Concussion or Whiplash? Seeing Past the Symptoms
Updated: Jul 31, 2020
It was the type of hit that would be played over and over on sports networks around the world. The kind that makes you wince and turn away from the screen only to return and watch it repeat again and again.
A couple of years ago I was called in to help a player in the Swiss National Hockey League who had taken one of those types of hits. In addition to sending his intake paperwork, he sent a link to the video of the hit before flying to the United States.
He was skating full speed down the ice after a loose puck. As he approached it, he leaned forward, stretching out his stick with his right hand to gather the puck when he was blind-sided by the opposing defenseman. The hit sent him crashing into the boards and he was knocked unconscious. He spun to a stop lying face down on the ice for what seemed like an eternity.
By the time I saw the video, it had been three weeks and his symptoms showed no improvement. His neck was so stiff and painful, he could barely move. He was having constant headaches, he felt dizzy and was having a hard time following along in simple conversations. His team doctors were having trouble making progress. They were conflicted about whether his symptoms were from a concussion or from a whiplash-associated disorder (WAD). Based on how the injury happened, it fit the criteria for concussion and WAD. If you base the diagnosis on symptoms, there is no clear choice either. There is no one-size-fits-all test for either concussion or WAD. This dilemma highlights the importance of being able to look past symptoms and make a diagnosis by finding the underlying problem.
So is the problem in his neck or in his brain? How do we treat this?
Quite frankly it is difficult to differentiate the signs and symptoms of a concussion vs. WAD. The chart below illustrates just how much the two injuries have in common.
Even though concussion and whiplash-associated disorder are considered two different diagnoses, the line separating the two is gray. In fact, they are so gray, it may be imaginary. Determining whether the injury is in the neck, in the brain or both is an important and often overlooked part of a successful recovery.
IS THE INJURY IN THE NECK?
Traditionally, whiplash-associated disorder has been treated strictly as an injury to the neck, but it is about so much more than strained muscles, sprained ligaments, or irritated joints. The most critical problem is with the information these tissues send to the brain.
The muscles joints and soft tissues of the neck are rich with sensory receptors that detect the movement and position of the head and neck called proprioceptors. Proprioceptors send their signals directly to the brain through several nerves in the neck. Proprioceptors signal to the brain every movement, position, and correction going on in the neck at any given tim.
IS THE INJURY IN THE BRAIN?
Once proprioception signals arrive in the brain, the information is used to help control a wide range of systems including balance, posture, vision, and cognition.
Disruptions in proprioception can occur in the neck itself or along the pathway to the brain. A problem anywhere in the pathway is likely to cause problems with neck pain/stiffness, headaches, blurred vision, dizziness, cognitive difficulties, and emotional turmoil like in the list above.
In the case of our hockey player, on his examination, I could measure that he had sustained injuries to his neck and had dysfunction in the sensory processing areas in his brainstem. From there, I constructed his treatment plan. His treatments consisted of manual therapy, photobiomodulation, and instrument-assisted manual therapy to help him regain control of his neck. He did isolated unidirectional vestibular exercises, oculomotor, and oculo-cephalic integration exercises based on the weakened pathways in his brainstem. As he started to function better, we began simulated training sequences, and within 2 weeks, he was feeling like himself again and back on the ice with his team.
The bottom line is whether you call it a concussion or a whiplash associated disorder, the solution to overcoming the injury is to restore function in the injured pathway. In the case of concussion and WAD, understanding proprioception is a great place to start.