Some questions about my concussion and neck injury

[jtoronto]

My concussion occurred 37 days ago when I slipped and fell backwards hitting the back of my head on a turf surface. In terms of the concussion recovery, I've been working with a concussion therapist to employ the practices of slowly getting back into activities without provoking symptoms. Unfortunately, I haven't seen much progress and may even have my symptoms come on earlier. I believe that this is related to sleep and neck issues that began about 18-20 days into the recovery.

There is a neck injury component but at first it wasn't particularly bothersome. I think I aggravated my neck several times since the initial injury and developed some significant pain/stiffness in my upper back and neck. This stiffness/pain caused my head to hurt wherever it made contact with the pillow. I've seen two athletic therapist, two RMTs, a physiotherapist and a chiropractor. I've had some relief with these therapies but the issue has remained. At this point, I don't feel much pain, but there is a lot of stiffness and I find it extremely difficult to find a comfortable position in bed. Despite the discomfort, I'm able to fall asleep every night but wake up every night after 3-4 hours. Some nights I'm able to get some more broken sleep but some nights I'm not. When I wake up I have lower back pain. The combination of neck and lower back issues are both factors in the disrupted sleep.

I was prescribed 25mg doses of the SSRI Trazodone. After 2 weeks or so using the meds, I haven't noticed much difference. I still wake up every night after a few hours, though it's possible that the meds make me a little bit more drowsy and make it more likely that I squeeze a few more hours of broken sleep.

I've had some dialogue with a lead contributor on a PCS/TBI forum who seems to have a great deal of knowledge on the subjects. He suggested that it is likely that the neck injury has probably caused some joint stiffness and has resulted in a situation where I'm not getting enough blood flow to my brain. he thinks that the neck issue will likely need to be resolved before I can expect much recovery from the concussion. He suggested that I be disciplined when it comes to my neck movements and that I should try not to shift my neck too much at night in search of a comfortable position. He suggests that it might be best to avoid therapists that prescribe range of motion exercises as these might make it harder to heal.

I've started seeing a chiropractor whose prescriptions run contrary. He went over some x-rays with me that showed a significant loss of spinal curve in the neck and he suggests that fixing this issue is crucial to healing my concussion symptoms. I wonder if this is a marketing tool that chiropractors often use. He wants to do adjustments on my neck with his activator tool to help realign my c-1/atlas vertebra. He has prescribed a bunch of range of motion/flexibility stretches and strength exercises for the neck. He has also given me a cervical neck stretch pillow called a Denneroll to help encourage my neck to regain some of it's curve.

My concussion therapist is also an Athletic Therapist and has done some gentle dura release work and gentle neck stretches with me and has given me some stretches and strength exercises for my lower back.

My family doctor has just prescribed some anti-inflammatory meds like ibuprofen and naproxen, which haven't done much.

I wonder if anyone might have an opinion on what therapist and modalities I should focus on. Does continuing to see the chiropractor make sense? Should I listen to the advice from the forum poster and try to focus on therapy that is gentler and less aggressive?

Is it likely that the neck injury will need to be fixed before I can hope for my concussion symptoms to start going down? Or is it more likely that the sleep issue is the main problem? Maybe both?

I'm also curious about whether or not the Trazodone is the right thing to be taking for my sleep. I believe that it has some similar side effects to the symptoms of concussions. I find it hard to tell if my increase in symptoms is related to these side effects, if they are just because I'm not sleeping well, or if it's some combination of both.

Would this post be more suited to a neck injury forum?

If I wanted to pay and ask these type of questions to one of the doctors in the professional forums, who should I direct them too?

Thanks

[Candice24601]

