Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion

J Head Trauma Rehabil. 2023 Nov-Dec;38(6):417-424. doi: 10.1097/HTR.0000000000000866. Epub 2023 Feb 28.


Objective: To examine the frequency and association of neck pain symptoms in patients with a concussion.

Study setting and participants: Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021.

Design: Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes.

Results: Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms.

Conclusion: Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.

MeSH terms

  • Athletic Injuries* / complications
  • Athletic Injuries* / diagnosis
  • Athletic Injuries* / epidemiology
  • Brain Concussion* / complications
  • Brain Concussion* / diagnosis
  • Brain Concussion* / epidemiology
  • Humans
  • Neck Pain / diagnosis
  • Neck Pain / epidemiology
  • Neck Pain / etiology
  • Neuropsychological Tests
  • Post-Concussion Syndrome* / diagnosis
  • Post-Concussion Syndrome* / epidemiology
  • Post-Concussion Syndrome* / etiology
  • Retrospective Studies