Finding Clarity After the Crash, Part 2: How We Treat Concussion After a Car Accident

A patient guide from Dr. Verg Chiropractic, serving Vancouver, WA and Clackamas, OR

Concussion treatment is hard to study. Every crash is different, every brain heals on its own schedule, and it is difficult to build a controlled trial around something you cannot see on a scan. So this part is written mostly from experience: what Dr. Verg does with concussion patients in our clinic, and why.

What chiropractic can and cannot do

Chiropractic care does not directly cure structural brain tissue micro-lesions or acute cerebral contusions. Chiropractic adjustments cannot fix inner-ear membrane ruptures or central vestibular strokes, and manual therapy is not a replacement for formal speech or neuropsychological therapy.

What it can do: auto impacts almost always injure the neck at the same time, with soft tissue damage, facet joint strain, and ligament micro-failure in the cervical spine. Those neck injuries feed the headaches, dizziness and muscle guarding that make a concussion feel worse. Severe neck pain and altered muscle recruitment in the upper trapezius and suboccipital muscles also consume cognitive bandwidth, so calming them helps unburden the brain.

In Dr. Verg’s words: “The correction of the cervical spine helps us with head pains. Not only in whiplash, as happens in an accident, but also in concussion. From every joint, nerve endings send a signal to our brain. When the brain itself is injured, manipulation is a good treatment to restore function. Not only pain, but also the function of our head.”

Research supports the idea that spinal adjustments change how the brain works, not just how the neck feels:

• Cervical spine dysfunction after brain injury: a randomized controlled trial published in the Journal of Manipulative and Physiological Therapeutics (2024) studied 40 young adults (ages 18 to 35) whose concussion symptoms had lasted more than three months, about a year on average. Chiropractic care significantly improved visual outcomes such as gaze stability, reinforcing that ongoing post-traumatic visual symptoms can stem from underlying cervical spine dysfunction (Cade & Turnbull, 2024). See “How the neck talks to the eyes and brain” in Step 3 for the details.
• In the prefrontal cortex: a single session of spinal manipulation reduced activity in the prefrontal cortex, the brain area that coordinates incoming sensation with movement, by about 20%. No change was seen after a control session (Lelic et al., 2016).
• In brain drive to the muscles: after spinal manipulation, the brain’s signal to arm and leg muscles increased by about 45% to 55%, with no change after a control session (Haavik et al., 2016).
• In body position sense and balance: adjusting the neck changed how accurately people sensed the position of their elbow (Haavik & Murphy, 2011), and chiropractic care improved sensorimotor functions linked to fall risk (Holt et al., 2016).

As the authors of the 2024 trial put it: “Once spinal dysfunction is corrected, the sensorimotor integration and cognitive function can improve.”

Step 1: Rest first, but only for a short time

Historical advice after a car crash often involved prolonged bed rest and rigid neck collars. Modern sports and trauma medicine confirms that prolonged immobilization delays tissue healing, weakens the neck’s stabilizing muscles, and increases fear of movement.

In the first one to two weeks, though, the brain does need rest. Dr. Verg commonly takes concussion patients off work for one to two weeks, and longer for jobs where mistakes are costly. “I have taken you off work because we had the concussion. We can’t make big mistakes there.” For one busy business owner, he asked that someone else plan his tasks for a while so “his brain can rest.”

He takes this seriously because concussions add up. In a study of 2,905 college football players, those with three or more previous concussions were three times as likely to have another one, and their symptoms were about twice as likely to last more than a week (Guskiewicz et al., 2003). In high school athletes, a history of three concussions made a severe on-field presentation (loss of consciousness, amnesia, confusion) 9.3 times more likely (Collins et al., 2002). Timing matters most. In young patients seen in the emergency room, a concussion within the past year nearly tripled recovery time (35 days versus 12), while a single concussion more than a year earlier made no difference (Eisenberg et al., 2013).

Dr. Verg’s view: “Concussions are usually cumulative. That has been shown in the literature. But I believe it’s because those people didn’t take the full time they needed to heal.” The research fits what he sees: the real danger is a new injury before the last one has fully healed.

That is why we would rather give the brain a full two weeks now than have a patient back in our office with a second, slower injury.

After that, patients return gradually: light duty, shorter days (for example, 4 to 5 hours), and a 10-minute break every hour.

