A concussion is a mild traumatic brain injury (mTBI) resulting from a forceful blow or jolt to the head or body that causes the brain to move rapidly inside the skull. This sudden movement temporarily disrupts normal brain function, leading to a wide range of physical, cognitive, and emotional symptoms. Because concussions are common injuries with complex recovery paths, the public often seeks assessment and management from accessible providers, including chiropractors. This article clarifies the specific role a chiropractor plays in identifying and managing this injury, emphasizing the distinction between clinical assessment and formal medical diagnosis.
The Authority to Diagnose
Chiropractors are primary contact practitioners, meaning they can be the first healthcare provider a patient sees following an injury. Their training includes extensive education in neurological and musculoskeletal assessment. Concussion diagnosis relies on a clinical evaluation, a thorough physical examination, and the exclusion of other serious injuries, as no single diagnostic test is the gold standard. Many chiropractors have the clinical training and competence to assess and manage a concussion.
The ability for a chiropractor to issue a formal, medical diagnosis for documentation purposes, such as insurance claims, varies significantly depending on state or provincial licensing laws. Some jurisdictions grant chiropractors the authority to diagnose, while others restrict their role to forming a clinical impression of symptoms consistent with a traumatic brain injury. This distinction is important because the formal diagnosis often rests with medical doctors or other authorized providers who may be needed for advanced imaging or medication management. Regardless of whether they provide a formal diagnosis or a clinical impression, their immediate responsibility is to triage the patient, rule out serious conditions, and determine if an immediate medical referral is necessary.
Functional Assessments Performed by Chiropractors
When evaluating a patient with a suspected concussion, chiropractors utilize specific tools focusing heavily on the neuromusculoskeletal system to identify functional deficits and symptoms. These assessments help the chiropractor understand the extent of the injury and guide the subsequent treatment plan.
Balance and Postural Stability
The Balance Error Scoring System (BESS) is a common assessment used to objectively measure postural stability by having the patient stand in various stances for a set period.
Ocular and Vestibular Screening
Chiropractors frequently screen for ocular and vestibular dysfunction, which are closely linked to concussion symptoms like dizziness and balance issues. The Vestibular/Ocular Motor Screening (VOMS) tool assesses eye movements and vestibular function, checking for symptoms like headache or nausea during specific eye-tracking tasks.
Cervical Spine Assessment
A detailed assessment of the cervical spine is standard because whiplash injuries often occur alongside concussions. Neck issues can mimic concussion symptoms such as headaches and dizziness, so this assessment helps differentiate symptom origins for targeted management.
Chiropractic Management of Post-Concussion Symptoms
After the acute injury phase has passed and severe issues are ruled out, chiropractic care focuses on the rehabilitation and management of persistent post-concussion symptoms.
Cervicogenic Symptoms
Care addresses cervicogenic symptoms, which are headaches and neck pain originating from the cervical spine due to soft tissue or joint injury. Gentle spinal manipulation, particularly in the upper cervical region (C1 and C2 vertebrae), and soft tissue therapies are used to restore proper alignment and reduce muscle tension.
Vestibular and Balance Rehabilitation
Chiropractors incorporate vestibular and balance rehabilitation exercises for patients experiencing dizziness, vertigo, and instability. These exercises are designed to retrain the brain and body to process sensory information effectively, improving spatial awareness and stability.
Graded Exertion Protocol
Management includes guidance on a graded exertion protocol. This monitored, step-by-step approach ensures a safe return to physical activity and sport without exacerbating symptoms.
Recognizing Red Flags and When to Seek Emergency Care
A primary responsibility of any healthcare provider assessing a head injury is to screen for “red flag” symptoms that indicate a potentially life-threatening intracranial complication. These signs suggest severe brain bleeding, swelling, or a skull fracture, requiring immediate emergency medical intervention and advanced imaging. A chiropractor will immediately refer a patient to an emergency department if they observe any of these emergent symptoms.
The most concerning red flags that signal a significant neurological compromise and require immediate emergency services include:
- A worsening or severe headache that does not improve.
- Repeated episodes of vomiting.
- Loss of consciousness lasting more than a minute.
- Seizures or convulsions.
- Slurred speech.
- Sudden numbness or weakness in the arms or legs, or any focal neurological deficit.
- Severe confusion, agitation, or an inability to wake up or stay alert.