The diagram schematically shows the relationships between some of the senses involved in post-concussion symptoms.
The diagram explains why symptoms such as headaches, light sensitivity, sound sensitivity or balance can be sourced in many different places.
Each one of the symptoms can be caused or located at the sense organ in the diagram be it the head/brain, brainstem, eyes, hearing, neck or balance centre.
The arrows show reflex pathways or communication lines between the centres. You can see the connections between the sense organs.
The interconnection between the senses in the diagram shows how there can be a different system causing the symptoms in what would logically be the equivalent sensory organ, such as the eyes. In concussion, it is not that often that the sense organ is the primary cause for the symptoms.
Some vision difficulties, for example, can be sourced in part or all at seemingly unrelated sensory system locations and yes, the neck/brainstem is a player in vision.
Light sensitivity, for example, can be the result of various kinds of visual processing or communication difficulties in the brain because of damage to neural pathways from the concussion. The literature suggest that the organ of the eye contributes only 20% of all we see.
For example, visual object location is a composite of information from the organ of the eye and integration of visual processing in the brain. It includes integrating visual information with the auditory equivalent of object location in the hearing centre in the brain and the organ for hearing. The combined visual and hearing information is compared with information about head /body position and movement including the direction of air across the face or ear. All the information is cross matched with data in the emotional centre in the brain and in the area of the brain for working memory. This example is a simplification of the multiplicity of components that combine to give us sight. The same complexity of interconnection exists for hearing, balance, smell and so on.
Clinical tests can show that vision is affected by the neck / brain stem and that the neck/ brain stem is a location for headaches and poor balance.
Clinical tests can show the cranial bones affect vision, neck pain, less often hearing, and it is often a source for headaches.
Clinical tests show that the cervical spine and hearing affect balance and vertigo as distinct from the balance or vestibular centre.
If the vestibular organ is the same as the eye, that is, it contributes 20% of balance control, then the source of balance dysfunction is more likely to be found in the multitude of communication pathways between the senses in the brain than in the organ for balance.
A neuro radiologist colleague has said many times to this therapist that no concussion is the same and because of this there is a separate protocol for concussion evaluations combining PET scan with 3T MRI imaging. This combination of brain imaging can clearly show damaged brain cells and areas of the brain not working. The physiological findings using this imaging protocol shows traumatic brain injuries have no pattern for injury location or laterality. It can affect the white matter or grey matter and be widespread and diffuse nature.
The diffuse nature of the injury and multiple locations explains why neurological evaluations using cranial nerve tests fail to find anything wrong. The wrong interpretation is that that there is nothing wrong. A better interpretation is that the tests could not find a location for the concussion client’s symptoms. A similar conclusion can be drawn for TBI with routine MRI imaging on older MRI machines.
Finally, neuropsychological evaluations are routine in the concussion world and highly valued. They are based on normative data. Bright clever individuals are routinely told that their brains are working fine and yet they continue to report that they have memory difficulties, slowed cognition, loss of cognitive flexibility and in some total loss of visual memory or visualisation ability. One reason for the difference between the expert findings and the client is that the expert does not have a pre-accident base-line for the client. The protocol cannot quantify the loss for the individual. So-called normal individuals are told everything is ok. The loss the individual has sustained goes undetected.
The brain is complex. Concussion injuries are complex which means assessments and treatments need to reflect that complexity and interconnectivity. It also means that some test protocols can’t explain why some symptoms persist.
Do you sometimes feel stuck or numb or want to escape and deny your challenges because you are afraid?
Fear was necessary centuries ago when we hunted or were hunted. We needed this keen awareness to be alert to find food and stay alive.
Today, we shop at stores with lots of choices for our food and most of us stay pretty safe. Every day normal is not a fight to physically survive unless we are critically ill, in an abusive relationship or live in a war-torn country.
Even though we are a long way away from our ancient days, inside of your brain, the amygdala or reptilian brain, still has the same fear loop or program that your predecessors had. Although your brain has developed much more advanced circuitry for executive functions, your amygdala is still present and active.
Only instead of firing up when a saber-toothed tiger is nearby, this fear loop responds to modern alarms like public speaking, fear of flying or heights, fear of rejection, starting your new book or business or failing an important test.