Step 2: Gentle neck, jaw and head care

• Gentle first. When the neck is inflamed, Dr. Verg uses gentle mobilization, low-force instrument (Activator) adjustments, and light traction. For the top bone of the neck (C1, the atlas), he adjusts from the front with no twisting of the neck. Low-force, non-thrust techniques are used especially with senior patients, pregnant patients, or those in acute post-collision distress, so treatment stays well within tissue tolerance.
• Traction and decompression for headaches. Patients often feel it on the table. As he asked one patient during traction, “Does your head feel lighter?” Many headaches after a crash come from irritated nerves in the upper neck (the greater occipital nerve), and pressing on the upper neck can reproduce the headache during the exam.
• Listening to the body. Neck exercises are done only as long as discomfort does not turn into a headache. When one patient’s ear ringing flared with traction, we stopped it and switched to gentler decompression and mobilization.
• The jaw (TMJ). Crashes often strain the jaw joint, and a strained jaw tightens the muscles that drive headaches. “There is a disc and there are ligaments that form the joint capsule. When there are adhesions or swelling, it starts to tighten, and the lack of right movement of the jaw tightens the muscles.” Dr. Verg treats this with gentle jaw adjustments, including from inside the mouth, and sometimes a night mouth guard.
• Cranial (skull bone) work. Dr. Verg uses gentle pressure techniques on the bones and sutures of the skull “so that the head begins to restore itself.”
• Supportive bracing. A soft collar, mostly at night, “prevents sudden movements” while tissues heal. This is short-term support, not long-term immobilization.

Step 3: Retrain balance and vision

Feeling lightheaded, off-balance, or floating when you turn your head is one of the most debilitating symptoms after a collision. This dizziness often comes from a mismatch between what the eyes see, what the inner ear senses, and what the neck joints report, known as cervicovestibular mismatch.

• The scientific evidence: In the Journal of Rehabilitation Medicine, Treleaven, Jull, and Sterling (2003) evaluated joint position error and balance in post-collision patients. They found that 75% of chronic post-collision sufferers experienced dizziness, which correlated with impaired neck joint position sense and head-repositioning inaccuracy compared to healthy controls.
• The upper neck joints contain the body’s highest concentration of position sensors (mechanoreceptors). Individualized neck mobilization, gentle alignment, and eye-head-neck coordination exercises help recalibrate the position signals going to the brainstem.

How the neck talks to the eyes and brain

Neck pain and measurable neck dysfunction are more common in people who have had a concussion (King et al., 2020, 2022). That matters because the neck is part of the system that keeps your vision steady:

• The neck helps steady the eyes. Position sensors in the neck feed the reflexes that keep your eyes locked on a target while your head moves. One is the cervico-ocular reflex, and the neck also contributes to the inner ear’s vestibulo-ocular reflex (Panichi et al., 2011).
• Faulty neck signals confuse the brain. When an injured neck sends signals that don’t agree with what the eyes and inner ear report, the brain may start to ignore them. That leaves the eyes with less information to stay steady (Peterka, 2002). Restoring normal neck motion may give the brain reliable signals again.
• What changed in the 2024 trial with chiropractic treatment. The 40 participants were randomly assigned to chiropractic adjustments or to a control that went through the same movements and setup positions without the adjustment. Each chiropractor adjusted the joints that needed it anywhere in the spine, about four areas per person. Compared with the control group, the chiropractic group:
  • held a steadier gaze while looking at a fixed point
  • kept the eyes steadier while turning the head (the vestibulo-ocular reflex)
  • moved the eyes to a new target faster, about 50 milliseconds faster versus about 17 in the control group
  • held up better on a timed word-reading attention task (the Stroop test)
• What did not improve. Smooth eye tracking of a moving target got slightly worse. The authors explain that smooth tracking runs through brain areas that rely on vision and the inner ear rather than neck sensors, and those areas may have reduced blood flow and energy after a brain injury (see Part 1, “Why standard scans look normal”). This is why we pair neck care with vision rehab: each treats a different part of the problem.

Dr. Verg’s view: this matches what he sees on exam. Many of our patients with dizziness, car sickness or trouble focusing also have a stiff, injured neck, and their eye and balance findings improve as the neck is treated. Patients whose tracking problems persist are referred for visual occupational therapy.

What Dr. Verg prescribes for home:

• “Always practice balance.” Stand on one foot. Brush your teeth with your feet together and your eyes closed.
• Belly bracing to “train the brain,” and finger coordination exercises.
• Brain games: word games, crosswords, eye-movement games.
• Vision rehab. When light sensitivity or nausea in the car persists, “visual therapy is the key.” Nausea while driving “means the visual reflexes are off. The body is not able to ignore all the movement and focus on something.” We refer to visual occupational therapy, and the focusing reflex “can be trained.”
• Inner-ear causes. If the dizziness is the common inner-ear type (BPPV), we use the Epley maneuver. We also use gentle Eustachian tube mobilization for patients with a plugged ear and dizziness.

