Post-Concussion Syndrome and the Upper Cervical Spine
Concussions are a “Mild Traumatic Brain Injury” or mTBI for short. But the truth is, a concussion is a multifaceted injury. A concussion involves cognitive, vestibular, cervical, physical, and psychological dysfunctions. The reason for the complexity is that a concussion shares more in common with a whiplash than with a blunt force head trauma.
In 2010, over 200,000 emergency visits that year for children aged 8 to 13 were for concussions. Football and hockey were at the top of the list for sports-related causes. Bicycling and playground accidents were the main reason for non-sport activities. The population most often seen in the emergency room for concussion is children.
Signs and symptoms of a concussion include a loss of consciousness, confusion or amnesia, nausea and/or vomiting, ringing in the ears, slurred speech and unusual fatigue. But looking at symptoms alone doesn’t always provide a complete picture of what is going on. Quoting Dr. John Leddy, the Clinical Director of Orthopaedics at the University of Buffalo:
“I think a lot of practitioners listen to the symptoms and just chalk it up to a concussion, but if they also examined the neck in these people, they might discover that a neck injury is involved...”
Dr. John Leddy exposes a stumbling block within medicine that is slowly getting addressed. Medical doctors recognize symptoms and treat them accordingly. But symptoms are an effect of a cause. A cause can be remote from its effects.
A notable but tragic analogy of this concept is the 2011 Japan earthquake and tsunami aftermath. An underwater earthquake 43 miles off the coast of Japan created large shockwaves that traveled 6 miles into the island nation wreaking havoc along its path. A concussion and its aftermath are like this event. An “earthquake of the body” can create “shockwaves to the brain.” In a lot of concussion situations, the epicenter of the cause is not in the head, but lower down in the body.
To help ignite new research on concussions, an International Consensus on Concussion in Sport Symposium was held in Zurich, Germany in 2012. Here they defined a concussion as:
“a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs may be utilized in defining the nature of a concussive head injury. This is caused by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head.”
When considering a concussion, you must also recognize inertia. Inertia is the tendency of an object at rest to remain at rest. Inertia is also the tendency of an object in motion to remain in motion. Whether in motion or at rest, different parts of the body have different inertias.
The inertia of the head is different than the inertia of the trunk. The difference in inertia is due to the differences in mass. The trunk makes up around 50% of our body mass while the head makes up around 7%. What attaches these two separate masses is the neck, with the focus on the upper cervical spine.
The muscles and ligaments of the upper cervical spine are “bridge-like” in design. The upper cervical spine spans the divide between the head and trunk and helps balance out the differences in inertia. And like a bridge, it has its limits. The clashing of different inertial properties creates stress. For example, if just the torso is suddenly moved, the head will stay at rest because it has different inertia.
Within the head itself, there are different inertias as well. Of that 7% head mass, only 2% is brain tissue. The brain is suspended inside the skull by cerebrospinal fluid and connective tissue. This provides a cushion and space between the hard bony skull and the soft squishy brain. But this cushion has limits.
A sudden change in motion of the head puts stress on the connective tissue and CSF to suspend and protect the brain. If the change in motion is too great for the neck to absorb the shockwave, the brain can “smack” against the skull causing trauma and injury to the brain.
The majority of the inertial stress is put on the upper cervical spine to absorb the change in motion. The upper cervical spine has limits in its ability to absorb the change in inertia. If the trunk moves too quickly for the spine to absorb the change, trauma can happen.
This trauma can result in a vertebral subluxation. A vertebral subluxation creates a weakness in the bridge of the upper cervical spine. An uncorrected subluxation will only lead to a higher chance of injury in the future, both to the spine and to the head.
Speed alone does not cause a concussion. For example, in a 24 hour period, the earth spins on its axis at roughly 1,000 mph. This means that all of us on planet Earth are also traveling at 1,000 mph. How are we not aware of this cosmic speed? Because we are relative to it. Similar to how we can be on an airplane at 500 mph and feel free to roam about the cabin with no problem.
Speed alone doesn’t cause a concussion, but how sudden the change in speed occurs. If you have ever been on an airplane, you have probably felt your stomach jump up into your chest during turbulence and when taking off or landing. The quick change in speed is called acceleration-deceleration.
This is how and why a concussion can occur at even 3 mph. If there is a gradual increase in speed from 0 to 3 mph, the body has the ability to adapt to the change in speed. But if the change from 0 to 3 mph happens very quickly, the chance of sustaining injury increases.
Contact sports and activities have a high incidence of concussions because they involve acceleration-deceleration mechanics. For example, football is a sport of opposing physics. The team that is on the offensive wants to accelerate in a certain direction. The team that is on the defensive wants to decelerate the offense in the completely opposite direction. When you add speed and mass to the equation, these clashing forces can set off a chain reaction that can result in a concussion.
The only way to reduce concussions in any contact sport or activity is to ultimately reduce the amount of contact. That realization is easier said than done. What are some things you can do to decrease the chances of a concussion? The most obvious way is to abstain from contact sports or activities. Any contact sport or activity could be boiled down to the acceleration-deceleration formula.
Improving neck strength and impact anticipation are ways to decrease concussion potential. A study demonstrated that greater neck strength and bracing the muscles for impact could reduce the magnitude of stress to the head.
Another study showed that the odds of sustaining higher magnitude head impacts are reduced with better cervical strength and lower angular displacement following impact. The best defense is a good offense. The more a solution is proactive instead of preventative, the better the results.
From a Chiropractic perspective, the goal of Chiropractic is to help improve the relationship between the upper cervical spine and the Nerve System. This is achieved by correcting a vertebral subluxation through an adjustment.
Neck strength has the potential to improve when the bones, muscles and ligaments are in better alignment. Neurological reaction times can also be at their peak when obstructions to nerve impulses are reduced. The absence of a subluxation can help reduce the incidence of concussions by improving biomechanics and the correction of a subluxation can improve healing from post-concussion syndrome.
Jarek Esarco, DC, CACCP is a pediatric, family wellness and upper cervical specific Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). Dr. Jarek has postgraduate certification in Pediatric Chiropractic through the ICPA. Dr. Jarek also has postgraduate certification in the HIO Specific Brain Stem technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.
