Frequently Asked Questions
What is Post Concussion Syndrome (PCS)?
The term “concussion” is thrown around a lot these days. It is a simple, straightforward term and it encompasses a wide variety of physical and cognitive symptoms. The problem with using this term is that it can sometimes oversimplify a patient’s condition, especially if symptoms last longer than a few weeks.
PCS is a complex disorder involving a collection of symptoms that can persist from weeks to years after a concussion is endured. One study found that 10-15% percent of people who sustain a concussion experience these lingering symptoms for a year or more (50).
According to Dr. Jeffrey Kutcher, a sports neurologist specializing in this field, concussion and PCS are not the same thing. He explains the complexities of PCS in his most recent book, “Back In The Game: Why Concussion Doesn’t Have To End Your Athletic Career”, and drives home the point that PCS is not a long-lasting concussion (17). While a concussion is the inciting event that causes PCS to walk through the door, they are two separate diagnoses that should be treated differently as a result (17).
There are a number of concurrent factors that can contribute to PCS symptoms, which makes it a complex disorder to effectively treat. Factors such as neck injury, ocular-motor dysfunction, sleep deprivation, depression, and anxiety can all play a role in prolonged symptoms (51,52,17).
This is why it’s important to see a doctor who has experience not only treating concussion, but the problems associated with Post Concussion Syndrome as well.
What are factors that could contribute to PCS?
Ask your doctor about the following:
A concussion occurs when a blow to the head or body transmits enough force to cause a rapid acceleration and deceleration of the brain within the skull (1,2,3). If this force is great enough to jostle the brain, don’t you think it might have an impact on the neck too? Interestingly, studies have found that damage to the neck and brain often go hand in hand. One study found that every athlete they saw who was diagnosed with a concussion had concurrently suffered a whiplash injury as well (32).
Because whiplash is so closely linked to concussion, the neck may play a role in symptoms even though there might not be any neck pain (32).
What is whiplash and how can it affect you?
Whiplash is defined as an acceleration and/or deceleration of the head and neck resulting in symptoms of cervical muscle strain and/or ligament sprain (33,34).
Okay, so that means damage outside of the brain. Why are we talking about this?
Well, symptoms of neck injury have been shown to closely mimic those of concussion in athletes (35). Studies have found whiplash to be associated with headache, dizziness, blurred vision, nausea, and vertigo (32, 36, 37). These are all common concussion symptoms too, right? Yes, which suggests that in certain cases typical post concussion symptoms may actually be coming from musculoskeletal dysfunction in the neck rather than the brain.
In fact, a high proportion of post concussion headache sufferers displayed physical signs of cervical musculoskeletal dysfunction and many had decreased range of motion and muscle tension in their necks (38). More research needs to be done to explore this link, but it’s worth inquiring about to your doctor.
How can this be assessed and treated?
A careful physical examination of the cervical spine and a neurologic examination focusing on the vestibular system and oculomotor responses can help identify the neck as a source for symptoms that mimic concussion (39).
Once diagnosed with neck problems, physical and manual therapy have the potential to reduce symptoms and speed up recovery (40).
A thorough evaluation of your neck can be done by a doctor or trained physical therapist to explore this connection. Ask your doctor about it at your next visit!
2. Ocular-Motor Dysfunction
Vision is more than just seeing 20/20. It is how each eye focusses and moves, how your eyes work together, and how your eyes communicate information to your brain. Your ocular-motor system is extraordinarily complex and is wired throughout many parts of the brain (51).
A concussion can affect specific areas of the brain, as well as the pathways needed for proper eye, brain, and body integration (51,52). Because our ocular-motor system is so complex and wired throughout many parts of the brain, it is very susceptible to being thrown off when a concussion occurs (51,52). This can affect all aspects of vision. (51, 52).
In fact, one study found that 69% of its pediatric patients had at least one vision problem diagnosed after concussion (51). When looking at adults, 30%-42% have been shown to develop vision problems post concussion (57-62).
Some of the most prevalent types of binocular vision dysfunction found in post concussion patients include:
Convergence insufficiency - problems with both eyes working together (51)
Deficiency of pursuits - problems with the eyes’ ability to follow a moving target (53)
Reduction in stereopsis - problems with your brain’s ability to judge visual depth (54)
Strabismus - when your eyes don’t look at the same point in space or gaze in exactly the same direction (52)
Saccadic dysfunction - problems with the ability to move quickly from one visual target to the next (51).
