How to Know if Your Car Crash has Caused a Concussion and What You Can Do about It

According to a report published by the National Highway Traffic Safety Administration (NHTSA) in 2018, over 6,700,000 motor vehicle crashes are reported each year. And those are just the incidents that the police know about! So the number is actually much higher. 

The most common problem that results from a car crash is injury to muscles that move various joints, the ligaments that hold those joints together, and the joints themselves. When such injuries occur in the neck, they are commonly referred to as whiplash injuries (so named because the injuries are caused by a whip-like motion of the head on the neck). 

Whiplash and Concussion: Same Mechanism

Whiplash injuries occur because muscles, ligaments and joints cannot easily withstand the forces they are placed under as a result of the crash. So, something has to give, and this causes tears in these tissues. Tears to ligaments are called sprains and tears to muscles or muscle tendons (which attach muscle to bone) are called strains. However, it’s important to understand that the same mechanism of injury that causes whiplash injuries can also cause concussion. In fact, over the past 10 years, there’s been a growing awareness among health care professionals that concussion due to car crashes is much more common than most people have realized.

You might think that you have to hit your head to get a concussion. However this is not necessarily true. A blow to the head causes a concussion because the energy of the blow causes acceleration of the head, and along with it, the brain within the skull. This same acceleration can result from the whiplike motion of the head on the neck in a car crash (see Fig. 1). Whether you receive whiplash injuries or both whiplash injuries and concussion depends on the forces generated during the collision. It takes greater force to produce whiplash and a concussion.

                                        Fig. 1. The acceleration of the head on the neck that occurs in a motor vehicle collision not only damages soft tissues of the neck but also accelerates the brain within the skull, which may--depending on the amount of force generated--cause a concussion.

What is a Concussion?

Concussion is a form of brain injury that causes a temporary disturbance in normal brain functions. In the best circumstances, the symptoms of concussion last 10-14 days, although it can take 30-45 days for the brain to recover fully. Children and those with a prior history of concussion or who have problems with anxiety and depression often take longer to recover.  It’s extremely unlikely, in most cases, for a concussion to cause “permanent damage” to your brain. However, the likelihood of lasting damage increases if you sustain another concussion before your brain has fully recovered from the first injury. This is most relevant in return-to-play decisions for an athlete involved in contact sports. Nevertheless, it is something to be aware of and is a striking reminder of the fact that the absence of symptoms does not necessarily mean you have achieved full recovery.

How Do You Know if You Have a Concussion?

There is no one test that can be used to diagnose a concussion.The diagnosis is made based on physical exam findings by a qualified healthcare provider and the presence of various symptoms. You should suspect a concussion after a blow to the head or body or acceleration of the head on the body due to a car crash or even a bad fall if you experience one or more of the symptoms shown in Table 1:

Physical Problems
Thought Problems
Emotional Problems
Sleep Problems
  • Headache
  • Neck pain
  • Sensitivity to light and/or noise
  • Fuzzy or blurry vision
  • Dizziness
  • Problems with balance
  • Nausea
  • Vomiting
  • Memory problems
  • Difficulty concentrating
  • Feeling slowed down
  • Feeling as though you are “in a fog”
  • Difficulty thinking clearly
  • Anxiety
  • Nervousness
  • Depression
  • Sadness
  • Irritability
  • More emotional

Table1. The common symptoms associated with concussion (by category).


When Should You Go to the Emergency Room?

The majority of concussions do not require a visit to the emergency room. However, there are certain warning signs--or red flags--to be aware of. These red flags, shown in Table 2,  suggest a more serious injury such as a skull fracture or a brain bleed. In their presence you should go to an emergency room immediately.

Warning Signs that Indicate You Should Go to the Emergency Room Immediately
  • Seizures or convulsions
  • Loss of consciousness
  • Weakness or numbness in arms or legs
  • Unable to wake up
  • Worsening headache
  • Bad nausea or repeated vomiting
  • Increasing confusion
  • Unsteadiness standing or walking
  • Bruising around eyes or ears
  • Odd behavior
  • Slurred speech
  • Inability to remember injury

Table 2. In the presence of these warning signs it is necessary to get to the nearest emergency room as soon as possible.


What to Do and Not to Do When You Suspect You Have a Concussion

Here’s a list of action steps to take when you suspect you have a concussion:

  1. Get in to see a qualified healthcare provider as soon as possible (call to find out if the provider has experience managing recovery from concussion). The longer you wait before seeking care, the greater the chances that your recovery will take longer.
  2. Sleep and get plenty of rest for 24-48 hours. If there are no red flags (see Table 2) after you have received a concussion, get a good night’s sleep, Concussion is essentially an energy crisis in the brain. The brain uses energy more quickly than it can replenish itself. Take naps if you need to. 
  3. After 48 hours, begin doing some form of aerobic exercise at an intensity that doesn’t make your symptoms worse. Concussion typically causes a 50% reduction in blood flow to the brain. Aerobic exercise such as walking can help restore blood flow. Healthcare providers used to think that at least two weeks of total rest was necessary to manage recovery from a concussion. However, research shows that this is not true--that concussion patients recover more quickly when they return to light-to-moderate aerobic exercise within two days. 
  4. Don’t participate in sports. If you participate in sports activities, this of course increases the risk of getting another concussion. The best-case scenario, should this happen, is that your recovery may be prolonged by several months.
  5. Eat good food and stay away from junk food. Eating modest amounts of protein with plenty of vegetables (especially the leafy green ones!) and richly colored fruits will provide the nutrients you need for energy and healing. 
  6. Modify “screen time” and work or study so as not to aggravate your symptoms.Initially, you may not be able to work or study or even use a smartphone or computer. After 48 hours, you can start engaging in such activities to tolerance, making sure you rest when your symptoms worsen. 
  7. Do not drive for at least 24 hours. Wait till you feel better. Essentially, your brain is experiencing an energy crisis. In practice, this means that all your perceptions as well as your judgement and reaction time will be diminished.
  8. Do not drink alcohol or take pain medications or other drugs. Alcohol or drugs can complicate your treatment and recovery by "masking" symptoms, and make it difficult to tell how the concussion affects you. Consult your primary care medical provider regarding any medications that are essential for you to take.
  9. Follow the directions of your healthcare regarding decisions on return to work and play.

Whiplash and Concussion Share Similar Clinical Characteristics

Immediately after a car crash, it may not be apparent whether you have sustained a whiplash injury and a concussion or just a whiplash injury. The reason for this is that the two conditions share similar characteristics clinically. The following common signs and symptoms can occur with both types of injuries:

  • Headaches

  • Problems of thought and emotion

  • Balance problems and dizziness

  • Abnormalities in the control of eye movements

  • Abnormalities in blood flow to the brain

This is why it’s wise to seek help from a chiropractic physician or other provider who knows how to assess and manage both concussion and whiplash injuries based on objective findings.

Coming soon: important tips on dealing with concussion symptoms.