Dizziness typically resolves gradually as joint mobility and balance retraining progress.

Step 4: Move every day

A prospective randomized controlled trial by Bunketorp et al. (2006) in Clinical Rehabilitation compared supervised, tailored physical training against self-administered home care in post-collision patients. Patients in supervised, active rehabilitation showed significantly faster improvements in self-efficacy, a greater reduction in pain disability (P = 0.03), and less medication use.

Dr. Verg’s most common prescription is walking: 30 to 60 minutes a day, increased gradually. “That’s going to be really good for the brain and the body.” Return to harder exercise is gradual too. If headaches keep coming back with exercise, he looks deeper, including for raised pressure inside the skull. Care moves from passive pain relief toward active, guided rehabilitation: deep neck flexor training, progressive range of motion, and core bracing.

Step 5: Feed the brain

After a concussion the brain goes through an “energy crisis.” Injured brain cells need more fuel (ATP and glucose) at the same time that blood flow to the brain drops (Giza & Hovda, 2001, 2014; Bergsneider et al., 2000). What you eat can ease that shortfall or make it worse. Our approach can be summed up as “feed the brain, starve the concussion” (Erdman et al., 2011).

• Cut sugar and refined carbohydrates. White flour and white sugar cause a fast spike and then a drop in blood sugar. That drop leaves brain cells short of energy and can contribute to insulin resistance in the cells (De La Monte & Wands, 2008). Dr. Verg asks patients to cut sweets, white bread, pasta and fruit, especially in the first two weeks. “We want the brain to heal.”
• What about keto? Ketogenic and Atkins-type diets are well studied as therapy for hard-to-control epilepsy (Kinsman et al., 1992; Freeman et al., 1998; Hemingway et al., 2001; Kossoff et al., 2003, 2006). They are not an established concussion treatment, so we use them only case by case.
• Healthy fats for the brain’s power plants. Extra virgin olive oil and olives, avocados, coconut oil and omega-3 fats support the mitochondria, the parts of the cell that make energy (Herbst et al., 2014; Storm, 2015).
• High-DHA fish oil. In adolescents with sport-related concussion, 2 g a day of DHA reduced total symptom severity and shortened the time to return to play (Monti et al., 2024; Feinberg et al., 2023). Dr. Verg typically recommends 4,000 mg a day of a high-DHA fish oil, and up to 6,000 to 8,000 mg in split doses for more significant injuries.
• Energy co-factors. B vitamins (B1, B2, B3, B5), magnesium (about 500 mg a day), chromium, creatine and CoQ10 help the steps cells use to make energy (Hoane et al., 2005; Goffus et al., 2010; Burd et al., 2010; McMorris et al., 2007; Gaby, 2010).
• Anti-inflammatory nutrients. Vitamin D3, vitamin E, vitamin C, curcumin (turmeric), ginger, green tea, rutin and resveratrol help neutralize free radicals and calm post-injury inflammation.
• Water, electrolytes and sleep. Drink more water, keep electrolytes up, and use sleep support such as magnesium or a melatonin/GABA lozenge when needed.

Choose supplements and doses with your provider, especially if you take blood thinners or other medications.

Step 6: Care for the emotional injury

A crash is frightening, and a concussion makes the brain more reactive. Patients tell us about avoiding the road where it happened, panic, and fear of driving. “I had patients that would avoid certain roads for years.” We refer to trauma counselors (including EMDR) and teach a simple breathing exercise: breathe in through the nose for 4 seconds, out through pursed lips for 6 seconds, 10 times, practiced when calm so it works when you need it.

Dr. Verg also helps patients reframe the frustration of a slow brain: “The brain inflames not only because of the injury, but because that’s the process of healing as well. So we can use that to re-establish different pathways. When the frustration comes, think: my brain is relearning something new, and long term it’s going to be good.”

Step 7: Work as a team

Post-concussion recovery works best through a collaborative care model. We refer patients to concussion specialists, neurologists, vision and occupational therapists, physical medicine (PM&R), psychologists, and pain specialists when needed. For stubborn post-concussion headaches, a specialist can offer further options, such as nerve blocks or Botox.

