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How Undiagnosed Atlantoaxial Instability Can Cause Post-Concussive Symptoms

Concussions, often referred to as mild traumatic brain injuries (mTBIs), have garnered increased attention in recent years, thanks to growing awareness about sports-related head injuries and their potential long-term consequences. While the immediate symptoms of a concussion are well-documented, there's a lesser-known aspect of post-concussive symptoms that deserves our attention: undiagnosed Atlantoaxial Instability (AAI). In this blog post, we'll explore what AAI is, its connection to post-concussive symptoms, and why it's crucial to consider this condition in the assessment and treatment of concussions.


Understanding Atlantoaxial Instability (AAI)

The atlas (C1) and axis (C2) are the first two cervical vertebrae at the top of the spine. These vertebrae play a crucial role in supporting the head and facilitating various head movements. The joint formed by the atlas and axis, known as the atlantoaxial joint, allows for rotation and flexion of the head.

Atlantoaxial Instability (AAI) is a condition characterized by excessive movement or instability of this joint. It can result from congenital anomalies, trauma, or degenerative changes in the ligaments that support the joint. AAI can be asymptomatic in some cases, but in others, it can lead to a range of symptoms, including neck pain, headaches, and neurological issues.


The Connection Between AAI and Concussions

Concussions often occur due to a blow or jolt to the head or body, causing the brain to move within the skull. While many people associate concussions with immediate symptoms like headache, dizziness, and memory problems, what's less known is that concussions can also affect the cervical spine, including the atlantoaxial joint.

When a concussion occurs, the rapid movement of the head and neck can place significant stress on the cervical spine, potentially leading to injury or exacerbating pre-existing conditions like AAI. Conversely, individuals with undiagnosed AAI may be at a higher risk of experiencing more severe or persistent post-concussive symptoms.


The Link to Post-Concussive Symptoms

Post-concussive symptoms can be diverse and vary from person to person. They may include:

  • Headaches: Persistent or worsening headaches are a common symptom of both concussions and AAI. These headaches can be severe and debilitating.
  • Neck Pain: Neck pain is a hallmark symptom of AAI, and it can also be exacerbated by the neck trauma associated with concussions.
  • Dizziness and Balance Issues: AAI can affect the nervous system, leading to dizziness and balance problems, which are also commonly reported post-concussion symptoms.
  • Cognitive Difficulties: Both concussions and AAI can impact cognitive function, leading to difficulties with memory, concentration, and mental clarity.
  • Nausea and Sensory Sensitivities: Sensory sensitivities like light and noise sensitivity, as well as nausea, can be part of both post-concussive and AAI symptom profiles.
  • Fatigue: Fatigue is a prevalent symptom after a concussion and can also result from the body's efforts to compensate for the instability caused by AAI.


Why Consider AAI in Post-Concussion Assessment

Undiagnosed AAI can lead to prolonged and persistent post-concussive symptoms. This is because the instability in the atlantoaxial joint can interfere with the body's natural healing processes, making it challenging for individuals to recover fully from their concussions.

Dr. B, with his extensive experience, has long recognized the importance of evaluating the cervical spine, including the atlantoaxial joint, in individuals with post-concussive symptoms. While standard concussion assessments often focus primarily on the head and brain, understanding the potential role of AAI in exacerbating or prolonging symptoms is crucial.


Treatment Options for AAI

When AAI is identified as a contributing factor to post-concussive symptoms, appropriate treatment becomes essential. The treatment approach may vary depending on the severity of AAI and the individual's specific circumstances. Treatment options may include:

  • Physical Therapy: Physical therapy can help strengthen the neck muscles and improve stability around the atlantoaxial joint.
  • Bracing: In some cases, a cervical brace or collar may be prescribed to limit movement and provide support to the neck.
  • Surgery: Severe cases of AAI may require surgical intervention to stabilize the atlantoaxial joint and relieve symptoms.
  • Medications: Medications may be prescribed to manage pain and inflammation associated with AAI.
  • Chiropractic Care: Chiropractic techniques, such as NUCCA (National Upper Cervical Chiropractic Association), can help realign the upper cervical spine, potentially reducing AAI-related symptoms.


The relationship between undiagnosed Atlantoaxial Instability and post-concussive symptoms is a complex and often overlooked aspect of concussion management. Dr. B's extensive experience underscores the importance of considering AAI as a potential contributor to persistent symptoms following a concussion. By addressing AAI alongside other aspects of concussion care, we can provide individuals with a more comprehensive and effective approach to their recovery, ultimately improving their quality of life and well-being. If you or someone you know is experiencing lingering post-concussive symptoms, it's crucial to consult with a healthcare professional who understands the potential role of AAI in the recovery process.