Concussion and Whiplash with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto. He's the owner, the chief physiotherapist at Insync Physiotherapy, sports physiotherapy in Vancouver, BC on Cambie Street. And we're going to talk about concussion and whiplash. Are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks Mark. Yeah, so quite often when people get a concussion, like whether it's like from a sports injuries, you know it's quite common with contact sports, and you get a neck injury related with that. And quite often that concussion can be missed. Or, you know, it could be so mild. 

Another area that right now that we're seeing sort of the combo of concussions and whiplash is motor vehicle accidents. And so I guess really to look at a concussion is essentially a brain injury. And what that means is that you've had like a force that's imparted in the skull, or, you know, your brain gets rattled. And you're essentially you have a injury to your brain. It's really hard to classify and it's hard to classify because a lot of the times you can have these symptoms and you do all these different tests like you know, an MRI or scans and all that stuff, and it can be negative. Because the brain is so complex. 

But the fact of the matter is that, you know, quite often when you have a concussion, you don't want to rule out a neck injury or whiplash. And in fact, quite often when you're able to treat the symptoms related to whiplash, because sometimes they can sort of overlap. Then you can actually also be helping the concussion type of stuff too.

Mark: So someone comes in and they think they've had a concussion or they have some symptoms. How do you go about diagnosing? 

Wil: Yeah. The biggest thing is you know, when I'm working with a sports team or with athletes and if it happens like in the moment or on the field of whatever at the time, then we run through a concussion screen test. And then there's all these things that we take them through. And then also in terms of subjectively, they tell us what's going on and we can sort of ascertain that we think that they might've sustained a concussion. 

And then when they come into the clinic and they're still feeling certain symptoms, you know, that they're having and we can do certain tests too, as well and to help measure that as well objectively. But ultimately those tests are definitely a good screening tool. So there's definitely a battery of tests from questions that we ask specifically. So the subjective exam is really important. And then also looking at a few objective tests and exams that we go through.

Mark: And how does that tie in with whiplash? What's different about diagnosing that? 

Wil: Well, so this is where there's a lot of similarity. Like for example, one of the biggest complaints with concussion that people get is that they may feel headachy, or they may feel like just the biggest one, you know, they're sensitive to light, sound you know, all that kind of stuff.

And those are sort of the more common types of head injuries that you can get where the symptoms overlap with a whiplash. So with whiplash, there's also different degrees of it, obviously. But like when you're looking at sort of where it starts to kind of overlap in terms of the symptoms, definitely those are the biggest ones.

And a large part of that too, if you also just think of the nervous system and the nerves that come out from the brain to the spinal cord, out to the neck, they are interconnected. And then also with the specific areas of the neck, with the muscles, and if you injure the muscles and the joints and then you have the nerves firing around those areas, and then they go back up into the spinal cord and the brainstem, then sometimes can be very confusing.

And you're not really sure what's causing what, because like a headache could be something related to the concussion. Or something related to your whiplash or your sprained neck or whatever that you've had going on. Cause you can get like also the muscle type of what we call a cervicogenic type of headache where it's coming from your neck.

Mark: So what kind of treatment protocols would be typical? 

Wil: Yeah. So there's specific stuff that is related to concussion treatment. But then when we're looking at treating the neck and if it's whiplash related, we're looking at specific things that are related with the mobility and the movement and function. So when I say function of the neck what we're we're talking about is how the muscles are moving and the way that they help the joints move. So you want to restore that joint mobility. But also that functional mobility that joint or joints, you're in respect to how the musculature are working together.

So if you have a whiplash injury where your joints are sprained, then quite often you get a lot of muscle spasming along with that. And so you get all this sort of a sequela things going on. So you want to try and normalize that. So you want to try and get some more normalized mobility.

And one of the biggest important things to do is that you're not increasing the bad symptoms that you're getting, where it stays even longer. Like you want to be gentle with it. So in an acute situation, you probably do want to let it rest a little bit. Because if it's an acute injury, you got to give that time to allow that acute aspect of it to settle right down.

And then once that part settled down a little more, then you can start to work on the mobility. And there's actually some research to show that there is actually some good results when you activate and you start to get things mobilized and moving to the neck to get it better, faster, and also in the long-term. And then also some correlation with working on whiplash and the whiplash symptoms in relation to the concussion. 

 Mark: And what would the typical healing protocol timeframe be? 

Wil: Oh, that's kind of a loaded question because, you know, with a concussion it's difficult. And then also it's hard to classify. Like there's just so many iterations of how the sports physiotherapy and the sports medicine and the medical community I've been trying to classify acute concussions. There was one point where the classified as mild and complex, well, you know, they don't really do that anymore.

And a lot of it is based on after the fact than the symptomology. And like what they're experiencing and how well they're recovering, like, Oh, okay well that was a complex concussion is what they classified it before, when they used to use that kind of a grading system. So it's really difficult.

And I think with whiplash, I think it's a little bit easier, you know, like if it's just an isolated whiplash, but then when you have whiplash and concussion it really depends on how they're presenting with those concussion and brain injury symptoms and dysfunctions.

So it can be really debilitating where they can't even like go out daylight. And stare at a screen for more than five minutes kind of thing. And those are cognitive processes. Like those are a lot of things that really affect you know, especially present day function, like we're on a screen. People are working on a computer a lot these days.

And so that's huge. And so then when you're looking at those factors and then also, there's this sort of research done on the visual aspect and the visual cortex and how that's been affected. So it's a really difficult question to answer. And I think that what we need to do is look at some of the things that we can address, like the dysfunctions in the neck. And because there can be relationships where there's, you know pain and stiffness and mobility in certain parts. That I have a direct connection with symptoms similar to concussions. 

So the headaches, like I was saying, for example and that can be sometimes mediated by working on mobility and restoring that functional mobility. So not just at the joint level, but the muscle level, and then even just doing some specific concussion rehab stuff as well. And I think this is an area that's just so rich to really you know, still continue to explore on the rehab level. But I think it's been shown that it's good to work on both and make sure that you address both the whiplash and the concussion.

Mark: So if you've had a concussion or you suspect you've had a concussion or you've got some neck pain, you suspect maybe you've had a whiplash, a car accident, you've been playing soccer, you've been playing football, hockey, et cetera. Something happened where you bonked the old coconut. Get ahold of Wil. Book online at or call the office at (604) 566-9716. You have to call and book ahead. He's booked up, but he can get you feeling better, fast. Or any of the other physiotherapists that Insync Physio. Get in there. Get after it. Get feeling better as soon as possible. Thanks Wil. 

Wil: Thanks Mark.