Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).


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Old 09-29-2017, 05:06 PM #1
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Default Head Pain on Pillow/ Neck Stiffness and soreness

My concussion occurred a month ago when I slipped and fell backwards hitting the back of my head on a turf surface. There may have been some whiplash, I had a little bit of pain but it wasn't particularly bothersome. I've aggravated my neck several times since the initial injury and have developed some significant pain/stiffness in my upper back and neck. This stiffness/pain causes my head to hurt wherever it makes contact with the pillow. This has caused me to wake up after a couple hours and lose 5 or 6 nights of sleep when it's particularly bad.

I've been working with an athletic therapist and a masseuse who have done some hands on work which has relieved the tension/pain each time for a short amount of time. I don't know if the pain is returning on its own or if i've been re-aggravating it by accidental quick neck movements like drinking back vitamin supplements too quickly or falling backwards onto my pillow as i mentioned in a previous thread. I lost another night of pain last night due to the head pain on the pillow and I was wondering if anyone had any ideas or advice about the best b=way to deal with the situation. does it make sense to continue seeing the athletic therapist who seems to be fairly well educated about concussions?

I went to see a doctor at a walk in clinic today because i was wondering if there might be a need to do x-rays/imaging to see if there was any damage besides soft tissue damage. She said that she thought it was just muscle stiffness. Might it make sense to get a second opinion? Any comments would be appreciated.
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Old 09-29-2017, 05:52 PM #2
Mark in Idaho Mark in Idaho is offline
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You don't describe the head pain on pillow so there is no way we can comment on that. From what you have said, I don't think your issue is concussion related. I believe it is whiplash related. Do not throw your head back when taking vitamins. Instead, gently tip you head back if you need to.

Does your head really hurt or does your upper neck hurt or do you just get a headache ?

Hands on work does not mean much. There are some who do amazing hands on work and others who cause injury or exacerbate symptoms with their hands on work.

Most athletic therapists receive their concussion training in week end seminars like those required to be certified to administer ImPACT testing.

Without knowing what the hands on therapy was, there is no way to know if it is worthwhile. Many focus on range of motion. That is not always good. Others are just too forceful. It should not be painful unless he/she is doing myofacial release where the pain is momentary as the muscle lets go.

A walk in doc is 99% worthless. Very few have any valid concussion knowledge. Again, weekend seminars. The x-ray or imaging that can be done is not capable of diagnosing the subtle neck injuries common to your situation. When it can, it requires a very skilled image reader. Some times, it requires a full motion x-ray with a very skilled reader. A doc in the box is never going to request such an imaging.

It would be best if you keep all of your posts in the same thread. That way, we can scroll through past posts.
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Old 09-29-2017, 06:09 PM #3
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Have PTs check for trigger points in your muscles and scalp.. If they don't know much about them, find better PTs..
You or a friend could also check for them.. this chart is very helpful..
Pain Reference Chart
A web search will bring up many other TRP info sites..
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Old 09-29-2017, 06:56 PM #4
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Originally Posted by Mark in Idaho View Post
You don't describe the head pain on pillow so there is no way we can comment on that. From what you have said, I don't think your issue is concussion related. I believe it is whiplash related. Do not throw your head back when taking vitamins. Instead, gently tip you head back if you need to.

Does your head really hurt or does your upper neck hurt or do you just get a headache ?

Hands on work does not mean much. There are some who do amazing hands on work and others who cause injury or exacerbate symptoms with their hands on work.

Most athletic therapists receive their concussion training in week end seminars like those required to be certified to administer ImPACT testing.

Without knowing what the hands on therapy was, there is no way to know if it is worthwhile. Many focus on range of motion. That is not always good. Others are just too forceful. It should not be painful unless he/she is doing myofacial release where the pain is momentary as the muscle lets go.

A walk in doc is 99% worthless. Very few have any valid concussion knowledge. Again, weekend seminars. The x-ray or imaging that can be done is not capable of diagnosing the subtle neck injuries common to your situation. When it can, it requires a very skilled image reader. Some times, it requires a full motion x-ray with a very skilled reader. A doc in the box is never going to request such an imaging.

It would be best if you keep all of your posts in the same thread. That way, we can scroll through past posts.
Thank you very much for the reply.

During the day, the pain is mostly in my neck and a little bit in my upper back at times. I don't have pain in my head until I lie down on the pillow at night. When I do, I feel a dull ache directly where my head is making contact with the pillow and not really anywhere else.

I still feel some neck pain/stiffness when lying down but it's the head pain that's disruptive to my sleep. I sleep on my back and have tried to use a thin pillow or a rolled up towel under my neck but when my neck is very stiff and the corresponding head on pillow pain is very strong, I still can't fall asleep.

The athletic therapist that I'm seeing has done some pretty aggressive squeezing under my shoulder blades and around my trapezius. I believe what he is doing is looking for trigger points and doing myofacial release. But I'm not certain. He has also done some gentle moving/rotating the neck while holding my head in his hands and has done some light massage on the base of the neck as well.
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Old 09-29-2017, 06:57 PM #5
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Originally Posted by Jo*mar View Post
Have PTs check for trigger points in your muscles and scalp.. If they don't know much about them, find better PTs..
You or a friend could also check for them.. this chart is very helpful..

