Concussion Treatment in Kansas City
What is a Concussion?
A concussion is a mild form of traumatic brain injury (TBI) that occurs when a blow or jolt to the head causes the brain to move rapidly within the skull, leading to temporary disruption in brain function. This sudden movement can cause brain cells to stretch or become damaged, triggering a range of physical, cognitive, and emotional symptoms. While concussions are generally considered mild, they should be taken seriously, as the effects can be long-lasting and require proper management.
Common Causes of Concussion:
A concussion is caused by a forceful impact or motion that results in the brain moving within the skull, disrupting normal brain function. While direct blows to the head are the most common cause, concussions can also occur without a direct impact. For instance, in cases of whiplash, where the head and neck experience rapid acceleration and deceleration—such as in car accidents or certain sports injuries—the brain can shift inside the skull even though the head is not directly struck. This sudden movement can lead to diffuse axonal injury, where nerve fibers are sheared or stretched, causing a temporary disruption in brain function. Concussions can also be caused by rapid acceleration or deceleration in situations like falls or high-impact collisions, or even from blast waves in military or industrial environments, which create pressure changes that force the brain to move within the skull. Additionally, sports-related injuries and blunt force trauma from accidents or altercations can also lead to concussions if the force is strong enough to cause the brain to move.
Whiplash and Concussion
When the body is subjected to a sudden, forceful movement, as in a rear-end car collision, the head and neck experience a violent forward-and-backward motion. This motion causes the brain to lag slightly behind the movement of the skull, resulting in internal stretching, twisting, or compression of brain tissue. This can lead to cellular damage and disruption of brain function, typical of a concussion.
Diffuse Axonal Shearing Injury
In cases of whiplash-induced concussion, diffuse axonal injury (DAI) is a key factor. DAI refers to the widespread shearing or tearing of axons—the long, thin nerve fibers that connect different regions of the brain. During sudden movements, axons are stretched and can become damaged, leading to cellular injury and impaired communication between brain areas. DAI is especially problematic because it is difficult to detect on standard imaging scans but can cause significant cognitive, physical, and emotional symptoms.
How DAI and Whiplash Lead to Concussion Symptoms
The shearing of axons disrupts the normal signaling pathways in the brain, leading to a range of symptoms associated with concussion. DAI affects multiple areas of the brain, so symptoms can vary widely, including:
- Cognitive impairments, such as difficulty concentrating, memory issues, and slowed thinking.
- Physical symptoms like dizziness, headaches, nausea, and visual disturbances.
- Emotional changes, including irritability, mood swings, and increased anxiety.
Because of DAI and the forces involved in whiplash, individuals may experience concussion symptoms even without a direct blow to the head. Recognizing these mechanisms is essential, especially since whiplash-related concussions may be overlooked if there was no direct head impact. Comprehensive evaluation and treatment can help address these complex injuries and aid in symptom management.
The symptoms of a concussion can vary widely depending on which part of the brain is affected. Since the brain is divided into regions that control different functions, the location of the injury determines the signs and symptoms experienced by the individual. Here are some examples:
Frontal Lobe (Cognitive Functions):
- Symptoms may include difficulty with concentration, memory problems, confusion, and issues with decision-making, planning, and problem-solving.
Temporal Lobe (Auditory and Memory):
- Injury to the temporal lobe can result in memory problems, difficulty with language and speech, confusion, or auditory disturbances (e.g., ringing in the ears).
Parietal Lobe (Sensory Processing):
- Symptoms may include problems with spatial awareness, coordination, and difficulty recognizing objects or sensations, such as feeling numbness or tingling.
Occipital Lobe (Vision):
- Injury to the occipital lobe can lead to visual disturbances, such as blurred vision, double vision, or difficulty focusing. Sensitivity to light may also occur.
Cerebellum (Balance and Coordination):
- Damage to the cerebellum can result in dizziness, difficulty with balance, lack of coordination, and problems with fine motor skills.
Brainstem (Basic Life Functions):
- The brainstem controls vital functions like breathing and heart rate. Damage here may lead to severe symptoms like loss of consciousness, difficulty with swallowing, and problems with autonomic regulation (e.g., heart rate, blood pressure).