The trigger may be different, but the fear response is the same.
Fortunately, with your growth of awareness now, you can be the master — not your reptilian brain.
Unfortunately, sometimes the mind abducts your awareness and your unconscious past habitual patterns take over.
So, when you notice that fear or anxiety has taken over your thoughts and emotions, apply your awareness and choose to follow these steps:
SERENE MIND PRACTICE
STEP 1 Choose to Pause by first closing your eyes; it stops the mind’s irrational thinking and emotional stream. This is the mind’s nature so just accept that this is what is happening in the moment. Pausing allows this to be observed like a witness.
STEP 2 Next, turn your awareness to your breath. This further stops the mind from high jacking your attention.
Take 3 conscious breaths as follows: Deeply inhale by pushing your abdomen out and using the full length of your lungs. Make the exhalation slow and long, about twice as long as the inhalation as you bring in your abdomen closer to your spine. Keep your awareness on the flow of air at your nostrils to be fully engaged in this breath awareness. If your mind moves, gently come back to your breath and be gentle with yourself. Stay with the breath awareness if you need to take a bit longer to become more calm.
STEP 3 Recognise the exact emotion that is arising inyou now; that fear within you at the moment. There is no need to do anything with it except to acknowledge it. This will engage the secret power of your consciousness.
STEP 4 Notice the direction of the movement of your thinking. Is it entangled in the past or in the future?
STEP 5 Now, move your attention to the centre of your eyebrows and picture a tiny gold flame. Visualise, feel or sense this flame moving inward to the middle of your brain and stay with this for a short while. Then slowly open your eyes.
This seemingly simple process activates the brain area that reacts without thought and tones it down. In physically unsafe situations, it could grow your calm courage to assist you in making a different decision.
If you are still feeling fearful, simply repeat the process until it starts to abate and slow down and you can engage in the activity that needs your attention. You can repeat this as often as you desire. The repeated practice over time will clear the mind of fear or disappointment or sadness or anxiety or any negative emotion and brings you to a state of calm and peace.
It is the first stage of an advanced consciousness technique to move you from unconscious feeling and reacting to a more conscious present moment state of awareness and being. This will assist you to become a more clear thinker and be more able to effortlessly take the next steps in your success.
We have several East Indian friends attending our weekly meditation evenings and when we shared a new brain exercise we learned in India last year, they all giggled and shared that it isn't new; in fact it is quite an ancient practice taught to all children. However, they also said that because it takes a bit of focus and physical exertion their parents used it as a punitive tool when they would misbehave. Quite clever I think to use something that is actually good for the child while setting clear boundaries. Something we should think about for our selves, eh?
In the west, this old practice has been adopted and renamed Super Brain Yoga by some. Here are some of the benefits of doing this regular exercise:
- energises and activates the brain power by synchronising alpha
brain waves (can enhance exam scores)
- decrease psychological stress (improves disruptive behaviour
- Increases intelligence and creative skills (more focused)
- promotes overall functioning of brain power (supports autism,
aspergers, and any learning disabilities)
- releases tension and calms brain (relieves depression and anxiety
levels) (helps in partial cleansing of mental stress)
- transforms low energy into higher forms of energy (increases flow
of energy in the body)
- become well-balanced and have clear thinking
- supports spiritual growth and maturity
- regulates and improves sex drive
- increases inner peace of mind
- great quad workout
Precautions: don't do on a unrested mind (angry, sad, etc)
- take off all jewellery as it distracts the energy
- practice in a quiet room
- keep good posture-stand straight and keep head down
How To Do This Ancient Mid-Brain Activation Practice
1. Facing eastward (elders face north)
2. Take left arm and grab the right earlobe, thumb facing out
3. Take right arm and grab the left earlobe, thumb facing out
4. Put your tongue up to the palette
5. Keeping focused, inhale and squat down and then lift the heels
6. Exhaling, come up and put heels down
7. Repeat for 14 times for 1 minute
8. Do this every day
Although the Indian practice is slightly different and is coupled with further breathing exercises and inner meditations, the physical aspect is the same.
