Mild Traumatic
Brain Injury

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Between 2000 and 2017, there have been 379,519 mild traumatic brain injuries (mTBI’s) among military personal alone.  This averages out to 21,084 mTBI’s per year.  Many of these mTBI’s are from blast injuries.  

Even though mTBI’s are common, they have been poorly understood, and many military members, veterans and others continue to suffer the long term effects of mTBI.  In one large review of outcomes from interventions such as pharmaceuticals, rest and information, they concluded that, “According to the published literature, no intervention initiated acutely has been clearly associated with a positive outcome for patients who sustain mTBI, and there is little evidence suggesting that follow-up interventions may be associated with a better outcome.”  They recommended looking to other forms of treatment outside of standard mTBI protocols. 

The Forces Behind mTBI

When encountering a concussive blast, the blast wave impacts the entire body and causes a sudden acceleration/deceleration of the head and the neck.  This sudden angulation can put forces upward of 160G’s on the neck.  To give perspective, 150G’s of force is a full speed head on collision of two pro-football players.  It only takes 4.5G’s of force to injure the ligaments of the upper neck, causing those bones to misalign.

This type of force is comparable to (and often more severe than) those encountered in concussions, whiplash, and direct blows to head or body.  Throughout training and deployments, many military personnel encounter these forces repetitively.  

Looking Below The Brain

The majority of standard protocols for mTBI focus on evaluating the brain, however, many of the symptoms point to upper neck involvement.  Common symptoms of mTBI include:

• • Headaches
  • Dizziness
  • Sleep Disorders
  • Cognitive Issues
  • Memory Difficulty
  • Visual problems
  • Motor disorders
  • Ringing in the ears
  • Speech difficulties

Headaches are one of the most common symptoms following a mTBI, and in many cases it continues for years.  Many studies and much more clinical evidence is recommending looking to the upper neck for the root cause of these headaches. 

All of these symptoms listed above can also be influenced by or directly caused by injuries to the craniocervical junction (the joints between the skull and the upper neck)  When the upper neck is misaligned, it can put direct pressure or tension on the brainstem and spinal cord.  This is vital to normal brain and body function.  A misalignment can also disrupt blood flow to and from the brain, the cerebrospinal fluid within the cranium, and nerve signals traveling to the brain.  These directly affect the health and function of the brain, and can lead to ongoing symptoms after a mTBI.

Current Protocols

Current protocols for mTBI in the VA/DOD Guidelines include:

• • Rest
  • Manage symptoms (pharmaceutical)
  • Provide the patient with information
  • Sleep hygiene education
  • Relaxation techniques
  • Refer to other professionals if symptoms continue

The VA/DOD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury states: 

“The inclusion of neck trauma is important to acknowledge because the most frequent forms of head trauma also cause injury to the cervical spinal column, spinal cord and neck musculature.”  

Although the research does show that the cervical spine is involved in mTBI, many management protocols still have not integrated craniocervical junction correction into the recovery plan.  This is where upper cervical care come in.

Correcting the Neck to Restore the Brain

Upper cervical care is very unique in the chiropractic industry.  Upper cervical providers are trained to evaluate and correct the alignment of the craniocervical junction using gentle and precise techniques.  By correcting the alignment of the craniocervical junction, nerve signals to and from the brain improve, blood flow to and from the brain can improve, and cerebrospinal fluid flow can improve through the brain and spinal cord.  This allows the brain to recover better and symptoms of mTBI can reduce.  

Upper cervical care is a vital part of mTBI evaluation and recovery and should be considered soon after a mTBI is encountered.  Symptoms can improve and resolve even long after a mTBI occurs.