BUFFALO, N.Y. – Athletes and others reporting cognitive
difficulties after a head injury are usually diagnosed as having
had a concussion. But is it really a concussion? A new study
published by University at Buffalo medical faculty finds that many
of the same symptoms are common to concussions and to injuries to
the neck and/or balance system, known collectively as
The research was based on responses about symptoms from 128
patients – some of whom were professional athletes –
who were being treated at UB’s Concussion Management Clinic
in the School of Medicine and Biomedical Sciences.
It was published online ahead of print last week in the Clinical
Journal of Sport Medicine.
The purpose of the study was to determine how to distinguish
between concussion injury and neck injury, based on symptoms.
“Based on our research, we conclude that some patients who
have been told they’ve suffered a concussion, and whose
symptoms persist for several months may actually have suffered a
neck injury, rather than a concussion, or in addition to a
concussion,” says John J. Leddy, MD, clinical professor in
the UB Department of Orthopaedics and senior author.
He embarked on the study based on his experience as director of
the UB Concussion Management Clinic.
“I’d seen enough patients in our clinic, some
previously diagnosed with post-concussion syndrome, who continued
to experience symptoms even after passing our treadmill test, which
indicates full recovery from concussion,” says Leddy, who
sees patients through UBMD, the physician practice plan of the UB
“The symptoms for both conditions are so nonspecific that
it’s really hard to make a diagnosis based on them,”
Leddy continues, “so we had to find another way to
discriminate between them.”
To determine which of the respondents had probably sustained a
concussion and which more likely had a neck injury, the UB
researchers used the graded treadmill test developed by Leddy and
co-author Barry Willer, PhD, UB professor of psychiatry.
“The treadmill test helps us make a first delineation
between what I call physiologic concussion and other possible
causes of cognitive symptoms,” says Leddy.
“Because a concussion is a brain injury, we thought that
cognitive symptoms would be more likely associated with
concussions,” he says. “Surprisingly, that didn’t
turn out to be the case. People who have had neck injuries can also
have problems with concentration and with memory. They feel like
they’re in a fog, which is exactly what people report after
Symptoms reported by both groups were headache, dizziness,
blurred vision, poor concentration and memory deficits.
Patients in both groups filled out a detailed questionnaire
concerning their symptoms. These responses were then correlated to
their treadmill test results.
“Then we did some sophisticated statistical
analysis,” says Leddy. “Even when we looked at the data
in multiple ways, there was really no way to separate out the two
groups based on their symptom patterns alone.”
Determining which condition a patient has experienced is
critical, Leddy explains, because courses of treatment are very
“The treatment for a neck injury is actually to be more
active, to do physical and vestibular therapy, to have a more
active intervention, whereas after a concussion, exercise must
begin slowly and incrementally after a period of rest,” he
Leddy notes that more research should be done on larger samples
concerning concussion and neck injury.
In the meantime, he says, patients who think they’ve had a
concussion and whose symptoms have not diminished after several
months, should instead be examined for neck and vestibular injury
by a sports medicine physician, a neurologist or a physiatrist, a
specialist in rehabilitation medicine.
“I think a lot of practitioners listen to the symptoms and
just chalk it up to concussion,” he adds, “but if they
also examined the neck in these people, they might discover that a
neck injury is involved and that’s a treatable
Physical symptoms specific to neck injuries include tenderness,
neck spasms, reduced motion and reduced perception of where the
head is in relation to the body, Leddy explains.
Co-authors with Leddy and Willer are John G. Baker, PhD, UB
Department of Nuclear Medicine; Asim Merchant, MD and Jason
Matuszak, MD, of the UB Department of Family Medicine; John Picano,
an MD candidate at UB and Daniel Gaile, PhD, of the UB Department
The UB Concussion Management Clinic is a joint effort between
the Department of Orthopaedics and the Department of