You can finish off your exercise with a few minutes of conscious breathing. (See this post)
There are many layers to us that make up our ability to encounter all manner of experiences in life. One structure is called the triangle of relaxation made up of the mind, energy and breath. What happens in one aspect affects the other two and same for the others. We cannot control our mind nor our energy but we can control and affect our breath. Therefore, this is one way we can bring some measure of command over our personal experience.
For example, if you are angry, the breath becomes fast. If you are frightened, the body contracts and the rhythm of the breathing changes. Not only that, but your energy rises or falls depending on the emotion and the breath and you feel high or low. Similarly, when you become aware of your breathing when you are angry, etc. your breathing automatically becomes normal and you calm down and the energies are also fine. You feel more alright or energetic.
Below is a very powerful meditation using the breath and the fingers which also affect the brain action. Engaging in this practice daily, begins to bring calm, restfulness and clarity. It also empowers your ability to bring about change in your life thru the power of intention.
What is the Brainstem & Autonomic Nervous System Dysfunction and use of the Treadmill Test for Sub-Clinical Progressive Exercise Training
During a concussion or traumatic brain injury, the soft jelly-like brain tissue is bumped against the inside of the skull causing injury to the nerve tissue of the brain or hemispheres. What is often overlooked is that the two brain hemispheres receive information via a long tube of nerves called the spinal cord. At the very top, just before this cord blends with the two hemispheres there is a section called the brainstem.
The brainstem has integrative functions being involved in cardiovascular system control, respiratory control, pain sensitivity control, alertness and awareness. Thus, brainstem damage is a very serious and often life-threatening problem. It also regulates the central nervous system, and is pivotal in maintaining consciousness and regulating the sleep cycle. So, the brainstem has many basic functions including heart rate, breathing, sleeping, and eating. Damage of the brainstem can result in abnormalities in the function of cranial nerves that may lead to visual disturbances, pupil abnormalities, changes in sensation, muscle weakness, hearing problems, vertigo, swallowing and speech difficulty, migraine, voice change and co-ordination problems.
This brainstem or tail-like structure at the bottom of the rounded brain hemispheres gets stretched and pulled when the head and the brain inside the head gets flicked forwards and backwards during a fall or a blow to the head. The brainstem is like a cord or rope that is attached to a ball. When the ball gets thrown or kicked that rope or cord gets yanked and pulled where it joins the ball.
The difference between a rope and ball versus the brain and the spinal cord is that the spinal cord is made of clusters of soft jelly strings similar in function to telephone wires carrying information to and from the brain to the body. The brainstem starts level with the bottom of the first neck bone which is 2-3 cm below the bottom of the head. So, the brainstem is not all contained nor protected by the skull. Therefore, the sudden rapid stretching and pulling on the brainstem and spinal cord damages those information pathways.
The brainstem is critical in that most of the bodies automatic activities are controlled from here. Such things as blood pressure, body temperature regulation, breath rate, heart rate, blood flow to and activity of the digestive organs such as the stomach, spleen, liver, kidney, pancreas, the large and small intestines and more. The brainstem even has a direct effect on the hormonal system.
A key control system for the organs is the autonomic nervous system which originates in the brainstem. This autonomic system has two parts: the sympathetic part that is like the accelerator in the car which speeds up and readies all the organs, blood flow etc. for action while the other part, the parasympathetic system, is like the brake in a car; it slows everything down and starts the rest and repair phase after a period of high activity. These two parts dance a continuous dance; one responding to the other; one speeding things up the other controlling and slowing things down.
When the autonomic system is out of balance, concussion clients can have trouble controlling body temperature so they will be cold and sweating or they might have low energy because one or the other part of that system does not do its complementary part to balance heart rate or blood pressure. This is tiring and makes people feel unwell and unmotivated or they can’t think straight because their brains are trying to make sense of information that it can’t correct or control. Often concussion clients can feel like they are going to black out but never quite do. Other symptoms can be lethargy or in a constant state of high alert or panic. These are just some of the symptoms of autonomic nervous system dysfunction.
How does this get assessed?
A simple three-minute test with a plethysmograph gives a pretty good clue if one part of the system is not working nor enough power to bring the system back into balance.
The plethysmograph is followed up with a treadmill test or the treadmill test can be carried out on its own. This is a test where the client’s heart rate, concussion symptoms and how hard they feel like they are working are closely monitored. If there are sudden changes in any one of those three things; heart rate, effort or symptoms such as headaches increasing, then the test is stopped and a baseline or starting point for treatment using a treadmill or exercycle for a progressive sub-clinical exercise program has been found.
The idea behind the exercise program is to keep the heart working at a set rate forcing the two parts of the autonomic nervous system to work/dance as a complementary inseparable duo again.
The Max Pulse is a simple, user-friendly, non-invasive, FDA Class
II medical screening device. This simple 3-minute
plethysmograph reading which measures arterial plaque and
aging vascular health, heart rate variability, autonomic nervous
system readout of the overall balance between the sympathetic
and para-sympathetic system and physical stress readings of
stress. This gives us better information to more accurately
prescribe a comprehensive treatment protocol, especially when
rehabilitating from injuries.
Do you still have ongoing head, neck or shoulder pain?
Do you hurt while you drive and are you kept awake at night? Do you make your neck crack and a little while later rub at that sore hard spot that just does not want to go away?
When your head is not balanced on your neck properly the results are not just local neck and head pain but discomfort in many other places as well. An unbalanced head on neck can be the cause of low energy levels and reduce your sense of well being
Your atlas is the top neck bone and forms the foundation for your head to rest on. The Atlas is located behind your jaw, below the ear hole, under the earlobe and in front of the base of your head. In the right place the head and the atlas fit snugly one on top of the other. When your head does not rest on the first neck bone correctly, then your head gets shifted forwards, rotated and tilted off centre.
The result — your head is not on straight.
To use a car analogy; it is like not having your wheels aligned. You steer to go in one direction while the wheels and the rest of the car is set to go in another. When this happens in your car… you as the driver get tired because if you let go of the steering wheel the car veers off the road. Not only that… it causes wear and tear on tires, suspension and increases fuel consumption.
It is the same for the head except there are many more sensitive structures involved.
A mal-aligned head affects nerves to and from the brain; it also affects reflexes between your neck, eyes and balance system which can make you feel off balance, nauseous and sore.
Your unbalanced head / neck affect blood vessels to and from the brain and strain the muscles and ligaments that hold your 5kg head on top of your neck.
Your five kg head is literally balanced on two small surfaces the size of the pad of the tip of your little finger.
Your unbalanced head causes other vertebrae or spinal bones to compensate by twisting and turning. This twisting compensation is called a scoliosis and your compensatory scoliosis often gets blamed for the pain and discomfort you have.
Additionally your spinal muscles have to work hard so that your feet and head both go in the same direction. The scoliosis makes it difficult to line your head up with your feet.
Over time your muscles, ligaments and nerves become overworked and sore …causing discomfort in places other than close to the neck.
For example, there is one nerve called the vagus nerve, (vagus means wandering….. you guessed it the vagus nerve goes to many places). Your vagus nerve goes to the ears, the lungs, the heart, large intestine, small intestine and that is not all!
The vagus nerve passes just in front of the atlas bone.
In the mal aligned twisted position the atlas can put pressure or stretch the vagus nerve so it can’t work properly.
Can you now more clearly see why a small mal positioned bone under your head can cause a problem as far away as your large intestine?
The vagus nerve is just one nerve; there are more nerves, muscles and ligaments which connect to the head and atlas that have connections a long way away from your head.
There is evidence that not having your head on straight can affect your moods, your ability to concentrate, your sleep and energy levels.
So it is vital to have your high neck checked out particularly since many practitioners don’t do so even if they are allied health practitioners focusing on spinal problems.
No, it’s not a cure all but unless you get your head positioned straight, you will never know if your head, neck, shoulder and tummy pain are all linked to your unbalanced head and atlas.
First Get Assessed for your Head and Neck by a Certified and Trained Practitioner who knows Atlas work.
Next post: What is the brainstem and the autonomic nervous system?
A seasoned vestibular & neuro physiotherapist with close to 40 yrs clinical experience with a special focus on concussion, head, neck and upper spine pain.