Mild Concussion — Case Report
Ms AP presented with mild neck discomfort and constant headaches following a motor vehicle accident one week previously.
Including neck pain AP suffered from insomnia, poor concentration, irritability, a tendency to become easily upset, tearfulness and a feeling of being ‘on edge’.
It seemed to be progressing and she was having recurring thoughts about the accident every day. AP had previously been of very good health and fitness.
Further inquiries about the incident revealed AP did not hit her head but did get violently thrown to the side. Immediately following the motor vehicle accident she felt vague and couldn’t concentrate.
So far her story and presentation sounded like a case of concussion.
Another more accurate name for concussion is mild traumatic brain injury. Recent studies have discovered that the violent trauma that leads to the signs and symptoms of concussion actually occur from damage to the delicate coverings of the nerves within the Central Nervous System; this is the Brain and Spinal Cord.
This type of damage affects the quality of nerve transmission, of impulses to and from many parts of the body which helps explain the diverse range of symptoms of concussion.
The brain is prevented from getting the usually full complement of information from the tissues that tell it what is going on, both internally and from the world around us. A multitude of sensors (muscle tone, pressure, pain, temperature, ligament and joint, oxygen, blood pressure, movement, sight and sound, taste and smell) feed information into our nervous system to allow the brain to construct a ‘reality’ of what we think is ‘us’.
The brain also sends out signals to match the incoming information. If the input is poor then it follows that the output will be poor. This allows symptoms like loss of concentration, teariness, anxiety, fuzzy head, fogginess, memory loss and muscle weakness etc. to occur.
There are many tests and established protocols for the diagnosis of concussion. Physical examination of AP was fairly straight forward as the diagnosis was already clear. This involved examining her cranial nerves and a spinal exam, testing her muscles, eye movements, reflexes, cognition, balance, memory and co-ordination. What was interesting was the hyper-reflexia of all her muscle reflexes; they were brisk and exaggerated to an alarming degree. Her muscles were tight, not unlike many presenting conditions, but her reflexes were so abnormal that they could be used as an objective sign to gauge improvement over time.
A brief explanation of the situation.
I explained to AP the likely mechanism of the injury and the reasons for her signs and symptoms; this was followed by my reasoning behind the management of her condition. I suggested she would need quite a bit of time to fully recover but initial rapid improvement would be expected. I explained that damaged nerves need
2. Nutrition and
Her diet was already excellent so I had only to focus on Oxygen and Stimulation. The stimulation of AP’s nervous system was achieved by the restoration of normal spinal mechanics using Chiropractic Adjustments and Yoga exercises.
Adjustments were to be carried out every few days for a week or so and the Yoga Exercises had to be performed a few times each day.
Increasing Oxygenation to the neuronal tissues was to be achieved by simple deep breathing for one minute three times daily.
The profound value of such a simple breathing exercise was demonstrated by connecting AP to a Heart Rate Variability (HRV) Monitor and recording the baseline result followed by the Deep Breathing Exercise for one minute and re-recording the result.
The HRV measurement was initially 47 which jumped to 56 after doing the breathing exercises for only one minute. This was a brilliant result; I was hopeful of a quick recovery due to AP already being very fit and flexible.
A follow-up consultation was to be held in three days; unfortunately AP stated she had only marginally improved. The Hyper-reflexia was unchanged which was very disappointing. Initially I found this result very confusing.
Upon further enquiry it transpired AP did not do the breathing or the yoga stretching exercises. I had to read ‘the riot act’ to her about this and again explained the reasons for the exercises. With her head feeling as if in a fog she didn’t really take in what she was told on the previous visit. No matter, she received Adjustments and encouragement.
The next visit was markedly different. AP was happier, brighter and more responsive. She stated she did the exercises precisely as she was told and as a result felt much better for having done so. Upon re-examination the Hyper-reflexia was much less. Adjustments were made and encouragement given and the next visit showed the reflexes were normal. AP felt she had recovered. This was a good result.
WHAT was going on with AP’s Brain and Spinal Cord?
Clearly the accident had upset her nervous system. Exactly how, modern neuroscience is not sure. It appears the excessive energy of the impact caused a disruption to the vastly interconnected but delicate neurological matrix thereby producing an inefficiency of some of the neuronal circuits. It appears logical that this reduced or aberrant signalling was the reason for the signs and symptoms discussed.
As a general principle the background to our nervous system is hard-wired to be in a constant state of excitatory activity. We overlay this with more precise inhibitory controls effectively calming it down to allow fine control.
The grasp reflex of a newborn baby is a wonderful phenomenon. It occurs when you put your finger across the palm of a new baby’s hand, it will close and not let go. This ‘grasp reflex’ is hard-wired before birth and as the little one’s nervous system develops he/she gains control over opening and closing its hand at will by inhibiting the reflex. This usually takes five to six months.
This same process is replicated in thousands of circuits as we develop. The young child will say what it thinks until, with increasing neuronal maturity, they learn to suppress or inhibit those urges, like saying, ‘mummy is fat and grandpa stinks’!
Learning to Juggle is another example. Initially the act of juggling is difficult as the movements needed are too gross to perform quickly and accurately. With only a small amount of repetition, our senses of sight and touch feed back to us the ability to increase the fine control of our muscles by further inhibition to their gross movements allowing the control needed to be able to Juggle.
Our nervous system strengthens and develops inhibitory pathways to fine tune and control our behaviour throughout our lives. Our brain uses the information from our senses of sight, sound, smell, taste, touch and proprioception to modulate or regulate the balance between excitation and inhibition within our nervous system.
AP had Hyper-reflexia because the trauma of the accident partially disrupted the inhibition to that part of her nervous system which controls muscle tone. Possibly, the trauma disturbed a part of the Basal Ganglia Brain Stem or Cerebellum within her brain which would normally help control the muscle tone.
As there were a lot of symptoms involving many parts of her brain it is probable the trauma affected a large number of regions, but only mildly; after all she was still a functioning human being, just not doing so well.
The correction of her spinal subluxations initially would have been a stimulus to her brain to force extra processing of her sensory signals. This was then followed by more sensory input from the now normal joint movement.
Neurons like stimulation. It’s what keeps them alive. The adjustments both initially stimulate the nervous system and restore normal movement to the spinal joints. This allows the brain to get its expected amount of sensory information which it then utilises to control itself.
The same principle applies to the anxiety and tearfulness etc. that AP experienced. The trauma disrupted the normally well connected components of her Limbic System and Frontal Cortex which controls our social and emotional behaviour. The deep breathing exercises increase the oxygen content of the blood for those damaged neurons. Even doing the exercise is stimulating.
Neurons need oxygen. It keeps them alive.
As mentioned AP had an excellent diet and was previously very fit and flexible. She had everything going for her to enable her recovery.