Accommodative insufficiency - problems with your eyes’ ability to focus (51)
Do you get headaches while reading or read slower than you used to? Feel overstimulated in a grocery store? Does your vision sometimes seem blurred?
All these problems and more can be linked to ocular-motor dysfunction typically associated with concussion (52, 55).
How are these vision problems assessed and treated?
Vision therapy is essentially physical therapy for your eyes, and has proven to be effective to treat vision problems in post concussion patients (56). It relies on the brain’s neuroplasticity, which is the ability to form new neural pathways through repetition. Certain eye exercises are used to target the use of and retrain each aspect of your eye-brain connection.
Post concussion ocular-motor dysfunction should be assessed by a knowledgeable concussion specialist, neuro-ophthalmologist, developmental pediatric optometrist, or neuro-optometrist who specialize in these problems. Ask your doctor if this could be a factor in your particular case and for recommendations on who to see.
You may already know that a concussion affects you cognitively and physically. But did you know that a concussion can also affect other physiological systems in your body, such as the cardiovascular and autonomic nervous systems (41,42,43)? (FYI - the cardiovascular system enables blood to circulate throughout the body, and the autonomic nervous system regulates things your body does automatically, such as heart rate and breathing.)
Studies suggest that dysfunction within these physiologic systems can contribute to PCS symptoms (44). In some cases patients experience altered autonomic function and impaired cerebral autoregulation, which is one reason why your symptoms may worsen with exertion (45,46).
Think about it - if the systems that govern circulation, heart rate, and breathing get thrown off after a concussion, it makes sense that this could factor into your symptoms and make them worse with physical activity.
Studies have found that one way to address this is through personalized rehabilitative exercise therapy.
What is exercise therapy?
Exercise therapy is the utilization of aerobic activity to help “reset” the autonomic nervous system after the acute phase of a concussion. A patient will gradually increase the amount and intensity of aerobic activity as he or she builds up a tolerance to it.
PCS may be safely treated by using a program of quantitative, individualized, and progressive sub-symptom threshold aerobic exercise rehabilitation (45,47).
Keep in mind, however, that exercise therapy should be done under the strict supervision of a trained medical provider such as a doctor or physical therapist.
How does it work?
Exercise does a few things to your body naturally that can help with concussion related physiologic dysfunction: it increases parasympathetic activity, reduces sympathetic activation, and improves cerebral blood flow (48,49). (FYI - the sympathetic nervous system is referred to as our “fight or flight” system, while the parasympathetic is known as our “rest and digest” system. Think of adrenaline for sympathetic, and relaxation for parasympathetic.)
This suggests that exercise helps normalize these two branches of the autonomic nervous system, which may alleviate some concussion-like symptoms.
In fact, a study at the University of Buffalo found that 72% of PCS patients who participated in the exercise rehabilitation program returned to full daily functioning (47). The rate of symptom improvement was related directly to the exercise intensity achieved (45).
Ask your doctor whether exercise therapy may be beneficial to your specific case.
4. Vestibular Dysfunction
5. The Emotional Element
Aside from the science of how concussion affects the brain, there is also the emotional tax that sometimes comes with lengthier recoveries. We know from experience that PCS can take a toll your mental well-being because it is an injury that often affects every facet of your life. It’s all too easy to become anxious and depressed, which are factors linked to concussion (8).
These mental health problems are serious and need to be addressed.
It may help to have someone to talk to. Talk to your family and ask your doctor about seeing a psychologist or psychiatrist who is familiar with concussion and PCS patients. Finding someone who specializes in Cognitive Behavioral Therapy might also be beneficial as he or she can provide tools to help manage PCS symptoms.
If you are depressed or experiencing suicidal ideations, please get help immediately. Talk to a trusted adult or contact the National Suicide Prevention Lifeline, which offers free and confidential assistance from a trained professional, by calling 1-800-273-TALK.
Need some extra support from people who have gone through the same struggle? Join Our Concussion Circle to be connected.
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DISCLAIMER: Headway is not a medical provider and does not provide medical advice. Any medical information included on this website is provided for informational purposes only. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment.