Neck pain after concussion? (Sarah Etheridge, PT)


Neck pain after concussion is a very common symptom. If you suffer from neck pain, learning about the muscles and nerves that may be causing the pain in this episode may be very helpful for you. However, if you don’t have any neck pain, or just minor complaints like stiffness, there may still be something going on with the muscles and nerves in your neck. That is why, PT Sarah Etheridge says, it is always important to check the neck after concussion. 

Table of content

02:04 International Brain Injury Association conference
03:34 Neck pain after concussion
04:25 Muscles to check after concussion
06:17 Nerves to check after concussion
09:03 Occipital neuralgia

Concussion Stories podcast introduction

[00:00 Melanie] If I say there is hope for complete recovery for people with a concussion, you say…?

[00:07 Professor McCrea] 100%!

[00:08 Professor Maas] And in fact, you didn’t only feel it: you were outside the regular medical system, because they were not interested in you.

[00:16 Professor Sitskoorn] Neuroplasticity actually opens you up to the world. It makes it possible to develop; it makes it possible to rehabilitate.

[00:25 Professor Wilson] Traumatic brain injury has been called a silent epidemic for that reason, because it consists of changes and disabilities that are not obvious to other people.

[00:35 Dr. Zasler] If, as a physician, you felt you had nothing to offer a patient, then I think ethically, you need to say] “I don’t think there’s anything I can offer you. Maybe you should see Dr. M.”

[00:48 Professor Diaz-Arrastia] Historically, we have called these things mild traumatic brain injuries, which implies that, well… It may be a brain injury, but it’s not going to have great consequences, right? And that’s frankly not true.

About the Concussion Stories podcast

[01:05 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your post-concussion recovery journey. My name is Melanie and I spent six and a half years learning, experimenting, and training in order to find a way to heal myself from post-concussion syndrome.

After making a full recovery by the end of 2018, I embarked on this mission to make the recovery journey easier for you. This is why I started this podcast, wrote detailed blog post and downloadable guides, offer coaching and also the course that I wish I had back when I was recovering — teaching you everything that I needed to know in order to make my recovery happen.

On Concussion Stories, we dig deep while discussing hopeful stories of recovery as well as the hard stuff in the messy middle. Let’s dive right in!

International Brain Injury Association conference

International Brain Injury Association conference

[02:04] Welcome to one of many episodes covering my visit to the Global brain injury conference by the International Brain Injury Association that took place in Dublin around the start of April 2023. It’s been my honor to attend and record presentations given by many prominent researchers and practitioners in the field of brain injury.

Concussion research insights

I learned things that I didn’t yet know, and spoke with people I was really looking forward to meeting someday. Now, I want to share everything that I learned, saw, and heard with you, so that you have access to the newest insights, directly from the top brain injury researchers and doctors who found them. Let’s get started with today’s episode. 

Concussion Care Center of Virginia

On the first day of the conference in Dublin, I went to a seminar by the Concussion Care Center of Virginia. You may remember the clinic’s founder, Dr. Zasler, from season one of Concussion Stories (Dr. Zasler on post-concussion rehabilitation and on post-concussion headaches). As the name implies, the center specializes in post-concussion care and has a specific focus on treating the neck (among others neck pain) and eyes in order to heal lingering concussion symptoms.

Concussion PT: Sarah Etheridge

[03:12] In this first episode, you’ll get to know Sarah Etheridge, the clinic’s physical therapist, or PT. In her experience, a lot of concussion symptoms actually come from neck problems, not always resulting in neck pain. This is why, she says, it is so important for doctors to check the neck in patients with concussion. Let’s hear it directly from Sarah.

Neck pain after concussion

Neck pain after concussion

[03:34 Sarah Etheridge] In a cohort where they looked at those with concussion and those with concussion plus cervical impairments, in the group that had neck impairments, almost 30 percent had zero complaints of neck pain or stiffness. So if we’re just asking the patient: do you have neck pain? And they’re like: yeah, it’s a little stiff, but no, that’s not really what’s bothering me – we are going to miss them. 

So maybe those with concussion and neck injury have more complaints about neck pain or have more complaints about dizziness versus those that just have a concussion? Maybe they just complain more about mood changes or sleep disturbances? That is not the case. 

Check the neck after concussion

These symptoms are evenly distributed between these two patient populations: those with concussion and those with concussion plus cervical impairments. So we have to be checking the neck, even if patients don’t complain about neck pain

So the patients who come see us, they’re the ones who aren’t getting better. Well, the literature also shows that those are the ones who are more likely to be having cervical impairments. If you treat those impairments, they feel better. 

Muscles to check after concussion

Muscles to check after concussion

Sarah continues to point out the muscles and nerves that may cause specific headaches. If you’re not already watching this episode over on or YouTube, you might wanna go there in order to see the slides and the palpation movements Sarah makes with her hands.