Immediate Symptoms
- Memory loss related to the traumatic event
- Temporary loss of consciousness
- Disorientation or confusion
- A dazed or stunned appearance
- Slow or delayed response to questions
- Visual disturbances (e.g., “seeing stars”)
- Dizziness
- Fatigue or excessive tiredness
- Feeling of pressure in the head
- Mental fogginess or difficulty thinking clearly
- Headache
- Loss of balance or coordination
- Nausea
- Ongoing neck pain
- Ringing in the ears (tinnitus)
- Slurred speech
- Eye strain or discomfort
- Vomiting
Delayed Symptoms
- Anxiety or feeling anxious without clear cause
- Blurred vision or difficulty focusing
- Motion sickness or nausea when moving, especially in vehicles
- Altered taste or smell, or a complete loss of either
- Depression or feelings of sadness and hopelessness
- Trouble concentrating or staying focused on tasks
- Difficulty locating things, misplacing objects
- Challenges with reading or understanding written text
- Easily distracted by external stimuli
- Feeling overwhelmed by simple tasks or responsibilities
- Getting disoriented or lost in familiar places
- Irritability or becoming easily upset
- Low energy or lack of motivation to engage in activities
- Irregular heartbeat or palpitations occurring occasionally
- Sensitivity to light or noise, causing discomfort or distress
- Short-term memory difficulties, struggling to remember recent events
- Sleep disturbances, including trouble falling or staying asleep
- Slow response time, whether in thinking, decision-making, speaking, or acting
- Fatigue without a clear cause, feeling tired even after rest
- Mood swings or noticeable changes in personality and behavior
Is There a Difference Between a Concussion and a Traumatic Brain Injury?
Post-concussion syndrome (PCS), also known as persistent post-concussion symptoms (PPCS), refers to a set of symptoms that continue to affect individuals well beyond the typical recovery period after a concussion, usually emerging between 22 to 45 days following the injury. While most individuals experience improvement within the first few weeks, PPCS involves prolonged symptoms such as headaches, dizziness, cognitive difficulties, and emotional changes that persist or worsen over time. The development of PCS is thought to result from disruptions in brain function caused by the injury, which can lead to ongoing changes in how the brain processes information, regulates mood, and controls physical functions. The exact reasons why some people develop PCS while others recover more quickly are not fully understood, but factors like the severity of the concussion, previous brain injuries, and individual health conditions may contribute. Early recognition and management are crucial for effectively addressing these persistent symptoms.
Our goal is to find out the CAUSE of our patient’s Post Concussion Syndrome.
5 Main Causes of Post-Concussion Syndrome
1. Autonomic Nervous System Dysregulation
2. Neuro-Inflammation & Hormonal Dysregulation
3. Visual and/or Vestibular Dysfunction
4. Cervical Spine Dysfunction
5. Psychological Factors
1. Autonomic Nervous System Dysregulation
Autonomic dysregulation is a potential underlying cause of persistent post-concussion symptoms (PPCS), where the brain’s control over the autonomic nervous system (ANS) is disrupted following a concussion. The ANS is responsible for regulating essential, involuntary functions like heart rate, blood pressure, digestion, and temperature control. When this system is disrupted by a head injury, it can lead to a range of persistent symptoms that characterize PCS, such as dizziness, fatigue, and sensitivity to light and sound.
In cases of autonomic dysregulation, the brain’s ability to balance its “fight-or-flight” and “rest-and-digest” responses becomes impaired. This can result in abnormal heart rate variability, difficulties with blood pressure regulation, and other symptoms that create ongoing physical and cognitive challenges. Because the autonomic system plays a central role in maintaining overall physiological stability, disruptions in this system can cause the brain and body to remain in a heightened state of stress, which exacerbates the physical and emotional symptoms associated with PCS. Addressing autonomic dysregulation through specialized therapies, like biofeedback and cardiovascular exercises, may offer relief and support recovery for those experiencing prolonged post-concussion symptoms.
