissue damage in areas that connect the head and the neck, and repair of these areas by regenerative medical techniques like Prolotherapy was curative.
It Takes Skill To Treat Damage From A Concussion
Prolotherapy and PRP injections are certainly the silver lining around a dark cloud, but must be used with caution. Having performed well over 45,000 procedures in my career, I know it takes an extreme amount of skill and dexterity to treat damage from concussion. However, successful treatment leads to regaining the patient’s life, allowing them to function again without pain, headache, blurred vision, and all of the other lingering symptoms of concussion.
While there has never been a controlled clinical trial on Prolotherapy for treatment of post-concussion syndrome, the results speak for themselves.
1. Treleaven, Julia. “Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain.” Journal of Orthopaedic & Sports Physical Therapy 0 (2017): 1-25.
2. American Academy of Pediatrics. “Complete rest until symptom-free after concussion may not be best for recovery: New study found that youth who exercised within seven days of head injury had nearly half the rate of persistent post-concussive symptoms a month later.” Pediatric Academic Societies 2016 Meeting
3. Kennedy, Ewan, et al. “Clinical characteristics and outcomes of treatment of the cervical spine in patients with persistent post-concussion symptoms: a retrospective analysis.” Musculoskeletal science and practice 29 (2017): 91-98.