I am about four months out on a car accident related TBI. The accident involved a lot of twisting. I initially had OT and Speech for the balance and speech, and that was good. I am now doing chiropractic and massage, mostly but not entirely focused on my neck. I am making progress, but slowly. This is my second (at least) concussion and fourth or fifth low speed car accident. I also had another significant head injury when four guys walking briskly and carrying a metal raft frame weren't paying attention and rammed the thing into my head. I was squatting on the ground with my back to them, working on another frame. The blow knocked me off my feet and sprawling.

I have trouble sleeping, in some part because I am anxious and worried about a number of things like if I made a mistake or that I am only working part time or what will become of me, etc. I have realized that when I become exhausted from lack of sleep and other stressors I not only feel exhausted but also feel nauseous, unsteady and frequently too hot or too cold. (Normally I sleep like the dead and am not sensitive to temperature.

This seems like adrenal fatigue...does it seem likely that this is related to the Post Concussive Syndrome? Is that something that other people with PCS have?

Adenium,

First, you need to try to ignore your history of head bumps and injuries. They have no direct impact on your recovery. They can only increase your anxiety. Your symptoms are all that matters. Causation does not dictate treatment or recovery.

My first concern for you is your sleep. You need a week of good sleep before you should start looking at other reasons for your symptoms. Finding a way to distract yourself before going to sleep is important. You should not be getting in bed and tossing and thinking while you try to go to sleep. Better to get everything ready. Turn the lights down and occupy your mind with a distraction so that when you feel sleepy, you can get in bed without starting any of your anxious thoughts. Then, get up when you wake up so you can repeat this the next night. For many with PCS, sleeping is a practiced discipline.

Are you rafting this summer ? My daughter is a rafting professional in the summer and ski school and race team pro in the winter. Her occupation has taken a toll on her body.

Thanks, Mark. I'll keep working on the sleep and try not to worry so much.

No, I haven't done any rafting in a long time. It is very hard on one's body and doesn't pay much. I loved the life but realized that if I continued it I would never have anything and would also have nothing to retire on. I figured out that I had more brains than braun and that I should go back to school and figure out how to use my head to support myself. I still miss the rafting.

It was very hard to give it up - like a terribly addictive drug. I have several friends who are former river guides and they all miss it. Nevertheless, it's nice to be able to buy a house, have a career, provide a home for a pet, and look forward to a retirement or partial retirement during which I can do watercolors, go to Hawaii to paint flowers, and maybe work a few months a year as a seasonal ranger. Maybe someday I'll even have a greenhouse to lengthen the growing season for my beloved plants.

I understand. My daughter lives out of her FourRunner during much of the rafting season. Her Toyo 4x4 pickup with a bunk in back was totaled last year. She has experience on rivers north of Yosemite, Utah and she is now in Idaho getting rated on the Salmon River by NOLS, then rated as a climbing instructor in Montana. All of her NOLS ratings help her get much better pay. She has her PSIA with a specialty with youth and runs the ski school, racing program, and the cat skiing program at Homewood on Tahoe's west shore during the winter. At 32, she realizes she needs to make it into management or be broke. She has never signed a lease anywhere for more than a ski season. She has friends who are always willing to rent her a room.

For her, the poverty is worth the benefits of working in the outdoors. She has plenty of brains but also has braun. She graduated high school in California 3 years early and had done college for outdoor skills, Wilderness First Responder, avalanche, and more.

As you try to reduce your worry, write those things down at the end of the day before settling down for a thought distracting activity. When we write things down, we are better able to let go at night because we know we will be able to read our notes the next day. The point is to get off any thoughts that will pester you as you try to fall asleep.

Hope you get some good nights sleep.

My best to you.

It has now been 6-1/2 months since my car accident, when a woman tried very hard to pass me on the inside of a rich hand turn. I really got twisted around. Initially I had OT and Speech Tx, and then did a few months of chiropractic. Three months ago I started medical massage to help with the muscle spasms in my neck, and then a neuro PT who does dry-needling and other work on my neck and upper back. I added the PT about the same time I stopped the chiro, six weeks ago.

I am now sleeping through the night without medications - was taking diazepam and then Trazodone (both for awhile). I am working part-time but still have a definite limit as to what I can do. I am still having very frequent headaches and cannot do anything that involves looking down - like seated working at a table - for very long without getting a headache. Nevertheless, I am much better in other ways; my memory and focus are better, I have returned to my former level of energy, and I am no longer having problems with speech, balance, irritability, etc.

I am getting the impression that the attorney and PT think it is taking a long time for me to get over the headaches and should reduce the frequency of headaches so that it looks better to the insurance company. They seem to be particularly focused on the massage as unnecessary, even though my doctor who referred me told me when I saw him last week that medical massage is a good way to address muscle spasms, adding that I definitely still have that.

The attorney told me, "anybody would like to have massage every week". This is about the same thing as saying that I am malingering to take advantage of the massages. Deep tissue work on injured tissues is painful and I'm not sure that everybody would think that was so terrific. I think it's been helpful, but it's not like I signed up for a car accident.

I'm not sure what to think about all this

I suggest you look for a different chiro to check out your neck. If head forward causes headaches, that seriously suggests an upper neck issue. A NUCCA.org or atlasorthogonality.com chiro may help. I have to sleep on my back without a pillow or I develop symptoms from the head tilted forward posture.

If your headaches accompany pain at the bony part behind your ears, that strongly suggest a C-1 or C-2 cervical problem.

If the muscles spasms need to be released with massage, something is wrong and causing them. The massage is treating the symptom, not the cause.

Has the PT done any gentle traction and gentle cervical mobilizations ?