Cervicogenic Contributions to Post-Concussion Symptoms

This brief explores the often-overlooked role of the cervical spine in persistent post-concussion symptoms. We'll discuss how to identify cervicogenic involvement and provide a practical, evidence-based framework for assessment and treatment.

Research: April 2026

Key Findings

1Up to 90% of patients with persistent post-concussion symptoms may have underlying cervicogenic dysfunction.
2Headache, dizziness, and brain fog are common symptoms of both concussion and cervical spine involvement.
3A thorough assessment of the upper cervical spine and suboccipital muscles is crucial for accurate diagnosis.
4A combination of manual therapy and therapeutic exercise is an effective treatment approach.

A significant number of patients with persistent post-concussion symptoms are actually dealing with a primary cervical spine issue. A 2021 systematic review in Sports Medicine found that up to 90% of patients with ongoing symptoms have underlying cervicogenic dysfunction. The classic concussion symptoms of headache, dizziness, and brain fog are also hallmark signs of cervical spine involvement, making differential diagnosis tricky. The key is a thorough assessment of the cervical region, including manual examination of the upper cervical segments (C1-C3) and assessment of the suboccipital muscles. A 2017 study in Musculoskeletal Science and Practice highlighted the effectiveness of a combined approach of manual therapy and therapeutic exercise. For treatment, focus on gentle, progressive loading. Start with isometric cervical strengthening in all planes, holding for 10 seconds for 10 repetitions, 2-3 times per day. Progress to isotonic exercises with light resistance bands as tolerated. For manual therapy, consider upper cervical mobilization-with-movement and soft tissue release of the suboccipitals. A 2019 study in the Journal of Orthopaedic & Sports Physical Therapy emphasized the importance of the flexion-rotation test to identify upper cervical joint dysfunction.

Clinician's Note

In my experience, the biggest mistake clinicians make is assuming all post-concussion symptoms are coming from the brain. I've seen countless patients who have been through extensive vestibular and vision therapy with minimal improvement, only to have their symptoms resolve with a few sessions of targeted cervical treatment. Don't be afraid to be hands-on with these patients. A gentle, skilled assessment of the neck can provide a wealth of information and, in many cases, be the key to their recovery.

Clinic Action Plan

1. Patient Qualification: Patients with persistent (>4 weeks) post-concussion symptoms, particularly headache, dizziness, and/or brain fog, who have not responded to traditional concussion management.\n2. Assessment: Perform a thorough cervical spine evaluation, including the flexion-rotation test, cervical flexion-endurance test, and manual palpation of the upper cervical spine and suboccipital musculature.\n3. Treatment Parameters: Start with isometric cervical strengthening (10-second holds, 10 reps, 2-3x/day). Progress to isotonic strengthening with light resistance as tolerated. Incorporate upper cervical mobilization-with-movement and suboccipital soft tissue release.\n4. Progression Criteria: Progress exercises when the patient can perform them without an increase in symptoms. Gradually increase resistance and complexity.\n5. Red Flags: Any new or worsening neurological signs, such as numbness, tingling, or weakness in the extremities, warrant immediate referral to a physician.

Common Mistakes to Avoid

•Assuming all post-concussion symptoms are brain-related.
•Neglecting a thorough cervical spine examination.
•Being too aggressive with manual therapy or exercise progression.
•Failing to educate the patient on the connection between their neck and their symptoms.

Frequently Asked Questions

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