When Your Concussion Evolves Into A Different Animal
I’ve been getting tingling down my left arm for the past 5 minutes, and it’s only been 30 minutes since I left the clinic.” That’s was the nail in the coffin for me and confirmed my suspition that they’ve developed Central Sensitization.
Central Sensitization is an uncommon condition where the nervous system becomes overly reactive to inputs that we would normally interpret as pretty mild—like tape on the skin (as in this case), a gentle massage to the area, or even ice on the neck.
This patient originally got their concussion after a pretty severe fall on their mountain bike. They took it easy for the rest of the day and the couple of days following—although the beer with friends after the crash probably didn’t help the recovery. Three weeks later, things weren’t progressing much on their own. They had a hard time getting back to work and were experiencing a low mood, that’s when we had our first appointment.
In the following weeks, we made good progress desensitizing the nervous system with cardio on a stationary bike and normalizing vision and balance. But something was getting missed. A short flight to another city, an ice pack on the neck for headaches, reading for long periods, or a mellow run would bring on these quick and intense flare-ups.
These flare-ups were peculiar in nature too—intense headaches, tingling into the arms, and a short period of amplified depression (lasting a few hours at most). After the third episode, I did a deep dive into neck training, as it was the last somewhat consistent commonality between all these aggravations.
Neck training after a concussion is often either under-considered or becomes the sole focus—while most other Concussion rehabilitation gets ignored.
Concussions typically involve a force that’s multiple times your body weight impacting your brain. The neck often gets involved too, because the small muscles and ligaments there require only a fraction of that force to become injured.
Neck recovery needs to address three key areas: restoring normal neck movement, rebuilding strength, and improving positional awareness (which isn’t a conscious process but still needs to be trained).
In this case, under-addressed whiplash recovery—something I mistakenly overlooked with my patient—led to the nervous system becoming overprotective. This resulted in flare-ups from otherwise benign activities and sensations and developing Central Sensitisation.
Two of the last tests I did was guiding the patient through a biking visualization—imagining the feeling the weight of the helmet gently shifting their head as they adjusted to the trail on their bike—and placing a small piece of athletic tape on their neck. Both triggered a mild flare-up: a headache and slight tingling into the arm.
Shifting the treatment focus toward managing Central Sensitization—calming the nervous system’s over-protection—and tying in targeted neck recovery made all the difference.
Along with time, this new approach helped the patient avoid further flare-ups and get ready for ski season without any hitches.
Altering the approach to treating this concussion to focusing more on central sensitization, where we calm down the nervous systems over protection and tied in neck strengthening made all the difference. In combination with time, this patient was able to avoid any more flare ups and prep themselves for ski season without any hitches.
Neck recovery needs to involve normalizing the amount of neck movement, strength and positional awareness
