Condition
Concussion & Mild Traumatic Brain Injury
Often missed in the initial ER visit and frequently co-occurring with whiplash. Concussion needs a careful neurological assessment and clear documentation to support both recovery and your legal case.
A concussion is a brain injury caused when a crash jolts the head, even without a blow. Symptoms can appear hours or days later. Go to an emergency room for a worsening headache, repeated vomiting, a seizure or confusion. Otherwise, Ryan Lloyd, DC, QME, tests nerves, eye movements and the neck in Petaluma, and refers you to a physician when needed.
Go to an emergency room or call 911 if you have:
- A seizure
- Passing out, getting drowsier, or not being able to stay awake
- One pupil larger than the other, or double vision
- Slurred speech, weakness, numbness or poor coordination
- Growing confusion, restlessness or agitation, or not recognizing people or places
- A headache that gets worse and does not go away
- Repeated vomiting or nausea
If you are 65 or older or take a blood thinner, get checked in an emergency department after any blow to the head. If none of these apply, book an evaluation this week at our Petaluma clinic or call (707) 658-2534.
Sources: CDC HEADS UP, Signs and Symptoms of Concussion; Canadian CT Head Rule (Stiell 2001, PMID 11356436).
Understanding the Injury
What is a Concussion?
A concussion is a mild traumatic brain injury (mTBI) caused by rapid acceleration and deceleration forces acting on the brain during a collision. The brain, suspended in cerebrospinal fluid inside the skull, is subjected to shearing and rotational forces that disrupt normal neural function without necessarily causing visible structural damage on standard imaging.
This is precisely what makes concussion so frequently missed. Emergency rooms focus on ruling out bleeds and fractures using CT scans, which appear normal in the vast majority of concussion cases. The patient is discharged with a clean scan, but the functional neurological injury persists.
Why Concussions Are Missed After Car Accidents
The collision forces that cause whiplash act on the brain simultaneously. When a patient presents with neck pain, the cervical spine injury often dominates the clinical picture while the concussion goes undiagnosed. Adrenaline, shock, and the focus on musculoskeletal complaints can mask neurological symptoms for hours or even days.
Without a thorough cranial nerve examination and cognitive screening performed by a provider who specifically looks for mTBI, concussion can go entirely undocumented, weakening both the patient's recovery and their legal case.
Invisible Injury
Standard CT and MRI often appear normal after concussion. The injury is functional, not structural, meaning clinical examination is the primary diagnostic tool.
Commonly Missed
ER evaluations focus on life-threatening conditions. Concussion screening requires specific neurological testing that most emergency departments do not perform.
Co-Occurs with Whiplash
The same acceleration-deceleration mechanism that causes whiplash also causes concussion. Every whiplash patient should be screened for mTBI, and vice versa.
Documentation Is Critical
Concussion findings require specific medicolegal documentation to be useful in personal injury cases. Objective cranial nerve findings provide the defensible evidence your case needs.
Recognizing the Signs
Common Concussion Symptoms
Symptoms can appear immediately or develop over hours to days. Many patients don't connect these symptoms to their car accident.
Diagnosis
How We Diagnose Concussion
The cranial nerve examination is the cornerstone of concussion diagnosis. We do it at every initial evaluation.
Cranial Nerve Examination
All 12 cranial nerves are systematically evaluated to identify functional deficits caused by the traumatic brain injury.
- Olfactory nerve (CN I) — smell assessment
- Optic nerve (CN II) — visual acuity and fields
- Oculomotor nerves (CN III, IV, VI) — eye tracking
- Trigeminal nerve (CN V) — facial sensation
- Facial nerve (CN VII) — motor assessment
- Vestibulocochlear (CN VIII) — hearing and inner ear
Vestibular & Eye Movement Assessment
Evaluation of the inner ear (vestibular) and eye movement systems that concussion can disrupt.
- Dix-Hallpike maneuver for BPPV
- Smooth pursuit and saccade testing
- Vestibulo-ocular reflex assessment
Cognitive & Functional Screening
Standardized assessments to document cognitive and functional deficits with the objectivity required for legal cases.
- Orientation and memory testing
- Concentration and processing speed
- Symptom severity scoring
- Functional capacity evaluation
- Return-to-activity baseline assessment
- Serial reassessment for recovery tracking
Treatment
How We Treat Concussion
Concussion recovery requires a carefully graded approach. We combine vestibular rehabilitation with progressive physical reconditioning, all documented for your case.
