A concussion, defined as a mild traumatic brain injury resulting from a blow or jolt to the head or body, can be linked to joint and muscle pain. Many people are surprised when pain appears in areas that were not directly struck. This discomfort is complex, arising not just from immediate physical trauma but also from changes that occur within the nervous system after the injury. Understanding the difference between these two sources is the first step toward effective recovery.
Separating Pain Sources: Impact vs. Brain Injury
The event causing a concussion rarely involves the head alone; the force is often transmitted through the body, causing immediate, localized musculoskeletal damage. The cervical spine, or neck, is frequently injured in the same incident. The rapid acceleration and deceleration of the head, similar to a whiplash event, can strain the muscles, ligaments, and joints of the neck.
This resulting neck injury, known as cervicogenic pain, can cause symptoms that mimic those of a concussion, including headaches, dizziness, and muscle tension in the shoulders. Because the upper cervical joints share neural pathways with the brainstem, irritation in the neck can directly contribute to concussion-like symptoms. Evaluating the neck is a primary step in diagnosis, as treating this localized physical injury can resolve a significant portion of the patient’s discomfort.
Pain that is worsened by specific head or neck movements often points to a musculoskeletal source requiring targeted physical therapy. This type of pain is distinct from the more diffuse, widespread aching that arises from changes in the central nervous system itself. The challenge in diagnosis is that both the local injury and the brain injury can generate overlapping symptoms like headache and lightheadedness.
How Concussions Alter Pain Signaling
When musculoskeletal pain persists long after any local injury should have healed, it often signals changes in the central nervous system. A concussion can lead to central sensitization, where the brain and spinal cord become overly reactive to incoming sensory signals. This process essentially turns up the “volume” on pain, causing a lowered pain threshold throughout the body.
As a result of central sensitization, a gentle touch or slight muscle strain that would normally be ignored can be perceived as significantly painful. The pain may also become less localized, spreading to new areas and causing widespread aching that can resemble conditions like fibromyalgia. This is a physical change in how the nervous system processes information, not simply an imagined sensation.
Another contributing factor is neuroinflammation, which is the inflammatory response within the brain following the traumatic injury. While inflammation is initially part of the healing process, if it becomes chronic, it can alter the function of pain pathways in the brain. The sustained release of pro-inflammatory signaling molecules can keep the nervous system in a heightened state of sensitivity, exacerbating persistent headaches and body aches.
Furthermore, a concussion can disrupt the autonomic nervous system (ANS), which controls involuntary functions like heart rate, blood pressure, and muscle tone. This dysfunction, known as dysautonomia, can lead to persistent muscle tension and blood flow issues that manifest as chronic pain syndromes. The inability of the ANS to regulate the body’s “fight or flight” response can keep muscles unnecessarily tense, contributing to widespread joint and muscle aching.
Managing Persistent Post-Concussion Musculoskeletal Pain
Management for persistent post-concussion pain must target the root cause, whether it is local cervical injury or central nervous system changes. For pain originating from the neck, specialized physical therapy is highly effective, focusing on the deep muscles and joints of the cervical spine. This therapy also includes specific maneuvers to address balance and visual issues, known as cervicovestibular rehabilitation.
A controlled return to physical activity is also a documented treatment approach for helping to reset the nervous system. Light, sub-symptom exercise, often guided by heart rate thresholds measured through tests like the Buffalo Concussion Treadmill Test, can gradually improve exercise tolerance. This controlled exertion helps reduce central sensitization and improves regulation of the autonomic nervous system.
This gradual exercise helps the brain relearn how to manage physical stress without triggering a pain response, slowly bringing the overactive nervous system back toward a normal state. The focus is on consistency and avoiding activities that sharply worsen symptoms, which can reinforce pain pathways. When pain is persistent despite initial efforts, consultation with a specialist, such as a neurologist or a pain management expert, is warranted.
A multi-disciplinary approach often yields the best results, combining the work of a concussion specialist with a physical therapist and sometimes a psychologist to address related factors like sleep and mood. Identifying the specific source of the pain—whether structural, cervicogenic, or centrally mediated—allows for a precise treatment plan that maximizes the potential for long-term symptom relief.