I have severe post-concussion syndrome for almost 15 months now. Already had neck/back therapies post neck surgery & C6-7 fusion 7 years prior, which may be from car accident & TBI 15 years prior to that. Yes, loss of curvature normal kyphosis of neck is a problem that inhibits concussion recovery, as does lack of quality sleep for the brain to heal.  Yes, gentle chirpractic has help for me, but stay away from "strengthening exercises" and overdoing physical therapy. Yes, concussion, neck problems & brain hypersensitivity causes headaches & migraines, as well as light & motion sensitivity, vision problems exacerbated if you try to focus or a number of other vision therapies elicit eye pain symptoms, headaches, dizziness. I'm blessed with an amazing physical therapist who is gentle, listens, helps me handle my whole person recovery. Before P-T, look up graston technique to "break up" stuck & stiffened muscles(you can use the straight edge of a butter knife to do this, it will feel like gristle, velcro, bubble wrap popping) otherwise it's useless, always don't push too far with any therapies, vision, vestibular, PT. After PT, ice. Both are important. Ice calms down the heat, swelling & symptoms aggravated by p-t (& most functions). All your nerves go through your neck can cause flair of symptoms ranging from headache, nausea, vision and vestibular problems & sensitivities. Look up Dysautonomia after head injury - basically, we need to employ every method possible to rest, relax, breath slow & deep, calm down anxiety & worry, try meditation & gentle (chair) yoga, epsom bath, aromatherapy, guided relaxation & sound or music therapy to sleep. As far as meds, l would be hesitant to take any - an SSRI or SNRI antidepressant- especially if you've never taken it before. I've had 20 years of trial and error of psych meds, migraine meds & mood stabilizers with bad results. I take tylenol er & Diclofenac 2x/d, zofran for nausea, rhizotriptan has worked wonders for my severe migraine attacks, but no luck with other migraine meds, except when l used to get botox. I also have ADHD, which was amplified again after recent head injury (rear-ended while stopped at red light at 60mph, then crush into two other cars) Getting back on 20mg extended release ritalin at 8am & 10mg regular ritalin at 3pm started to regulate my energy, sleep/wake cycle - and calmed me down form feeling like going full speed in every direction - an even keel. Try Zyflammend nighttime for sleep & natural pain releif. Ask doc amout meloxicam or Diclofenac- both better anti-inflammatories better & safer than naproxen ibuprofen. I know l threw a lot out there, but listen to your instincts- especially about side effects of prescriptions. Oh! Try Epsom salt rub if you can't or don't bath. Also, l'll alternately use diclofenac gel (Voltarin gel, otc or script) for deeper pain. The most functional muscle relaxant for me is baclofen b/c not drowsy, Robaxin is also good & zanaflex is a favorite of a couple healthcare workers l know. Drs. usually first prescribe Flexoril, but it totally puts me out - l also have opposite reactions to meds that are supposed to cause drowsiness but cause insomnia - like some pain meds, muscle relaxants, even klonapin & benadryl, so be careful with otc sleep meds. Ashwaganda root is calming & harmless, Rhodiola Rosea or melatonin might be a good idea, but Zyflammend works well for me. Also, curcumin (from turmeric) helps with inflammation. I mustn't forget to mention dry needling. My vestibular therapist does "cranial pathway" dry needling at the base of scull, also, neck, trap, shoulder, upper/liwer back & sacral - depending on time. It's not for everyone, but if ypu can stand it, it has been very helpful for me. Dry needing gets to the center of knots, trigger points in muscle, activates healing deep at the source, can feel like deep massage or sparkler tickle, just ask about it - it's a part of phtsical therapy. I don't know if l'll ever find my way back to this blog - it's the only time l ever responded, b/c l felt compelled by your story that l might be able to help. The sruggle is real, therapues are hard work, but find a balance; mindfulness is good, but over analyzing can get stressful. Atitude is everything, fear not, find peace & appreciate simple things. Do something you enjoy every day, distraction from the burden of coplex recovery is very helpful to healing. Best of luck to you! Blessings!

[Candice24601]

BTW, if you have access to see an "Osteopath" doctor, do so ASAP. They can do a number of gentle musculoskeletal techniques like cranial-sacral which restores healthy flow of CSF up/down spine & around brain. Also, it's billed as a dr. appointment & doesn't take away from limited therapy visits allowed. I'm lucky to live near & go to Cleveland Clinic for this (& other amazing therapists) but when l was first looking for concussion specialist, it seemed pretty limited to youth sports injuries. Post-concussion vision therapy is top-notch, and don't be afraid to ask for a different physical therapist if yours doesn't seem right. It took me three tries for mine. It was my retina specialist who recommended my neck PT b/c head & neck positions affected my vision & headaches. Again, l may have rattled off a bunch of stuff, have double vision letters & can't read what l wrote to edit b/c that's still difficult for me - and tiny gray letters & words close together. Osteopath. Try to find one, or a doc who does ostopathic (musculoskeletal) manipulations. AND not all chiropractors are created equal - try to find one with post concussion experience or knowledge neurological interplay of chiro treatments. I found PEAK Health & Wellness in Fairlawn Ohio & commute an hour to be treated there - bad experiences with other chiros, Again, all the best to you, take care!

[Sara_MHModerator]

We want to thank you your excellent information! You have been through a lot and are now a wealth of information and hope you come back to our forums. Dry needling is probably something most people do not know about.