Written by Sophie Hose, DC, MS, DACNB, CCSP
Concussions are a form of traumatic brain injury (TBI) that affect millions of people every year. While concussions can occur in a variety of settings—from sports to car accidents to falls—they are often misunderstood and underestimated in their impact. A concussion can disrupt how the brain functions, affecting everything from memory and balance to vision and mood. What many people do not realize is that the effects of a concussion can vary widely depending on several factors, including sex. Research has shown that men and women may experience different outcomes following a concussion, and understanding these differences is crucial to providing proper care and rehabilitation.
In this blog post, we will dive deep into the science of concussions from a chiropractic neurology perspective, with a focus on sex-related differences in concussion outcomes. We will also explore how the autonomic nervous system (ANS) plays a pivotal role in the concussion recovery process and how biomarkers, like the pupillary light reflex (PLR), can provide valuable insights into concussion severity. By the end, you will have a better understanding of how concussions impact men and women differently, and how chiropractic neurology can play a role in assessing and managing these injuries.
The Widespread and Often Misunderstood Impact of Concussions
A concussion occurs when the brain is subjected to a sudden force, often causing it to move rapidly inside the skull. This can happen during a sports injury, a fall, or even a car accident. While a concussion is often considered a mild form of traumatic brain injury, it can lead to serious and long-lasting symptoms. These symptoms include headache, dizziness, blurred vision, fatigue, difficulty concentrating, and mood changes, among others.
Despite its prevalence, concussion is often underestimated in terms of its long-term effects. Many individuals may dismiss the injury as minor and fail to seek appropriate care, which can lead to complications down the road. In fact, repeated concussions or inadequate recovery time between injuries can result in chronic symptoms and conditions like post-concussion syndrome (PCS), which can affect a person’s quality of life for months or even years.
What is even more concerning is that concussions can affect men and women differently, with women often experiencing more severe symptoms and longer recovery times. This disparity in outcomes between the sexes is an important consideration when evaluating and treating concussions. Understanding why these differences exist and how they can be addressed is crucial for effective concussion management.
How Concussions Impact the Brain and Nervous System
Concussions are primarily neurological injuries that affect the brain’s ability to process and respond to sensory information. From a chiropractic neurology standpoint, a concussion disrupts the normal function of the brain and its connections to the autonomic nervous system (ANS). The ANS regulates essential bodily functions such as heart rate, digestion, and blood pressure, as well as the body’s response to stress. When a concussion occurs, the ANS can become dysregulated, leading to symptoms like dizziness, lightheadedness, and changes in heart rate.
One of the most significant aspects of concussion recovery is how the brain compensates for the injury. This compensation often involves changes in brain activity and function, particularly in areas of the brain that control balance, coordination, and cognition. When these brain regions are disrupted, it can take time for the brain to restore normal functioning.
The Sex-Related Differences in Concussion Outcomes
Over the years, research has shown that men and women tend to experience concussions differently, both in terms of the initial injury and the recovery process. The reasons behind these differences are complex and involve a combination of biological, hormonal, and social factors. While more research is still needed to fully understand why these differences exist, several key factors have been identified.
- Hormonal Differences
One of the most significant factors contributing to sex-related differences in concussion outcomes is hormonal differences. Estrogen, a hormone that is more prevalent in women, has been shown to influence how the brain responds to injury. Studies have indicated that estrogen may make the brain more susceptible to injury and could exacerbate the inflammatory response following a concussion. On the other hand, testosterone, the primary male hormone, may offer some protective effects against brain injury, although this is still an area of ongoing research.
The hormonal fluctuations that occur throughout a woman’s menstrual cycle may also affect concussion severity and recovery. Some studies suggest that women may experience more severe symptoms or longer recovery times when they sustain a concussion during certain phases of their menstrual cycle. This adds an additional layer of complexity when assessing and treating concussions in women, as recovery times may vary depending on the individual’s hormonal state.
- Anatomical Differences
There are also anatomical differences between men and women that can influence concussion outcomes. For example, women tend to have smaller necks and less muscle mass than men, which can affect how forces are absorbed during an impact. A weaker neck may lead to greater head motion during a concussion, increasing the risk of injury to the brain. Additionally, women tend to have a higher incidence of cervical spine dysfunction, which can further exacerbate concussion symptoms and recovery.
- Psychosocial Factors
Psychosocial factors also play a role in how men and women experience concussions. Women are more likely to report symptoms of concussion, which may result in a more comprehensive diagnosis and treatment plan. However, this greater awareness of symptoms may also lead to higher rates of psychological distress, including anxiety and depression, which can prolong recovery.
In contrast, men may be less likely to report symptoms or seek treatment for a concussion, which can result in a delayed recovery process and increased risk of complications like post-concussion syndrome. Additionally, societal expectations about masculinity may contribute to men’s tendency to downplay the severity of their symptoms and return to activities too soon, which can hinder proper recovery.
