[postconcussion]

I've had a second concussion and reinjured my neck. i have all symptoms headache dizziness still can't exercise, need to lie in dark room.

sorry hard to be on computer= bad typing

pcp wants to wait one month b4 pt for neck physical therapy

neuro wants to start imm. tommorrow if possible

concussion was jan 5th.

when is safe? dont really feel ready yet for neck manipulation. new neuro says i have chronic neck syndrome and nothing wrong with my brain but ive had this pcs 2plus years now. he says b/c i wasn't unconscious i have no organic brain injury. he wants to do mra next meeting.


mark what do you think pls and thank you anyone start immediately?

[greenfrog]

Postconcussion, fwiw, the osteopath who works in the clinic of one concussion specialist I consulted (she has about 10 years' experience and has worked on a number of athletes with PCS) says that osteopathy/cranial-sacral work is contraindicated during the acute phase post-concussion. However, she mentioned this in passing (I was at the 5-month mark when I contacted her), so I'm not sure at what point she normally deems it OK to initiate treatment. Personally, I did not want any manipulation done on my neck and head for quite a while.

I'm no expert, but I'm skeptical about your neurologist's "no LOC = no organic brain injury" formulation.

I hope you feel better soon - hang in there.

[postconcussion]

thank you greenfrog,

i also have doubts about starting immediately. He doesn't seem to believe that I have anything wrong (or ever did). I have to see him in a week and don't know what to do. He wants me to start the pt before then.

[Mark in Idaho]

greenfrog is 100% correct about your neuro. Any neuro who makes such a statement should lose his board certification.

I would run from this neuro and keep running until you find a neuro who understands concussion. The saving grace to that neuro's comment is the value of neck work. I would be very careful about who you let work on your neck. You need to find a therapist who has a very highly developed skill at working with an injured neck.

There should be no chiro type of twist and pop. Some soft tissue work to first identify spasming muscles should be the best start, maybe some myofacial release release with some light traction work.

Did he say he wants an MRA (Magnetic Resonance Angiogram)or maybe an EMG? An MRA is done in an MRI facility. It is done to look for abnormal vascular structures. It is basically a double MRI with a modification to the second image to ignore the blood in the blood vessels. The second limited MRI image is subtracted from the first MRI image and the result is an image of the vascular structure. The resulting images are quite interesting. I have a copy of an MRA done on me about 10 years ago.

If the MRA is to look for abnormalities in your upper neck, it makes more sense. Upper neck inflammation can impede blood flow through the vertebral arteries. Most of this same information can be found with a Doppler Ultrasound of the vertebral arteries at much less cost and discomfort.

Cranial Sacral Therapy has been replaced by Osteopathic Manipulative Therapy in some schools of osteopathy. It does not focus on the cranial rhythm concepts that CST uses. It takes the best of CST and leaves out the controversial and sometimes hocus pocus of cranial work.

For the record, cranial work has been studied and researched and shown to have very poor ability to repeat diagnostic results on the same subjects. But, enough of that.

My biggest concern is starting with the right therapist. Waiting to find a good one is better than rushing and finding one looking for billings.

If you decide to look outside that neuro's office, try to find a Physiatrist (Physical Medicine and Rehabilitation) with good skills with upper cervical diagnostics. maybe your PCP can refer you, but she/he sounds less than top notch for PCS and upper neck. Have either suggested icing your neck? It should be your first therapy. Easy to do at home. Just a big bag of frozen peas in a light dish towel for 20 minutes on, 30 to 60 off (to refreeze) and repeat three or more cycles.

Anti-inflammatory meds (ibuprofen or aspirin) can also decrease swelling.

I like the soft ice bags with a gel in them. They can wrap around the neck easily. You can also make a soft ice bag with water and isopropyl alcohol combined in equal amounts in a freezer grade zip lock bag. It freezes to soft ice.

btw, I type typos like a mad man. I use spell check to help me make things readable. Spell check can be turned on in internet options for web forms.

My best to you all.

[postconcussion]

I agree with running from the neuro, but should I to go back to get the MRA? But if I get the MrA then I will need a follow up appointment as well, and that will be already three appointments.

I need a referral from my pcp to go to any doctor. I already have this referral. Also, there are only a couple of neuros here that take my insurance. If I don't go to him I won't have another one to go to. About a week before I was injured I asked my doctor for a referral to a physiatrist who performs osteopathic manipulation. Should I go there... how long should I wait? I don't know if it went through, they haven't contacted me.. so she probably didn't do it.

I have had months of PT previously around month 8 or so after my first injury. Should I go back to the same person? Is it better to have continuity of care? How do I know that she did well if I haven't been to anyone else? I know that it got better but I did still have lingering issues- that is why it is so bad now.

I was feeling ok about my 2nd injury but once i went to this guy i felt devastated and had a little breakdown. There is nothing worse than someone saying that it is in your head.

Also, I haven't been using ice, they recommended the heating pad. This neuro gave me no instructions to rest at all... just discounted the brain injury. He said that all my symptoms.. light, noise, overstimulation, fatigue are all from my neck and that I have a type of migrane.
Yesterday I felt so discouraged. If my neck was the only problem I would be in a lot of pain, but I would not have the other horrible pcs stuff- fogginess, etc.

[Mark in Idaho]

A neck injury would not necessarily be painful. I can manually feel the muscle spasms in my neck but there is no pain. Try pressing on the various points around your upper neck and behind your ear and at the back of your skull. If you find some tender spots, there is injury/spasming going on.

I don't have any affinity for seeing neuros for a concussion. They can be more problem that benefit, especially if they put a somatoform diagnosis in your medical record. If the neuro has bad information about concussion, what help will he be.

A physiatrist can also prescribe the MRA if needed. Does your health insurance have a telephone advice nurse? Sometimes, they can give you some direction.

A physiatrist who is an MD may be good. They can refer you to the therapy they prefer. A CST trained DO is suspect in my book. I have been seen by DO's that were helpful and by DO's who wanted to take off down rabbit trails of inappropriate treatment. The patient needs to make informed choices.

Since you are so close to your last injury date, maybe it would be good to just rest and give it some time before moving ahead. Develop a good posture discipline for your neck while resting. It may be as beneficial as therapy. Some PT's push too hard with range of motion goals and don't allow natural healing. I've seen both. Conservative PT's who teach a patient how to work with their own body are rare.

keep in mind that there is no magic bullet for treatment of concussion. Only individual symptoms can be treated and not all symptoms can be treated. Head aches, yes. Brain fog, no.

My best to you.

[postconcussion]

thank you so much for your information. I am happy you agree with me. I have found over the last two years the less doctor's and the more rest the better.

I am not going to go back to the neuro and will cancel the appointment. I do not want him to start treating me and have his opinion on my record.

In one month I will go to my pcp and get a pt prescription and start then. This month I will go back to my early pcs days of complete rest. I do have very tender spots all over my neck as you mentioned.

One lingering question I need so I don't second guess... say i did get the mra. What will it show in regards to my neck injury. Say it shows abnormalties... how will they treat them? Would those abnormalities be a reason for more intensive neck physical treatment therapy? Would the insurance approve more sessions? Am I hurting myself by not getting this?


Anyone have this result?

The only scan/ sray that showed anything was an upper cervical a year ago. it showed slight reversal of the curvature of the spine due to spasms.

[Mark in Idaho]

I doubt the MRA will show anything important. It is more likely an effort to rule out very rare conditions.