Neck Pain and Cervical Dysfunction After Concussion

Your head aches at the base of your skull. Your neck is stiff and sore, and turning your head feels restricted. Maybe you assumed the neck pain would go away once your concussion healed. But weeks or months later, it’s still there, and it may be the reason your other concussion symptoms haven’t fully resolved either.

Neck pain after a concussion isn’t a minor side effect. It’s a central piece of the recovery puzzle. At Fredericton Family Chiropractic, Dr. Scott Brayall specializes in identifying and treating the cervical spine dysfunction that drives so many persistent post-concussion symptoms.

What Post-Concussion Neck Pain Feels Like

Neck symptoms after a concussion can take many forms. You might have pain or aching at the base of your skull, or stiffness that makes it hard to turn your head fully. Headaches that start in the neck and wrap over the top of the head are common. You might notice tenderness in the muscles on the sides or back of the neck, or a feeling of tightness and tension across the shoulders. Soreness that gets worse with prolonged sitting, reading, or screen use is typical. Some people get sharp pain with certain head movements, or a sense that their neck feels “weak” or unstable. Grinding or clicking sensations when you move your neck, or pain that radiates into the shoulder or upper back are also common.

Many patients don’t connect their neck pain to their concussion. They may have been told to focus on brain rest and symptom management while the neck was never assessed. This is a significant gap in care, because the cervical spine plays a critical role in concussion recovery.

Why Concussions Injure the Neck

Any force strong enough to cause a concussion is strong enough to injure the cervical spine. Whether it’s a car accident, a sports collision, a fall, or a blow to the head, the neck absorbs the same rapid acceleration and deceleration forces as the brain.

This creates what is essentially a whiplash injury happening at the same time as a concussion. The cervical spine structures most commonly affected include the following.

Facet joints are the small paired joints on the back of each vertebra that guide neck movement. These joints can become irritated, inflamed, or restricted after trauma. Facet joint dysfunction is one of the most common causes of post-concussion neck pain and headaches.

Deep cervical muscles are the small, deep muscles that stabilize the cervical spine and contain high concentrations of proprioceptors. These muscles are particularly vulnerable to strain and often lose their ability to stabilize and coordinate movement after injury.

Upper cervical ligaments stabilize the upper cervical spine (C0-C2) and can be stretched or sprained during concussive forces, leading to increased joint laxity and altered movement patterns.

Intervertebral discs between cervical vertebrae can be compressed or irritated, contributing to pain and restricted motion.

The challenge is that concussion symptoms and cervical spine symptoms overlap significantly. Headache, dizziness, difficulty concentrating, and visual disturbance can all originate from the neck, and without a proper cervical spine assessment, the true source of symptoms may be missed.

How Neck Dysfunction Drives Other Concussion Symptoms

The cervical spine does far more than hold up your head. It’s a critical hub in the sensory network that coordinates balance, eye movement, spatial awareness, and even cognitive function.

Cervicogenic Headaches

Headaches are the most common concussion symptom, and many post-concussion headaches originate from the cervical spine rather than the brain. Dysfunction in the upper cervical facet joints (particularly C1-C3) can refer pain over the top of the head, behind the eyes, or into the temples. These headaches are often described as a dull ache that starts at the base of the skull and gets worse with sustained positions or neck movement.

Dizziness and Balance Problems

The proprioceptors in your cervical spine communicate constantly with your vestibular and visual systems. When cervical dysfunction disrupts these signals, your brain receives conflicting balance information. The result is cervicogenic dizziness, a sense of unsteadiness or disorientation that’s driven by the neck rather than the inner ear.

Visual Symptoms

The cervico-ocular reflex coordinates eye movement in response to neck movement. When cervical proprioception is impaired, this reflex becomes inaccurate, contributing to blurred vision, difficulty tracking, and eye strain.

Cognitive Fatigue

When your brain has to work harder to process inaccurate proprioceptive information from the neck, it uses up cognitive resources that would otherwise go toward thinking, concentrating, and remembering. This can amplify brain fog and mental fatigue.

A 2021 systematic review published in Sports Medicine confirmed that cervicogenic symptoms are present in up to 90% of persistent post-concussion cases and that neck pain at initial evaluation is a significant predictor of prolonged recovery.

How We Treat Post-Concussion Cervical Dysfunction

Chiropractic Adjustments and Mobilization

Spinal adjustments and mobilization are the foundation of treatment for post-concussion cervical dysfunction. These techniques restore normal movement to restricted joints, reduce irritation, and improve the proprioceptive signals that your brain relies on.

Treatment is tailored to your specific presentation. Some patients respond best to gentle mobilization techniques, while others benefit from more targeted adjustments. The approach depends on the severity of dysfunction, the stage of recovery, and your comfort level.

