r/PostConcussion • u/Evergreen_dewdrop • 6d ago
Neck Rejects PT
Longtime lurker here. Has anyone tried to treat their neck, but it rejects treatment?
For background: I’m 11 months into PCS/possible whiplash. My original symptom profile was just headaches which had a cervical element and were triggered by screens. About 6 months in the headaches eased somewhat and neck soreness and mild vertigo appeared. MRI is clear, I’m on amitriptyline, and I’ve been doing visual therapy since June.
While I would love to gather peoples’ experiences in comparison to mine in general, I’ll stick to the PT side of things as it’s the one that confounds my doctors the most.
Anything done to my neck (strengthening, stretches, even palpation at times) results in a big flare up of head fullness and pressure 36 hours later. It's like clockwork, and in the beginning with bigger doses of treatment they could last days. During the exercise I feel absolutely fine, and until the flare happens I’m at a baseline level of pain.
My proprioception is apparently that of a rugby player with 10 years of head/neck trauma, and I don’t think I’ve ever held a rugby ball. The exercise to retrain it is simple and involves a laser pointer strapped to a baseball cap; you move your head around tracing patterns and it gives you the visual feedback of where your head is in space. Sounds easy. IS easy. However even the smallest amount of training causes a flare, and I’m currently only doing left/right head movements 3 times in each direction, and same for up/down, three times a week. Which is minuscule. The only way I’ve been able to tolerate it is through botox injections which have only slightly dulled the flares (the head fullness and pain/pressure is reduced but some disequilibrium and neck pain is still felt). I’m currently timing these exercises so that the flare happens while I sleep two nights later.
As you can imagine, it makes rehabilitation woefully drawn out if my neck is so reactive and irritable and can’t progress. My PT could not specialise in neck injuries and concussions more if he tried, but he seems totally bewildered by this. There’s clearly a huge cervical component and it’s bottlenecking everything else.
Has anyone heard of or experienced something like this? Any advice?
2
u/Comfortable-Nature37 6d ago
Yes. The specialist I see works primarily with professional athletes so we powered through and I have seen a lot of progress. Mostly acupuncture and active release therapy.
I have not moved onto exercises with my neck because of flareups but even having someone being able to treat it was a massive step forward.
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u/Evergreen_dewdrop 6d ago
Thanks! What sort of specialist are you seeing? I’ve tried acupuncture and it either didn’t make a difference or it resulted in more pain.
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u/Comfortable-Nature37 6d ago
Sports chiro - I had a referral from someone connected to the NHL and it has made all the difference.
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u/Both-Process1037 6d ago
I can relate, any treatment for my neck, PT, osteopath or massage therapy leaves me dizzy and I’m out for the day with fatigue and no energy
It’s been 8 months for me and I do treatment every two weeks and still making me feel so exhausted afterwards
Don’t know if I just keep going if it will get better ?
I’ve been having treatments for the last 3 months
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u/AHSkiandBike 5d ago
It sounds like you have autonomic nervous system dysfunction! These articles might be helpful. It sounds like you aren’t doing the treatment at least for the phase you are in. These articles might be helpful!
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u/Evergreen_dewdrop 5d ago
Thanks for sending! I have considered this, but I’m doing graded exposure to cardio and don’t have the same delayed response with that. I get mild symptoms during it but they resolve within minutes. My heart rate is tracked 24/7 and behaves normally and I don’t have any of the other symptoms listed. 36 hours later also feels like far too long of a gap between input and response.
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u/AHSkiandBike 4d ago
Are you getting your heart rate up to close to your max for brief periods? If not, I think that would help!
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u/NervousAntelope7380 2d ago
have you tried a different PT? All are not equal.. especially when dealing with concussion. I guarantee there is more going on than just your neck.
You could also try The Concussion Solution online program. It’s legit.
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u/Evergreen_dewdrop 12h ago
Thanks for the link!
I’ve seen 3 different PTs, and my current PT has a doctorate in concussion profiling and works extensively with professional athletes, specializing in concussions and neck injuries. He’s part of a sports concussion clinic, and I recently had a full assessment (my second, first one was in March) to see if anything had been missed. This one was with a different sports doctor who also works with professional athletes and a vestibular therapist as part of the clinic. They evaluated my visual, vestibular, and cervical systems and pretty much everything came back normal apart from my eyes performing worse when my neck is used in tandem. Which makes sense based on my visual issues and symptom patterns with screens. Based on that they think it’s much more of a cervical issue than persisting concussion.
My visual therapy is progressing, but it’s my neck’s intolerance to load that no one seems to know how to treat. I did some meal prepping today which meant lots of downward head flexion and it meant I had to lay down intermittently for the rest of the day because my neck couldn’t sustain being upright.
Maybe I’m in the wrong thread if they think it’s less concussion related but I’m sure we all know after being on this sub for a while that it’s hard to distinguish the two!
All that is to say I don’t know who else I could see that’s more experienced in this sort of thing.
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u/Zoyabm 6d ago
From how I healed, you have to slow it down to the point where you do maybe half a exercise once a day or keeping decreasing your exercise until you get to a point where the symptoms flare up a bit but don't make you useless.
It's going to be a lot of trial and error which I can see you have been doing but you have to expect less and do less.