A cervical concussion is an injury to the soft tissues and structures of the neck that results in symptoms similar to a mild traumatic brain injury (TBI). This condition is distinct from a cerebral concussion, which involves the brain itself, yet the two frequently occur together. Symptoms arise directly from trauma to the cervical spine. Differentiating the source of the symptoms is crucial for guiding specific and effective treatment, especially since many persistent post-concussion symptoms may be rooted in the neck structure.
Understanding the Injury and Mechanism
The injury typically results from an acceleration/deceleration force, most commonly associated with a whiplash mechanism in a motor vehicle accident or a sports-related impact. This rapid, forceful movement hyperextends and hyperflexes the head and neck, causing trauma to the ligaments, muscles, and facet joints of the cervical spine. This damage disrupts the sensory input the brain relies on for balance and spatial orientation.
The neck houses specialized sensory receptors, called proprioceptors, which constantly relay information about the head’s position to the brain. When these structures are injured, the proprioceptive input becomes faulty, sending erroneous signals to the central nervous system. This disruption leads to neurological disturbances that mimic traditional concussion symptoms. Significant ligamentous damage in the neck can occur at lower acceleration forces than those required for a cerebral concussion, making a cervical injury a probable co-occurrence.
Specific Physical Manifestations
The symptoms of a cervical concussion often center on the physical experience of pain and dysfunction originating in the neck. Neck pain and stiffness are the most common complaints, frequently extending into the shoulders or upper back. Patients often report limited range of motion, where moving the head and neck triggers or worsens other symptoms.
A specific type of pain, called a cervicogenic headache, often radiates from the base of the skull up toward the forehead or temples. Unlike a migraine, this headache is typically triggered by sustained or awkward neck postures. Dizziness and balance issues, known as cervicogenic dizziness, are also frequent manifestations, described as unsteadiness, lightheadedness, or a sense of disequilibrium. This dizziness is closely related to changes in head or neck position.
Faulty proprioceptive signals from the neck can also cause visual disturbances. Patients may experience blurred vision, eye fatigue, or difficulty focusing, as the eyes try to compensate for the inaccurate information about head position.
Confirmation and Clinical Assessment
Diagnosing a cervical concussion is often a process of exclusion, where the clinician must rule out other causes of the symptoms, such as a fracture or a primary inner ear (vestibular) problem. The assessment begins with a detailed clinical history, focusing on the mechanism of injury and the temporal relationship between neck pain and the onset of other symptoms. A physical examination includes palpation of the neck muscles and joints to check for tenderness and muscle tension, which are highly specific to a cervical injury.
Assessment of the cervical spine’s range of motion is performed to identify limitations and pain-free movement thresholds. To specifically test for proprioceptive deficits, a Joint Position Error (JPE) test may be used, where the patient, blindfolded, attempts to return their head to a central or target position after movement; a larger error indicates impaired neck sensation. Advanced imaging like X-rays or MRI is typically used to rule out more severe structural damage, such as ligamentous instability or disc herniation, rather than confirming the concussion itself. Specific tests for cervicogenic dizziness, such as the smooth pursuit neck torsion test, help determine if neck movement provokes the patient’s symptoms.
Recovery and Management Protocols
The management of a cervical concussion is multidisciplinary, focusing on active rehabilitation rather than prolonged rest. Current guidelines encourage a brief period of relative rest, typically no longer than 48 to 72 hours, to avoid symptom exacerbation without leading to deconditioning. The subsequent phase involves targeted physical therapy aimed at restoring mobility, strength, and the proprioceptive function of the neck.
Physical therapy includes manual therapy techniques, such as joint mobilization and soft tissue release, to reduce pain and stiffness in the cervical joints and muscles. Sensorimotor and proprioceptive exercises, such as the chin tuck and head-eye coordination drills, are prescribed to retrain the neck’s ability to sense head position accurately. If dizziness is a primary complaint, vestibular rehabilitation exercises are introduced to help the brain compensate for the altered sensory input.
Recovery is guided by a symptom-limited approach. The typical recovery timeline for the neck component often aligns with that of a mild TBI, with most patients seeing substantial improvement within four to six weeks, though symptoms can persist longer. Patient education on proper posture, activity modification, and gradual return to work or sport is integrated throughout the rehabilitation process.