Playing a lot of contact sports in my youth (Hockey, Rugby, Football and Lacrosse) hearing the phrase “I got my bell rung” was certainly not uncommon. I was one of the lucky ones I suppose. I don’t recall any serious head injuries (though I suppose one might say that perhaps I just don’t remember them) in all my years of playing.
Today, it seems; whether by better awareness or by a more physical game with bigger players, we see far more concussions. For example, in the last week I have had two patients come in complaining of concussion symptoms. The onsets were different; but similar enough. Without going into too much detail as to the onset (for confidentiality purposes), both occurred on the ice. in each case the contact with the ice was thought to be the major causative factor. Here is the thing… that may not be the case for the majority of concussions. Let’s look at the theory that many understand in regards to concussion; it’s known by the moniker “frog in a jar”.
It refers to the brain-skull relationship; with the frog representing the brain and the glass jar being the skull. The theory of the frog in the jar suggested that the brain impacting the skull caused the injuries. This was the accepted theory for as long as I can remember to be honest. Nowadays, however, there is more believed to be involved in the process. It is now believed to have a far more involvement than a ‘brain bruise’. Studies as well as clinical evidence are supporting more involvement of the neck, spinal cord and brain stem. There are components of whiplash involving the structures of the neck that play into the overall appearance of a concussion.
When we look at the structures of the head and neck we can clearly see how a blow to the region can easily cause a shift of the neck structures. These spinal shifts can then impact how we sense not only discomfort or headaches, but also vision and balance. How? Well, depending on the literature that you read, in a standing position the brain stem sits at approximately C2. What this means is that a impact to the head-neck region can directly impact the brain stem via these spinal shifts. This is the “new” theory on concussions. Some researchers have stated that they also feel micro tears in the brain stem-spinal cord connection may play into a lot of the symptoms seen by many. The brain stem has many basic functions, including regulation of heart rate, breathing, sleeping, and eating. Which, when you look at it, appears to explain a lot of the associated symptoms of a concussion. So whether there is a spinal shift causing some cord pressure (usually in the upper neck) could very well determine how quickly one resumes their daily activities.
So what do you do? That can be the big question mark for many. I wish it was a simple answer, unfortunately each case seems to react specific to the individual. Often a multifaceted approach is most effective. The research shows certain methods to be helpful though:
- Spinal adjustments
- Stability training
- Visual training
- Daily behaviour adaptations (computer use, ergonomics, sensory input etc)
- …and more
With my patients they all respond a little different, and require different intervention. the good news is that we already have a ‘baseline’ for their normal when they are existing patients. Once they had the injury they came to see me quickly and we could see their deviation from “normal” for them. This is why I often recommend assessing people who are 100% asymptomatic so that we have a baseline to judge them by in the future. With a known starting point we can see where they have deviated in the instance of a sports injury, car accident, slip or fall, etc.
In the end, we are adding to our knowledge base in the area all the time; so things may change once again!
Hope you enjoyed the read. Comment or ask questions!
Dr. Matt Lindsay, DC