A web search will bring up many other TRP info sites..
Thank you very much for this information.
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Old 09-29-2017, 08:41 PM #6
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It sounds like the AT is doing classic therapies, not myofacial or other release protocols. The best therapies my PT used were not forceful except for her finger tip. When she did neck work, she used gentle traction with gentle mobilization. When she did release therapies, she would hold a point until the spams released. Then, the joints and muscles would settle down.

You still don't define the pain when you lay down. Is it at the surface, on the skin over your skull ? Is it behind your ears ? Is it below the bony part of the back base of your skull (occiput) where the C-1 vertebra connects to the skull ?

You can traumatize the nerves in the many layers of skin. These can be very tender for weeks. If your upper neck is radiating muscle spams and tension, the pain will be more behind your ears.

Do you have a recliner ? Sleeping in a reclined position with a thin pillow rolled up at the edges to support your head from rolling to the side may help you get good sleep.



You might find better help from a Physiatrist (Physical Medicine and Rehabilitation) rather than an athletic therapist. A good Physiatrist may be able to better diagnose your injury. A good Osteopath may be helpful. Look for either who has good whiplash experience. The upper back and lower neck are difficult to diagnose and treat.

You may have suffered a minor concussion but your symptoms are neck/whiplash.

Did you look for the Post Reply button at the bottom left or top left of the thread ?
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Last edited by Mark in Idaho; 09-29-2017 at 10:06 PM.
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Old 09-29-2017, 09:30 PM #7
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To Reply without quoting look for Reply button @ Left side above or below posts,
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Old 09-30-2017, 02:12 PM #8
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I think that the pain is either on the skin or between the skin and my skull. I find it difficult to tell exactly.When I'm lying directly on my back with my head straight, the pain is where the base of my skull meets the top of my neck which I think is the occipital, as you mentioned. This is essentially where my head makes contact with the pillow. If I turn my head to the left or right, I feel the same kind of pain but higher up on the skin/skull because a higher portion of my head is making contact with the pillow.

It might be relevant to mention that the pain is not there every night. it seems to correspond with the times when my neck is especially stiff or sore. Each time that I've had a difficult night with that pain, I've seen either my AT or a PT or a masseuse and the next night has generally been better. The pain has returned after a day or more but again, I'm not sure if it's returning on its own or if it's because i've re-aggravated the neck.

I will look into finding a Physiotrist and an Osteopath who have experience with whiplash.

Aside from the neck pain/whiplash I am also dealing with the regular concussion related symptoms. Although it is unpleasant to have a sore neck and lose sleep, I'm most concerned with how the neck issue and poor sleep are affecting my brain recovery from the concussion itself.

If I had some other questions to ask, not related to the neck pain, should I ask them in this thread or ask a new one?

Thanks again, Mark. I really appreciate your input.
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Old 09-30-2017, 03:35 PM #9
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Keep your posts in the same thread. You may not realize how issues can be related.

It sure sounds like your pain in topical or skeletal. As I said, it takes a very long time for the nerves in the skin to heal. They can remain sensitive to touch for months.

Has your AT or PT mentioned the value of icing ? You have inflammation that is causing problems. Anti-inflammatory meds, aspirin, ibuprofen, etc. will help. But, you need to use them consistently.

If the pain returns after a period of being free from pain and stiffness, you are re-aggravating the injury. Poor sleep posture is often a cause but head movements can also be a cause. Some ATs and PTs push for range of motion. This can trigger symptoms. Many do best with minimal range of motion until improvement then start to work on regaining range of motion.

You really need to find that comfortable sleep position where you are not tempted to move to find a new comfortable position. As I said, in the early stages, I did best with a recliner. My wife commented that my facial expression when sleeping in my recliner was peaceful. When sleeping in bed, my face looked stressed. I felt more rested in the recliner. Some find an adjustable bed helps. More people have access to a recliner than to an adjustable bed.

What are your 'regular concussion related symptoms'?

Poor sleep can be causing them.

Thanks for using the Post Reply button.
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Old 09-30-2017, 08:18 PM #10
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I've been icing periodically but I will start doing it consistently. I've been taking ibuprofen pretty consistently. If I can't find a comfortable position lying down I'll look into trying to sleep in a reclined position.

My concussion symptoms have been a combination of dizziness, fatigue, lack of clarity/focus, light sensitivity, a deep dull head pressure, sometimes a little bit of nausea and headaches.

These are brought on or exacerbated by too much physical or mental activity. Screens have been especially problematic.

I was referred to a concussion specialist by my family doctor. She has been working with me to put in to practice the "return to play" protocol. During my first three weeks of recovery I slept pretty well but in the last 10 days about half or so of the nights have been significantly disturbed.

I've been doing a lot of self monitoring as per the return to play stuff but it's hard for me to evaluate how much progress has been made. The days after a poor sleep are particularly difficult to evaluate.

I've been pretty conservative with the short bursts of more strenuous activities like reading, exercise, and screen use. I wonder how much I should be pushing during those short activities and if I should be stopping immediately upon any increase of symptoms or if I should allow them to come on a little bit before stopping. I'm using screens for approx 15-20mins total throughout the day and not more than 7-10 minutes at one time. It would be great to find a way to slowly build up my ability to use screens as i use them a lot for work and recreational activities.
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