Concussion and the neck: Part 1 - Why the neck matters after a concussion

When most people think about concussions, they picture the brain. And that makes sense—after all, a concussion is a mild brain injury. But what often gets missed is the role of the neck in recovery.

A recent study by Kinney, Richmond, and Mizner, Cervical spine sensorimotor

deficits persist in people post-concussion despite minimal symptoms, (2024) found that even when concussion symptoms seem almost gone, hidden neck problems can still be present. These issues may slow down recovery and make symptoms last longer than expected.

Why Look at the Neck After a Concussion?

A concussion happens when forces are transmitted to the head. What many people don’t realize is that those same forces also whip the neck around, much like a whiplash injury. This strain can lead to:

• Neck pain

• Stiff joints

• Changes in how the neck muscles work

  
  

Research shows that if the neck doesn’t function properly, concussion recovery can be delayed. The big question is: can someone feel “better” after a concussion but still have hidden neck issues?

How the Study Was Done

The researchers compared 25 people who had a concussion within the past year to 26 people with no concussion or neck problems within the past two years. On average, the concussion group was tested about five months after their injury.

Participants completed three assessments:

• Symptom questionnaire (PCSS): To measure how many concussion symptoms they still felt.

• Head repositioning test (Joint Position Error Test): With eyes closed, participants tried to move their head back to a specific target position. Accuracy was determined by using a laser pointer attached to their head and measuring how far they were (in centimeters) from the centre of the target.

• Neck mobility test: A therapist checked how freely the neck joints moved and whether pressure caused pain.

  
  

What They Found

Even when people with concussions said they felt “almost normal,” their necks told a different story:

• The concussion group's head repositioning was less accurate than the control group (7.4 cm vs. 5.6 cm).

• 60% of the concussion group felt pain during joint and pressure testing—even if they reported not having experienced daily neck pain.

  • Interesting, those in the concussion group with pain during joint and pressure testing had worse accuracy and stiffer neck movements in parts of their neck.

Why This Matters

The study shows that neck problems can last long after a concussion, even when obvious symptoms like headache, fatigue, or brain fog are mild or gone. These hidden neck issues may explain why some people don’t fully recover or why their symptoms come back when they return to sport, work, or school.

What Therapists Can Do

The good news is that therapists can assess and treat these problems. By carefully testing neck mobility and movement control, therapists can find issues that patients may not notice themselves.

Targeted treatments may include:

• Appropriate manual therapy to optimize neck movement

• Sensorimotor exercises to retrain coordination and control

• Strength and mobility work to improve stability and reduce pain

  
  

Addressing the neck can help reduce the risk of chronic problems and support a smoother, more complete recovery after concussion.

Takeaway

If you or someone you know is recovering from a concussion, don’t assume that “feeling almost normal” means everything is healed. The neck may still be holding back full recovery. A therapist can identify hidden issues and provide a treatment plan to get you back to feeling like yourself again.