Progressive Resistance Training
Graded physical reconditioning that follows concussion recovery protocols. We carefully increase exercise intensity through a graduated exercise protocol to rebuild physical capacity without triggering symptom exacerbation, using heart rate and symptom monitoring.
Graded Exertion ProtocolVibration Therapy
Vibration training hasn't been studied after concussion, and balance problems after concussion mostly involve vision and the inner ear. If the platform is part of your care, sessions are short and supervised. Tell us right away if you feel dizzy.
Vestibular RehabilitationShockwave Therapy
No trial has studied shockwave after a car crash. For headaches that come from the neck, two small trials found that adding it to neck rehab eased headache pain and disability more than a sham, so we may suggest it when neck muscles add to lasting headaches.
Neck-Related HeadachesChiropractic Adjustments
Neck adjustments when your neck is part of the problem, after checking for warning signs that would rule one out; in the first weeks after a crash, we use gentle, low-force techniques. Right after an adjustment, many people with neck pain feel less pain and tenderness and can turn their head further. Research on adjustments after a head injury is thin, so we use them as one part of your graded exercise and vestibular rehab.
A Window to MoveObjective Recovery Documentation
Every concussion evaluation and treatment session generates objective, defensible data: cranial nerve findings, cognitive screening results, symptom severity ratings, and functional milestones. This creates the measurable recovery timeline that personal injury cases require, from initial injury documentation through maximum medical improvement and permanent impairment assessment.
Medicolegal DocumentationWhy adjust.clinic
What Makes Us Different
We perform a cranial nerve examination on every patient, every time, so the findings are documented from the first visit.
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Cranial Nerve Examination
A complete 12-nerve cranial examination is standard in every initial evaluation. This is the primary clinical tool for identifying concussion.
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QME-Level Documentation
As a Qualified Medical Evaluator trained in medical-legal report writing, Dr. Lloyd documents concussion findings objectively and in the detail that personal injury claims, insurance negotiations, and testimony require.
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Defensible Causation Opinions
We connect the dots between the collision mechanism, the neurological findings, and the diagnosis, creating the causation analysis that your personal injury attorney needs to build a compelling case.
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Active Recovery Model
Current evidence shows that prolonged rest worsens concussion outcomes. We use carefully graded physical activity and vestibular rehabilitation to drive neuroplastic recovery.
Common Questions
Frequently Asked Questions About Concussion
What are the signs of a concussion after a car accident?
Common signs include headache, dizziness, confusion, difficulty concentrating, memory problems, sensitivity to light or noise, nausea, and fatigue. Some symptoms appear immediately while others may not develop for hours or days after the collision. Any head impact or sudden deceleration in a crash warrants evaluation.
Why does Dr. Lloyd perform a cranial nerve examination for concussion?
The cranial nerve exam is the gold standard for detecting subtle neurological deficits that standard concussion screening misses. It evaluates all 12 cranial nerves — testing eye tracking, pupil response, facial sensation, and coordination — to identify specific areas of brain function affected by the injury. This level of detail is critical for both treatment planning and legal documentation.
Can I have a concussion without hitting my head?
Yes. A concussion is caused by rapid acceleration-deceleration of the brain inside the skull. In a car accident, the sudden stop or impact can cause the brain to move forcefully even without direct head contact. This is especially common in rear-end collisions where the head whips forward and backward.
How long does concussion recovery take after a car accident?
Most mild concussions resolve within 2–4 weeks with proper management. However, post-concussion syndrome can persist for months, especially when the initial injury is not properly documented or managed. Early evaluation and structured return-to-activity protocols significantly improve outcomes.
Why is concussion documentation important for my personal injury case?
Insurance companies frequently undervalue or deny concussion claims because symptoms are subjective. A detailed cranial nerve exam, documented cognitive deficits, and objective neurological findings create a defensible medical record that supports your claim and establishes the injury's connection to the accident.
Think you might have a concussion?
Early diagnosis is critical for both your recovery and your case. Book a neurological evaluation today.
Have MedPay on your auto insurance? Learn how to use it here.
Learn more about our car accident chiropractic care in Petaluma.
Related Conditions
Other Conditions We Treat
Concussion frequently co-occurs with cervical spine injuries. Explore the other accident-related conditions we focus on.