SYMPTOMS OF AUTONOMIC DYSREGULATION:
- Dizziness or lightheadedness, especially when standing up (orthostatic intolerance)
- Heart rate irregularities (e.g., racing or slow heart rate)
- Blood pressure fluctuations, including sudden drops or spikes
- Fatigue that doesn’t improve with rest
- Temperature sensitivity or intolerance to heat and cold
- Sweating abnormalities, such as excessive sweating or lack of sweating
- Gastrointestinal issues, including nausea, bloating, or constipation
- Exercise intolerance, feeling exhausted after physical activity
- Blurred vision or visual disturbances
- Brain fog or difficulty concentrating
- Increased anxiety or feelings of panic
- Sensitivity to light and noise
2. Neuro-Inflammation & Hormone Dysregulation
Neuroinflammation
After a concussion, the brain may initiate an inflammatory response to heal damaged tissue. However, in some individuals, this neuroinflammation becomes chronic, leading to prolonged immune cell activity and release of inflammatory chemicals. Persistent inflammation can impair communication between brain cells, affecting areas that control memory, mood, balance, and sensory processing, resulting in symptoms like cognitive fog, emotional instability, dizziness, and fatigue.
Hormone Imbalance
The pituitary gland and hypothalamus, essential parts of the brain’s endocrine system, are particularly vulnerable to trauma. These structures regulate hormone production, so when they are disrupted by a concussion, it can lead to hormone imbalances involving cortisol, thyroid hormones, growth hormone, and sex hormones (like testosterone and estrogen). These imbalances can lead to symptoms of fatigue, mood swings, sleep disturbances, cognitive impairment, and weight changes. For example, a deficiency in cortisol may reduce the body’s ability to handle stress, while low thyroid hormone levels can slow cognitive processing and reduce energy.
Gut-Brain Axis and Gut Dysbiosis
The gut-brain axis is a communication network between the gut and the brain, mediated by neural, hormonal, and immune pathways. After a concussion, disruptions in this axis may lead to gut dysbiosis—an imbalance of the gut microbiome, where beneficial bacteria decrease and harmful bacteria proliferate. This dysbiosis can increase intestinal permeability (commonly known as “leaky gut”), allowing toxins to enter the bloodstream and triggering systemic inflammation that can worsen neuroinflammation. Since the gut produces a large proportion of neurotransmitters like serotonin, gut dysbiosis can also contribute to mood changes, anxiety, and depression, which are common in PPCS.
Combined Effects
These three factors—neuroinflammation, hormone imbalances, and gut dysbiosis—are closely connected and can create a self-perpetuating cycle that complicates recovery from a concussion. For instance, neuroinflammation can worsen gut dysbiosis, while gut dysbiosis can amplify inflammation in the brain. Similarly, hormonal imbalances can disrupt the gut microbiome, further affecting mood and energy levels. Addressing PCS requires a comprehensive approach that not only targets brain and hormone health but also considers gut health and the role of the gut-brain axis in recovery.
3. Visual and/or Vestibular Dysfunction
The visual, vestibular, and proprioceptive systems all play essential roles in maintaining balance, spatial orientation, and movement control. After a concussion, disruptions in any of these systems can lead to post-concussion symptoms (PCS), as each system works interdependently to provide a clear sense of where the body is in space. When one or more of these systems are compromised, it can lead to ongoing issues with balance, coordination, and cognitive processing.
Visual System Disruptions
The brain relies heavily on visual input for balance and spatial awareness. After a concussion, individuals may experience visual disturbances such as blurred or double vision, light sensitivity, and difficulties with eye-tracking or focus. These symptoms can result from damage to areas of the brain responsible for visual processing, affecting balance and coordination. Struggles with visual processing can lead to headaches, fatigue, and cognitive overload, contributing to the “brain fog” commonly reported in PCS.
Vestibular System Disruptions
The vestibular system, located in the inner ear, provides critical information about head position and movement, which is essential for balance and orientation. Concussions can disrupt the brain’s ability to interpret vestibular information, leading to dizziness, vertigo, unsteadiness, and nausea. These symptoms can make it difficult to maintain balance and can worsen in environments with a lot of visual motion or changes in elevation. Individuals with vestibular dysfunction may also feel disoriented, especially when moving or in visually stimulating environments, which can compound other symptoms of PCS.
Proprioception and Balance Issues
Proprioception is the body’s sense of its own position and movement in space, relying on signals from muscles, tendons, and joints. After a concussion, the brain’s ability to integrate proprioceptive feedback with visual and vestibular information can be impaired, leading to balance and coordination difficulties. This disruption in proprioception may cause individuals to feel clumsy or unsteady, struggle with tasks requiring fine motor control, and experience an increased risk of falling. Balance issues often become more pronounced in low-light or uneven environments, where visual cues are limited.
