Post-Concussion Care: Why the Neck and Balance Matter (and How We Test Them)

A concussion is a brain injury — but many of the symptoms people feel afterward aren’t coming from the brain alone.

After a hard hit (sports, fall, car accident), it’s common for the neck and the body’s balance system to get thrown off at the same time. That’s one reason symptoms like dizziness, headaches, “pressure,” nausea, light sensitivity, and brain fog can linger.

Modern concussion care is multidomain — meaning good clinicians look at more than symptoms alone (balance, vestibular/vision, neck function, exertion tolerance, etc.).

In our office, two tools we use to add objective data are:

• NeckCare (cervical range of motion + joint position sense/proprioception + sensorimotor control testing, including the Butterfly Test®)

• BTrackS Balance Test (BBT) (a force-plate balance system that measures postural sway)

Important note: These tests don’t diagnose a concussion by themselves. They help us measure and track common post-concussion deficits—and separate “neck-driven” issues from other contributors.

Why the neck is a big deal after a concussion

Most concussions involve acceleration/deceleration forces — basically a whiplash mechanism. Even if the primary injury is to the brain, the cervical spine often takes a hit.

The neck matters because:

• The upper neck has a huge amount of proprioceptive input to the brain (position sense).

• The brain relies on three main systems for balance and orientation: visual + vestibular + proprioceptive (especially cervical). When those inputs don’t match, dizziness and “off” sensations can ramp up.

• If the neck is stiff, painful, or poorly coordinated, it can perpetuate symptoms even as the brain is recovering.

Why we test balance after a head impact

Balance is one of the clearest objective domains we can measure after a suspected concussion.

The BTrackS Balance Test quantifies postural sway. Research on BTrackS has shown it can detect balance declines relative to baseline in a meaningful portion of concussed athletes shortly after injury (it’s a useful piece of the puzzle, not a standalone decision-maker).

BTrackS also has large published normative datasets (including athlete baselines), which helps interpret results when baseline data isn’t available.

What NeckCare testing tells us (and why it helps post-concussion)

NeckCare gives us objective numbers for:

1) Cervical Range of Motion (ROM)

Is the neck moving normally in rotation, side-bending, flexion/extension?

2) Joint Position Error (JPE) / Proprioception

This looks at how accurately you can return your head to “neutral” after moving — a marker of cervical position sense.

3) Sensorimotor control (Butterfly Test®)

This challenges eye–head–neck coordination. Athletes often want to be good at this from a performance standpoint — it reflects control, coordination, and precision.

When these metrics suddenly drop compared to someone’s typical performance, it can be a clue that the system took a hit.

The “baseline vs. after-hit” advantage (athletes, especially)

If an athlete has a baseline on file (pre-season or pre-injury), retesting after a hard hit becomes much more meaningful.

Why?

• We can compare the athlete to their own normal, not just population averages.

• A “bad” result isn’t automatically a concussion — but it’s a flag that says: “Something changed. We need a fuller concussion/neck/vestibular evaluation.”

This is similar to how many concussion programs think about testing: use objective measures to support clinical decision-making, not replace it.

A practical way to use this after games

If an athlete wants ongoing monitoring, the cleanest approach is:

• Test on a consistent schedule (ex: the morning after games rather than immediately post-game)

• Keep conditions consistent (sleep, hydration, footwear, no intense warm-up right before)

• Look for meaningful change:

  • A big drop from their personal trend, or

  • Worsening across multiple domains (example: Butterfly + BTrackS both decline)

One reason we standardize timing: balance can be affected by fatigue and exertion, so we want consistency to avoid false alarms.

What to expect in our office

A typical post-concussion visit may include:

• Symptom and history review (including red flags)

• Cervical screening and NeckCare testing (ROM + JPE + sensorimotor control)

• BTrackS balance testing

• A plan to address what we find:

  • neck mobility + motor control

  • balance / stability retraining

  • coordination drills (as appropriate)

  • referral to the right provider if needed (sports medicine, neuro, vestibular PT, etc.)

When you should seek urgent care immediately

If you or your athlete has any of the following after a head injury, don’t wait:

• worsening headache, repeated vomiting, increasing confusion

• fainting, seizure, severe drowsiness, slurred speech

• weakness/numbness, severe neck pain, or symptoms that rapidly worsen

When in doubt, get evaluated urgently.

Bottom line

Concussion recovery isn’t just “brain rest.” The neck and the balance system are often part of the picture — and they’re measurable.

Using NeckCare and BTrackS helps us:

• quantify deficits that can drive symptoms

• track changes over time (especially with baselines)

• guide a clearer, more targeted recovery plan

If you’re in Encinitas / North County San Diego and dealing with lingering dizziness, headaches, or “off” balance after a head impact, we can help you figure out what’s going on — and what to do next.

Book at the link on our website!