Concussion Management – Looking Beyond The Brain
- Oct 21, 2024
- 5 min read
Dr. Michelle Speranza is a NUCCA Upper Cervical Chiropractor, owner of Core Balance Centre, and co-founder of re-HUB Health Collective. She holds a Diplomate in Chiropractic Craniocervical Junction Procedures (DCCJP) and is passionate about serving and educating people on the impact head and neck injuries have on brain health and wellness.
Brain health is a hot topic right now, and when it comes to the world of concussions, this takes center stage. Your brain orchestrates every process in your body and when injured, can result in widespread stress and dysfunction. Reducing neurological stress is at the centre of concussion management and while most people will jump to rest and avoidance of screens, there can be other factors underlying a concussion which can also impact brain function, prolong recovery, and lead to long-term symptoms if not sufficiently addressed.
What is a concussion?
A concussion is classified as a mild traumatic brain injury sustained when the brain experiences a jarring force. This can occur from a direct blow to the head or a force applied to the body that causes the brain to undergo rapid acceleration-deceleration within the skull resulting in altered neurological function. While many concussion injuries will recover within 7-10 days, approximately 10-15% of people will go on to experience prolonged concussion symptoms beyond 30 days. This is now termed post-concussion syndrome (PCS).
Oftentimes, in cases of PCS, the injury is more complex and has resulted in an imbalance in other systems that may be impeding full neurological recovery. These systems include your neck (cervicogenic system), your balance system (eyes, ears, and proprioceptive systems), and your energy system (breathing system).
Concussion and upper neck injuries go hand-in-hand
Studies on the amount of force required to stimulate a concussion injury have found that forces ranging from 60g-120g can cause a mild traumatic brain injury, with the average force coming in around 96g. This is well beyond the amount of force required to sustain a neck injury, which averages around 4.5g of force. The upper neck is particularly susceptible to injury following a concussion due to its unique design.
The average adult head weighs around 10-14lbs. This is balanced on the first cervical vertebrae, called the atlas, and forms what is called the craniocervical junction (CCJ). This is the most mobile region of the spine and is supported solely by a robust suspension system of muscles and ligaments (no disc supports the upper neck). Whenever the head and body sustain a blow, the CCJ is vulnerable to injury. In fact, many symptoms of a concussion overlap with symptoms of an upper neck injury:
Common symptoms of a concussion
Headaches
Head and ear pressure
Dizziness
Visual disturbances
Nausea
Brain Fog
Fatigue and sleep disturbance
Neck Pain
Common symptoms of an upper neck injury
Headaches
Head and ear pressure
Dizziness
Neck and jaw pain
Nausea
Fatigue and sleep disturbance
In addition, the upper neck plays a critical role in maintaining upright posture and body spatial awareness. When underlying upper neck injuries are not adequately addressed this can result in delayed concussion recovery and a greater risk of further injury down the road.
Regaining balance after a concussion
One of the major functions of your brain is to keep you upright and maintain your eyes and ears on level. To do this, you have evolved to have a multi-faceted balance system that combines information from your eyes, ears, and sensors in your muscles and ligaments (called proprioceptors).
Your eyes provide visual information to orient you with the horizon and determine which way is up versus down. This allows you to smoothly navigate through your environment without bumping into objects.
Your ears contain little gravity-sensitive organs that work to orient you with gravity. These sensors tell your brain if your head is upright, tilted, or moving (such as nodding or shaking) due to changes in how gravity is acting on these organs.
Your proprioceptive system orients your brain to where your body is in space. This system consists of little sensors (proprioceptors) that detect changing levels of tension in your muscles and ligaments. Information from these proprioceptors allows you to maintain your posture and understand how your body is moving as you go about your daily activities. The largest concentration of proprioceptors is found in eight small muscles located at the base of your head and upper neck and play an important role in maintaining your head and neck posture.
All too often, following a concussion, these systems can be disrupted. When there is incongruent information coming from these three systems, a conflict or sensory mismatch is created in the brain. This creates more stress and exacerbates concussion symptoms, such as dizziness, nausea, and fatigue. These symptoms may not be present at the time of injury, but may slowly develop over time. As such, following a head injury, it is important to make sure your eyes, ears, and neck are assessed for any compounding injury that may delay your concussion recovery. Working with specialists who can address each system can help detect and reduce dysfunction in these areas quickly before further neurological stress is created. Some of these specialists may include vision therapists, vestibular therapists, and upper cervical chiropractors.
Breathing to improve brain function
Your brain is one of the most metabolically active organs in your body. It makes up just 2% of your body weight but uses approximately 20% of your metabolic output. This means it needs to have a good supply of blood flow to meet its energy needs.
Following a concussion, the brain undergoes an inflammatory process and requires a lot of energy to repair and heal itself. However, while there is an increased demand for energy, studies have demonstrated that there is a reduction in cerebral blood flow that occurs following a head injury. This results in a metabolic crisis: an increased demand for energy but less supply of it. This perpetuates concussion symptoms, such as cognitive effects (brain fog, fatigue, memory challenges), physical effects (headaches, dizziness, sleep challenges), and emotional effects (anxiety, depression, irritability), and can contribute to the recovery roller coaster experienced by so many.
To optimize concussion recovery, you need to make sure your brain is getting an adequate supply of energy. One of the quickest ways you can change your internal chemistry is through breathing. How you breathe can directly impact the function of your nervous system, either putting you in a stressed or recovery state.
Short, shallow breathing triggers a part of your nervous system called the sympathetic nervous system. This is responsible for your fight-or-flight response. Slow, deep breaths, with a long exhale, help to stimulate your vagus nerve, one of the largest nerves in your body and a key component of your parasympathetic nervous system. The parasympathetic nervous system is responsible for your rest, recovery, and repair response.
Following a concussion, the sympathetic nervous system tends to go into overdrive. By focusing on breathing exercises that involve breath holding and long exhales, you can turn on your parasympathetic nervous system and calm down your internal stress response. As an added benefit, these types of exercises help to optimize oxygen delivery to your tissues, enhancing energy production. Breathwork exercises should be introduced at the discretion of a healthcare practitioner or breathwork coach.
In summary, concussions are complex injuries, often requiring a multifaceted approach to recovery. Working with a team of practitioners to address concurrent injuries in your neck, or dysfunction in your visual, vestibular, proprioceptive, and breathing systems can help optimize your brain function and expedite concussion recovery.
Read more from Dr. Michelle Speranza
Dr. Michelle Speranza DC, DCCJP, BSc, NUCCA Upper Cervical Chiropractor
Dr. Michelle Speranza is an upper cervical Chiropractor in Airdrie, Alberta, Canada. She is a member of the National Upper Cervical Chiropractic Association (NUCCA) and has advanced training in craniocervical junction procedures. Working with people suffering from headaches, neck pain, hypermobility, and dizziness, her passion is helping people restore balance in their body, return to doing the activities that they love, and ultimately take back control of their health.