4. Cervical Spine Dysfunction
Cervical spine dysfunction is a significant contributor to post-concussion symptoms (PCS), as it often directly overlaps with symptoms associated with concussions. In fact, many concussions occur in tandem with whiplash injuries—sudden acceleration-deceleration forces on the neck during impacts, such as those in car accidents. This close connection between concussion and cervical spine injuries can complicate recovery, as issues in the cervical spine can mimic or exacerbate PCS symptoms.
How Cervical Spine Dysfunction Contributes to PPCS
When the cervical spine is injured, it affects the muscles, joints, and nerves in the neck, leading to a variety of symptoms that often overlap with those of a concussion. Damage or strain in the neck can disrupt blood flow, neural pathways, and muscle coordination in the region, which can lead to:
Headaches – Tension in the neck muscles and irritation of cervical nerves can contribute to persistent headaches, particularly at the base of the skull, known as cervicogenic headaches. These headaches are common in both PCS and cervical spine injuries.
Dizziness and Balance Issues – The cervical spine plays a key role in proprioception, which informs the brain about head and neck positioning in space. When this system is disrupted, individuals can experience dizziness, balance problems, and a sense of spatial disorientation, common symptoms of PCS.
Visual Disturbances – Misalignment or muscle tension in the cervical spine can impact ocular reflexes, contributing to blurred vision, difficulty focusing, and eye strain. These visual disturbances overlap with typical post-concussion visual symptoms and may increase with head movement or changes in posture.
Neck Pain and Stiffness – While neck pain is not exclusive to concussions, it is frequently associated with whiplash injuries and can become a chronic symptom after a concussion. Neck pain can also contribute to a feeling of general discomfort, stiffness, and difficulty with daily activities.
Cognitive Fog and Fatigue – Persistent neck pain and tension can increase fatigue and reduce cognitive clarity due to the body’s ongoing efforts to manage and compensate for discomfort. Chronic pain can also impact sleep quality, further contributing to cognitive fog and the sense of being “out of it” that many individuals with PCS experience.
5. Psychological Factors
Psychological factors play a critical role in the persistence of post-concussion symptoms and can greatly influence recovery after a concussion. Following a brain injury, psychological issues such as anxiety, depression, and stress are common, and their presence can lead to prolonged or intensified physical symptoms. This overlap often creates a cycle where physical and psychological symptoms reinforce each other, making recovery more complex.
How Psychological Factors Contribute to PCS
Anxiety and Hypervigilance – After a concussion, many people become highly aware of their symptoms, monitoring their bodies closely and feeling anxious about any discomfort or change. This heightened attention, or hypervigilance, can amplify symptoms like headaches, dizziness, or fatigue. When individuals feel that their symptoms are unpredictable or may worsen at any moment, anxiety levels can increase, further heightening the body’s stress response and making it more difficult to feel “normal.”
Depression and Fatigue – Concussions often limit activity levels, leading to isolation, loss of productivity, and changes in daily routines. These lifestyle shifts, combined with a sense of unpredictability, can increase the risk of depression. Depression may also lead to fatigue, low motivation, and cognitive sluggishness, which are frequently reported in PCS and can compound physical symptoms like “brain fog” or low energy.
Stress and the Body’s Physical Response – The body’s stress response is a natural reaction to both physical and emotional trauma. After a concussion, stress hormones like cortisol can remain elevated, putting the body in a constant state of alertness. This state can make physical symptoms such as headaches, muscle tension, and sleep disturbances worse. Chronic stress also impacts the immune and autonomic nervous systems, potentially leading to prolonged inflammation and delayed recovery.
Sleep Disturbances – Difficulty sleeping is both a symptom of concussion and a common result of stress, anxiety, or depression. Poor sleep quality can exacerbate cognitive symptoms like difficulty concentrating, memory issues, and irritability, all of which are central to PCS. The frustration of not sleeping well can, in turn, worsen emotional symptoms, creating a cycle of sleep disruption and symptom persistence.
Fear of Re-injury and Avoidance Behaviors – Many individuals with PPCS fear activities that could lead to further injury or worsen symptoms. This can lead to avoidance behaviors, where they limit physical, social, or work-related activities. While some caution is beneficial, long-term avoidance can lead to deconditioning, social isolation, and a sense of helplessness, all of which can perpetuate symptoms and hinder the recovery process.
