5 Main Areas of Dysfunction associated with Persistent Concussion Symptoms (PCS)
Introduction: Persistent Concussion Symptoms (PCS) is one of the terms used to describe when one continues to experience various symptoms — such as headaches, dizziness, brain fog, etc — that last for weeks, months, or even years after sustaining a concussion. Recognizing the common causes of PCS can help in managing this condition more effectively. At Remarkable Recovery & Rehab, we adhere to the Complete Concussions Management Inc. (CCMI) protocols to guide our treatment strategies. Based on CCMI’s principles, there are 5 main potential components to PCS as Follows:
Autonomic/Physiologic ("Blood Flow") Dysfunction:
This domain deals with dysfunction in the body’s Autonomic Nervous System that affects the body’s ability to regulate blood flow to the brain with physical activity. Such dysfunction that impairs one’s ability to exercise, play sports, & in some cases physical exertion altogether. A proper return to activity/sports protocol is vital for addressing this domain of PCS.
Metabolic/Hormonal Dysfunction:
After a concussion, the body's normal metabolic and hormonal pathways can be significantly disrupted. This disruption involves dysfunction of the biochemical signaling pathway that takes place between central nervous system and the gastrointestinal tract (known as the gut-brain axis), resulting in hormonal imbalance and increased neuroinflammation that can affect one’s energy levels, mood, & cognition. CCMI has developed a PCS diet for those who are affected by this domain of PCS, which we prescribe to our patients.
Vestibular/Visual Dysfunction:
Issues with the vestibular system (which affects balance) and visual system are common in PCS. Symptoms can include balance problems, vertigo, and/or visual disturbances. Treatment for this domain includes vestibular rehab and vision therapy, with use of exercises designed to recalibrate the brain’s processing of balance and visual inputs.
Cervical Spine Dysfunction
All concussions have some form of cervical spine (i.e. neck) dysfunction due to the whiplash component of sustaining a concussion. With this being said, it’s important to screen the neck following a concussion especially for those with PCS as persistent symptoms may be due to continued dysfunction at the neck. Manual therapy and neck exercises are beneficial for those with PCS due to cervical spine dysfunction.
Psychological Dysfunction
The psychological impact of concussions can cause/contribute to emotional symptoms of PCS like anxiety, depression, and irritability. Dealing with a concussion can be very stressful, to say the least. Thus it is important to obtain proper stress management tools. Yoga, adequate sleep, and psychological counseling (possibly including but not limited Cognitive Behavioral Therapy) can help with this domain.
