A concussion is a complex physiological process affecting the brain, caused by biomechanical forces transmitted to the head or body. When the head undergoes rapid acceleration and deceleration, the neck structures are often simultaneously injured in a whiplash-like mechanism. This injury to the cervical spine’s joints, muscles, and ligaments is a frequent source of post-concussion symptoms, leading to pain referred to as cervicogenic. Neck pain is reported by nearly 43–60% of people following a concussion, and addressing this underlying cervical issue is an important part of a complete recovery.
Initial Safety Assessment and Warning Signs
Before beginning any treatment for neck pain after a head injury, it is necessary to rule out a severe structural injury to the cervical spine. Any neck pain or tenderness occurring immediately after a concussive event should be evaluated by a healthcare professional to exclude a fracture or ligamentous instability. Red flags that demand immediate emergency medical attention include severe weakness or numbness in the arms or legs, or the inability to move the neck normally.
Sudden, profound worsening of a headache, new seizures, or a loss of consciousness after the initial injury are also urgent warning signs. These severe neurological symptoms suggest a more dangerous underlying condition, such as an intracranial bleed, and require immediate assessment. A professional diagnosis ensures that self-treatment is only pursued once serious spinal or brain injury has been definitively excluded.
Conservative Home Management Techniques
Assuming a serious injury has been ruled out, mild to moderate neck pain can often be safely managed with targeted home techniques. Applying ice to the acutely painful area for 15 to 20 minutes helps reduce inflammation in the first 48 hours following the injury. For more persistent pain, moist heat, such as a warm towel or gel pack, can be applied for 10 to 15 minutes to relax tight muscles and promote blood flow.
Avoid prolonged periods of immobility, but general rest is still recommended; the goal is to balance rest and gentle, approved movement. Gentle range-of-motion exercises, such as slow chin tucks or side-to-side rotation within a pain-free range, can prevent stiffness and promote mobility. These small movements should only be performed if cleared by a doctor, and they must be stopped if they increase headache or dizziness.
Making ergonomic adjustments can significantly reduce strain on the injured cervical structures. When sleeping, use a small pillow under the neck if lying on the back, or enough pillows to keep the head aligned with the spine if sleeping on the side. Adjusting computer monitors so the eyes are level with the top third of the screen prevents the forward-head posture that increases muscle tension.
Professional Physical and Manual Therapies
When home care is insufficient, professional physical therapy is often employed to address the underlying mechanical dysfunction of the neck. Therapists use manual therapy techniques, such as gentle cervical mobilization, which involves rhythmic, passive movements to improve joint mobility and decrease pain signaling. This differs from manipulation, which is a high-velocity thrust, and is generally avoided in the acute phase of concussion recovery.
Targeted therapeutic exercises are prescribed to restore muscular control and stability to the neck. Strengthening the deep neck flexor muscles, often using exercises like chin tucks performed against light resistance, improves the neck’s stabilizing function. Postural training is integrated to teach the patient how to maintain a neutral head and neck position during daily activities, thus reducing chronic strain.
Soft tissue techniques, including massage and myofascial release, can be used to treat trigger points and reduce excessive muscle guarding and tension. These hands-on methods help relax the suboccipital muscles, which are often implicated in headaches originating from the neck. If the neck injury is contributing to symptoms like dizziness or balance issues, a physical therapist may incorporate vestibular rehabilitation. This specialized therapy addresses the sensory mismatch between the inner ear, eyes, and neck, which can alleviate symptoms of cervicogenic dizziness.
Pharmacological and Advanced Pain Interventions
Medications are used to manage symptoms when mechanical therapies alone do not provide complete relief. Over-the-counter pain relievers, such as acetaminophen, are recommended. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are sometimes used cautiously in the acute phase due to theoretical concerns about bleeding risk. Patients should discuss the appropriate use of any pain medication with their physician, as masking symptoms can potentially interfere with recovery monitoring.
For persistent muscle spasms, prescription muscle relaxants may be used for a short duration to break the cycle of pain and tension. If pain becomes chronic and has a neuropathic component, medications like gabapentin may be prescribed to calm overly sensitive nerves that transmit pain signals. These pharmacological strategies are secondary to active physical therapies.
When localized pain persists despite conservative and oral medication management, more advanced medical interventions may be considered. Trigger point injections involve injecting a local anesthetic into tight bands of muscle to relax the area and relieve referred pain patterns. In cases of severe, refractory pain originating from a specific joint, a physician may recommend a cervical nerve block to temporarily disrupt the pain signals being sent from the affected facet joint.