Continue to Part 3: Real Concussion Recovery Stories

Supportive, non-surgical care in Vancouver, WA & Clackamas, OR

If you or a loved one are struggling with lingering headaches, dizziness, or brain fog after a motor vehicle accident, you do not have to navigate recovery alone. At Dr. Verg Chiropractic, we provide comprehensive, non-surgical evaluations tailored to your specific injury history and recovery goals.

What we offer auto accident patients:

• Complimentary new-patient consultation: Discuss your crash history and symptoms with our team to explore whether our non-surgical approach is right for you.
• A concussion screen at every car accident exam, whether or not you hit your head.
• Direct insurance claim handling: We work directly with auto insurance Personal Injury Protection (PIP) claims, handling paperwork so you can focus entirely on healing.
• Multilingual care team: To best serve our diverse local communities in Clark and Clackamas counties, our compassionate staff offers fluent care in English, Ukrainian (Українська), and Russian (Русский).

Visit one of our convenient clinic locations:

• Vancouver, WA clinic: 109 SE 101st Ave, Vancouver, WA 98664. Phone: (360) 203-6000
• Portland / Clackamas, OR clinic: 10001 SE Sunnyside Rd #120, Clackamas, OR 97015. Phone: (503) 386-9819

Call today to schedule your complimentary evaluation and take the first confident step toward lasting recovery.

Medical disclaimer

This article is provided for educational and informational purposes only and does not constitute formal medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider regarding any medical condition or post-accident symptoms. Never disregard professional medical advice or delay seeking it because of something you have read in this article. If you suspect you have an acute brain injury or neurological emergency, or wish to adjust prescribed medications or supplements, consult your primary care physician or emergency medical services immediately.

References

• Bunketorp L, Lindh M, Carlsson J, Stener-Victorin E. The effectiveness of a supervised physical training model tailored to the individual needs of patients with whiplash-associated disorders: a randomized trial. Clinical Rehabilitation. 2006;20(3):201-217.
• Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. Journal of Rehabilitation Medicine. 2003;35(1):36-43.

Added references: cumulative concussion

• Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):2549-2555.abstract
• Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery. 2002;51(5):1175-1179.abstract
• Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013;132(1):8-17.summary

Added references: spinal manipulation and brain function

• Cade AE, Turnbull PRK. 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;47(1-4):1-11.atlas.chiro.org
• Lelic D, Niazi IK, Holt K, Jochumsen M, Dremstrup K, Yielder P, Murphy B, Drewes AM, Haavik H. Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: a brain source localization study. Neural Plasticity. 2016;2016:3704964.PMC
• Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of spinal manipulation on cortical drive to upper and lower limb muscles. Brain Sciences. 2016;7(1):2.

Cited within Cade & Turnbull, 2024 (full citations are in that paper’s reference list)

• Haavik H, Murphy B, 2011: cervical manipulation alters elbow joint position sense in subclinical neck pain
• Holt KR et al., 2016: chiropractic care and sensorimotor function associated with falls risk
• King D et al., 2020, 2022: neck pain and cervical dysfunction after concussion
• Panichi R et al., 2011: neck proprioception and the vestibulo-ocular reflex
• Peterka RJ, 2002: how the brain weights sensory signals for balance
• Roy JE, Cullen KE, 2003: smooth pursuit depends on vestibular rather than neck input

Added references: nutrition

• Giza & Hovda, 2001, 2014; Bergsneider et al., 2000; CDC (neurometabolic “energy crisis”)
• Erdman J, Oria M, Pillsbury L, eds. Institute of Medicine, 2011 (“feed the brain, starve the concussion”)
• De La Monte & Wands, 2008
• Kinsman et al., 1992; Freeman et al., 1998; Hemingway et al., 2001; Kossoff et al., 2003, 2006 (ketogenic and modified Atkins diets in epilepsy)
• Herbst et al., 2014; Storm, 2015; Hoane et al., 2005; Goffus et al., 2010; Burd et al., 2010; McMorris et al., 2007; Gaby, 2010
• Monti K, Conkright MW, Eagle SR, Lawrence DW, Dretsch LM. The role of nutrition in mild traumatic brain injury rehabilitation for service members and veterans. NeuroRehabilitation. 2024.
• Feinberg C, Dickerson Mayes K, Jarvis RC, Carr C, Mannix R. Nutritional supplement and dietary interventions as a prophylaxis or treatment of sub-concussive repetitive head impact and mild traumatic brain injury: a systematic review. Journal of Neurotrauma. 2023.