Research supports this approach. A retrospective analysis in the International Journal of Sports Physical Therapy found that addressing cervical dysfunction early, within the first three weeks after injury, followed by integrated vestibular therapy, produced improvements across multiple symptom systems. A randomized controlled trial by Schneider et al. found that patients who received combined cervical and vestibular rehabilitation were nearly four times more likely to return to full activity within eight weeks.

A 2024 proof-of-concept trial also found that cervical spine mobilization produces measurable physiological changes. Upper cervical mobilization increased parasympathetic nervous system activity, while lower cervical mobilization reduced cortisol levels. Both responses support the healing environment your body needs after concussion.

Soft Tissue Therapy

The muscles surrounding the cervical spine often develop tension, trigger points, and guarding patterns after concussive trauma. Soft tissue therapy helps release these restrictions, improve blood flow, and reduce the muscle tension that contributes to headaches and stiffness.

Functional Rehabilitation

Manual therapy alone isn’t enough for a complete recovery. The deep cervical muscles that stabilize your spine and provide proprioceptive information need to be actively retrained. This is where functional rehabilitation becomes essential.

Exercises That Help

Deep cervical flexor activation targets the small muscles at the front of the cervical spine that play a critical role in stability and posture. After concussive injury, these muscles often become inhibited, meaning they stop activating properly. Specific low-load exercises retrain these muscles to support the neck effectively. This is one of the most well-supported exercise interventions for cervical spine rehabilitation.

Cervical joint position sense training involves closing your eyes, turning your head, and then trying to return it to the starting position accurately. This retrains the proprioceptive system in your neck, the same system that, when impaired, contributes to dizziness, visual problems, and cognitive fatigue. Improving joint position sense reduces the conflicting signals your brain has to sort through.

Cervical range of motion exercises are controlled, progressive exercises that gradually restore full neck movement. These may include active rotation, flexion, extension, and lateral flexion performed within comfortable ranges and gradually progressed as symptoms allow.

Cervical and scapular strengthening builds up the muscles that support the neck and upper back, helping distribute load more effectively and reducing strain on cervical spine structures. These exercises typically target the deep cervical extensors, lower trapezius, and serratus anterior.

Graded aerobic exercise at sub-symptom threshold intensity improves blood flow, reduces neuroinflammation, and supports autonomic nervous system recovery. For patients with cervical dysfunction, aerobic exercise also helps reduce the muscle tension and guarding that perpetuate neck pain.

Postural education and ergonomic strategies address a common problem. Many post-concussion patients find that sustained positions, particularly sitting at a computer or looking down at a phone, aggravate their neck symptoms. Targeted postural strategies can significantly reduce the daily load on the cervical spine and prevent symptom flare-ups.

When to Seek Care

If your neck pain started after a concussion or head injury and hasn’t resolved, if you’re getting headaches that start at the base of the skull, if neck stiffness is limiting your ability to turn your head, if your dizziness or visual symptoms get worse with neck movement, if your other concussion symptoms have improved but your neck hasn’t, or if you were treated for a concussion but your neck was never assessed, it’s time to get it looked at.

The cervical spine is too important to concussion recovery to be ignored. A thorough assessment can determine whether your neck is contributing to your symptoms, and targeted treatment can often produce rapid improvement.

Evidence and Sources

1. Cheever K et al. The role of cervical symptoms in post-concussion management: a systematic review. Sports Medicine. 2021.
2. Reneker JC et al. Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International Journal of Sports Physical Therapy. 2021.
3. Hides L et al. Autonomic nervous system and endocrine system response to upper or lower cervical spine mobilization in males with persistent post-concussion symptoms: a proof-of-concept trial. Journal of Manual & Manipulative Therapy. 2024.
4. Langevin P et al. Cervical spine sensorimotor deficits persist in people post-concussion despite minimal symptoms. Musculoskeletal Science and Practice. 2024.
5. Schneider KJ et al. Physical therapy evaluation and treatment after concussion/mild traumatic brain injury: clinical practice guidelines. Journal of Orthopaedic & Sports Physical Therapy. 2020.
6. Cade A, Turnbull D. Effect of chiropractic intervention on oculomotor and attentional visual outcomes in young adults with long-term mild traumatic brain injury: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics. 2024.
7. Marshall CM et al. Multi-modal management of sport and non-sport related concussion by chiropractic sports specialists: a case series. BMC Musculoskeletal Disorders. 2021.
8. Kennedy E et al. Characterization of cervical spine impairments in children and adolescents post-concussion. International Journal of Sports Physical Therapy. 2019.
9. Schneider KJ et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. British Journal of Sports Medicine. 2014.