Trapezius and sternocleidomastoid

[04:59] The upper trapezius is common to come right into the temple area. It will have sort of a ramphorn distribution, and is commonly involved. The SCM (sternocleidomastoid) is also one that can contribute to not just headaches, but also tinnitus. So patients sometimes will say: hey, I feel fullness in my ear or cotton in my ear.

Suboccipital muscles and occipital neuralgia

The suboccipital muscles are almost always involved to some extent – especially if patients have occipital neuralgia going on. But this one can give a lot of retro orbital pain. This is definitely in those patients who sit with that forward head who are office workers that are on screens and are doing that upper cervical extension. 

Semispinalis and splenius muscles

The semispinalis and splenius muscle groups refer up into the head, and are important to check. 

These are the nerve groups that I always check on my patients that are complaining about headache. What about the occipital nerves? 50 percent of patients that have occipital neuralgia also complain about dizziness.

Nerves to check after concussion

Nerves to check after concussion

[06:17] So if your patient’s complaining about a really intense headache – it can be brief, it can be persistent, it can be retro orbital, and they are also having dizziness, and they struck the back of their head or they have had symptoms for a long time: please, please, please check the following nerves. 

Supratrochlear and supraorbital nerves

The supratrochlear and supraorbital nerves run in the front, they are branches off the trigeminal nerve. I don’t find these as commonly involved unless the patient has struck their forehead or they have a migraine component to their headache and they have been having headaches for a while. Again, because these are branches off the trigeminal nerve, there are neuromodulation devices out there like cephaly that can be a noninvasive way to help these patients.

Occipital nerves

To palpate the occipital nerves (the anatomy is a little different on everybody), I go and I find the mastoid process, which is the bone right behind the ear. Then I find the external occipital protuberance, which is the bony knot at the base of the skull, and I run my fingers right through there.

[07:26] About a third of the way in on that diagonal line is your lesser occipital nerve, and it tends to run in a little bit of a trough. So sometimes I’ll run my finger, I’ll find the groove and then I’ll palpate along it. About a third of the way in from the external occipital protuberance, should be your greater occipital nerve. And again, I sort of find the little trough that it runs in. Not everybody can feel it, but some people have that divot, because nerves tend to run in a groove. And then I’ll palpate along the lines of that.

Pain sensitization

When it’s hot and irritable, it’s really obvious. One of the things that I think is hard, especially if somebody has been in pain for a while: they can have some peripheral sensitization and some central sensitization, so they are a little bit tender everywhere.

But what I’m really looking for is that person who’s like: yikes! And they are trying to jump off my table and are like: thanks, nice to meet you, I gotta go, bye. That’s the kind of reaction I’m looking for. 

If they are a little bit tender and then they have this delayed reaction where they then, within the next minute, say: ooh, I have got that headache going on. Then I start to think: okay, maybe it’s irritable, but maybe it’s not the primary driver of their pain and still something to address. We may try them on something like an icing program that’s a very benign treatment that doesn’t have a lot of side effects. 

Occipital neuralgia

Occipital neuralgia

[09:03 Dr. Zasler] Sarah, may I just make a quick comment? One caveat I would add: when you find people who have occipital neuralgia, they typically also have involvement of suboccipital musculature. If you try to inject to treat the occipital neuralgia before treating the myofascial dysfunction, the occipital neuralgia will likely just come back. 

Injections or neuromodulation

So you need to treat the muscular component first, and then often the occipital neuralgia will abate. If it doesn’t, at that point, you can consider injection or neuromodulation, which we have been using for a number of years with good success with Cephaly, as well as a device called Relevion that can also do occipital nerve stimulation externally.

Icing nerves

[10:00 Jacqueline Theis] And ice. While they are waiting to see one of them, I tell them to ice. 

[10:04 Sarah Etheridge] Ice tends to work well. The nerves are really superficial, so if they are really inflamed. It can get a little dicey if they have had pain for a while and have some central sensitization. They can have a little bit of hyperalgesia towards cold, in particular.

But 10 to 15 minutes of icing a day is what I tell my patients to do, whether it’s a good day or a bad day. I get them started on that because it’s really easy to implement, and they can usually tell me: yes, that makes a difference for me or no, it doesn’t. Then that can lead us down the track of neuromodulation, or injections while I’m working on their suboccipital muscles. It can help guide treatment. Ice is easy, it’s cheap, so why not? 

Share your thoughts with me?

[11:00 Melanie]  Now, I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to and leave your comment now.

And if you want to hear and read more Concussion Stories, actionable steps and inspiration, be sure to subscribe to the Lifeyana email list while you’re there, so that you never miss out on new materials we constantly make for you.

If you want to support this podcast, head on over to Thank you for listening to this concussion stories episode by Lifeyana. May you will be well and may you be happy.

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