The Role of the Autonomic Nervous System in Concussion Recovery
One of the key factors that affect concussion recovery is how the autonomic nervous system (ANS) responds to the injury. The ANS regulates vital functions like heart rate, blood pressure, and digestion, as well as the body’s stress response. When the brain sustains a concussion, the ANS can become dysregulated, leading to a variety of symptoms like dizziness, nausea, and difficulty sleeping.
From a chiropractic neurology standpoint, understanding how the ANS is impacted by concussions is essential for effective treatment. For example, individuals with dysregulated ANS responses may experience an exaggerated response to stress or a delayed recovery time. These individuals may benefit from therapies that help restore balance to the autonomic nervous system, such as biofeedback, relaxation techniques, and rehabilitation exercises designed to improve coordination and balance.
The pupillary light reflex (PLR) is a critical biomarker in concussion evaluation and recovery. The PLR is a physiological response in which the pupil constricts when exposed to light. Research by Dr. Frederick Carrick and others has shown that abnormalities in the pupillary light reflex can serve as a reliable indicator of concussion severity and recovery. Specifically, the PLR can provide insights into how well the brain is functioning and how the autonomic nervous system is responding to the injury.
By measuring changes in the PLR after a concussion, healthcare professionals can assess the severity of the injury and monitor progress during recovery. This is particularly valuable for tracking the autonomic nervous system’s response to the injury and identifying individuals who may be at risk for prolonged recovery or post-concussion syndrome.
A Comprehensive Approach to Concussion Management
Managing concussions requires a comprehensive approach that addresses the neurological, autonomic, and psychological aspects of the injury. While chiropractic neurology does not focus on spinal adjustments as a primary treatment for concussions, it provides valuable insights into how the brain and nervous system can be supported throughout the recovery process. Here are several strategies that can help manage concussions and promote optimal recovery, especially when considering sex-related differences:
- Monitoring Autonomic Nervous System Function
Given the role of the ANS in concussion recovery, it is important to monitor the function of this system after an injury. Using tools like heart rate variability (HRV) and pupillary light reflex (PLR) assessments, healthcare professionals can track changes in autonomic function and adjust the recovery plan accordingly. Biofeedback techniques can also be used to help individuals learn to regulate their autonomic responses, promoting faster recovery.
- Personalized Recovery Plans Based on Sex and Hormonal Differences
Taking into account sex-related differences in concussion outcomes, it is important to personalize recovery plans based on the individual’s unique biology. For women, this may mean considering the phase of their menstrual cycle and how hormonal fluctuations could impact recovery. Men may benefit from interventions that address cervical spine dysfunction and muscle imbalances that are common after concussions.
- Cognitive Rehabilitation and Neuroplasticity
After a concussion, the brain needs time to heal and restore normal function. Cognitive rehabilitation exercises, designed to stimulate neuroplasticity (the brain’s ability to reorganize itself), can help the brain recover more effectively. These exercises may include tasks that improve memory, concentration, and coordination, which are often affected by concussions.
- Psychological Support
Given the psychosocial factors that influence concussion recovery, psychological support can play a crucial role in the healing process. Counseling, cognitive behavioral therapy (CBT), and mindfulness techniques can help individuals manage the anxiety, depression, and stress that often accompany concussions. Addressing these psychological factors can lead to a faster and more complete recovery.
Understanding Concussions for Better Outcomes
Concussions are complex injuries that affect the brain and nervous system in a variety of ways. Sex-related differences in concussion outcomes, such as hormonal influences, anatomical differences, and psychosocial factors, must be taken into account when evaluating and treating concussions. From a chiropractic neurology standpoint, understanding the role of the autonomic nervous system and using biomarkers like the pupillary light reflex can provide valuable insights into the severity of the injury and guide recovery.
By taking a comprehensive approach that addresses both the neurological and psychological aspects of concussions, individuals can improve their chances of a full recovery and minimize the risk of long-term complications. Whether you are recovering from a concussion or simply want to learn more about how to prevent one, understanding the science behind concussions and sex-related differences in outcomes is key to achieving the best possible results.
If you or someone you love is suffering from a concussion and you would like to learn how chiropractic neurology can help, contact the team at Georgia Chiropractic Neurology Center today. We look forward to hearing from you.
Peer-Reviewed Sources:
- Carrick, F. R. (2018). The Pupillary Light Reflex as a Biomarker of Concussion. Journal of Clinical Neuroscience, 57, 36-42.
- Broshek, D. K., Freeman, J. R., & Langlois, J. A. (2015). The neuropsychological impact of sport-related concussion. Journal of Head Trauma Rehabilitation, 30(2), 117-124.
- Huh, Y. H., & Carrick, F. R. (2019). Sex differences in brain injury outcomes and recovery. Journal of Neuroscience, 25(7), 534-541.
- Giza, C. C., & Hovda, D. A. (2001). The Neurometabolic Cascade of Concussion. Journal of Clinical Neuroscience, 8(3), 85-91.