Patient Background

The patient, a 28-year-old female university student, came to our MVA injury rehabilitation clinic in Brooklyn after living a high-functioning, active life balanced among academic study, part-time work, and regular fitness routines. She had no prior history of concussion, headaches, or vestibular issues, and she had no record of cervical injury or chronic musculoskeletal complaints. Her cognitive demands were high, with long study sessions, screen time, and consistent academic performance expected of her, all of which would be directly affected once her symptoms emerged.

She was a passenger in a vehicle that was struck on the side during a side-impact collision. The force of the impact caused her head to strike the side window, producing both a direct cranial impact and a rapid lateral acceleration of her cervical spine. She did not lose consciousness and was not transported from the scene. She initially attempted to rest at home, expecting her symptoms to resolve, but came to TRIPT NYC five days after the MVA when headaches, brain fog, and neck stiffness had progressively worsened rather than improved.

Presenting Complaint

The patient experienced persistent headaches that began within hours of her accident, as well as cognitive fogginess and short-term memory lapses, which interfered with her studies. She reported frequent dizziness upon quick head movements as well as tightness across her skull base and upper neck that led to intermittent dizziness with quick head movements; fatigue throughout the day as well as difficulty sleeping; reading or screen use caused an increase in head pain as well as mental exhaustion.

Initial Assessment Findings

An extensive intake evaluation was performed, beginning with the administration of a structured concussion symptom checklist to measure symptoms severity across cognitive, somatic, emotional, and sleep domains. Cervical mobility was assessed, which revealed restrictions in rotation and side-bending as well as hypertonicity within suboccipital muscles, upper trapezius muscle, and deep cervical paraspinals. A vestibular screen identified gaze stability deficits, mild positional dizziness, and balance asymmetry consistent with post-traumatic vestibular involvement. Biofeedback brain assessments for post-concussion syndrome provided objective baseline data regarding autonomic regulation and cortical activity, enabling progress to be tracked beyond subjective symptom reports. Cervical ligamentous integrity was evaluated through stress testing in order to identify any instability which might be driving her symptoms.

Diagnosis / Classification

The patient was diagnosed with post-concussion syndrome combined with cervicogenic headache and post-traumatic vestibular dysfunction. Clinical findings supported a working diagnosis in which the cervical injury and the concussive injury were contributing simultaneously to her symptom burden, with neck dysfunction acting as a primary amplifier of headaches, dizziness, and cognitive fatigue. The presence of both components made a combined neck-and-brain treatment approach essential, rather than treating the concussion in isolation.

Treatment Approach (TRIPT)

The treatment was based on the TRIPT model, which integrates manual, neurological, vestibular, and regenerative therapies into a coordinated plan rather than relying on a single modality. The approach was designed to first calm symptom load and restore cervical function, then progressively retrain the vestibular and cognitive systems, and finally consolidate gains with neuromuscular and autonomic regulation work. Care was co-managed with the TRIPT psychology and neurology team to address the cognitive and emotional dimensions of her recovery.

The following treatment modalities were layered in based on the patient’s response and recovery stage:

Cervical Ligamentous Instability Evaluation through stress testing to identify any structural contributor to persistent symptoms.
Vestibular Therapy Training to address dizziness, gaze instability, and balance deficits.
Manual Therapy and Joint Mobilization to relieve cervicogenic headache and restore segmental cervical motion.
TRIPT Headache and Migraine Treatment Program to reduce frequency and intensity of post-traumatic headaches.
Laser Therapy to reduce cervical inflammation and support soft tissue recovery.
Trigenics for cervical neuromuscular re-education and to relieve protective guarding patterns.
Balance Physical Therapy to retrain proprioceptive control and reduce fall risk.
Trigger Point Therapy to deactivate suboccipital and upper cervical referral patterns contributing to headaches.
Neurological Rehabilitation with biofeedback to support post-concussion brain recovery and autonomic regulation.
Psychotherapy Co-Management with the TRIPT psychology team to address anxiety, sleep, and cognitive load.
PRP and Regenerative Therapy where ligamentous laxity was confirmed on stress imaging.
Prolotherapy for cervical ligamentous instability and joint hypermobility.
Dry Needling for myofascial trigger point release and pain relief.
Homeopathic Pain Management as a complementary, holistic modality.

The patient was seen approximately two times each week for fourteen weeks, with care co-managed alongside her physician. Visit frequency was kept consistent through the early symptom-control phase and adjusted as cognitive tolerance improved, allowing her to gradually increase study and work demands without provoking flare-ups. The schedule was designed to support steady progress without overloading her cognitive or vestibular systems between sessions.

Complicating Factors

Several non-physical factors threatened to slow recovery and were directly addressed within the care plan:

Return-to-work and school pressure created urgency to push cognitive demands faster than her recovery allowed.
Light and noise sensitivity, which limited her ability to study, commute, and tolerate normal environments.
Psychological distress related to the accident itself, the loss of cognitive sharpness, and uncertainty about long-term recovery.
Sleep disruption, which slowed both neurological recovery and symptom regulation.

Turning Point

At this patient’s recovery journey’s turning point was her first headache-free day combined with an increase in concentration during work and study sessions. Following weeks of constant headaches, mental fogginess, difficulty with tasks that had previously been routine, these two changes happened together and signalled her cervical and neurological systems were regulating more normally – once her headaches subsided and concentration improved significantly her tolerance for vestibular work increased as did screen time management and her confidence to return to full academic and work demands quickly increased.

Outcomes

By the end of her treatment, the patient had achieved significant improvements across every functional domain. Her symptom burden, as measured on the post-concussion symptom inventory, was substantially reduced. Cognitive function had normalized, allowing her to study, work, and engage in daily activities without provoking head pain or fatigue. Cervical range of motion was restored, dizziness had resolved, and balance scores returned to age-appropriate norms. She was cleared for full academic, work, and physical duties, and she left the program with self-management strategies for cervical care, sleep, screen exposure, and vestibular maintenance to protect her long-term recovery.

Outcome Measures Used

Throughout the course of care, progress was tracked with validated and clinically relevant tools.

Post-Concussion Symptom Inventory (PCSI) or SCAT, capturing symptom burden across cognitive, physical, and emotional domains.
Dizziness Handicap Inventory, quantifying the functional impact of vestibular symptoms.
Visual Analog Scale (VAS) to track headache and neck pain intensity over time.
Biofeedback reassessment, providing objective neurological data alongside subjective reports.
Return-to-function milestones, anchoring clinical progress to her real-world academic and work demands.

Key Clinical Insight

The defining lesson of this case is that cervical dysfunction is often a primary driver of post-concussion symptoms, not a secondary issue. Headaches, dizziness, cognitive fog, and fatigue that are routinely attributed solely to the brain often have a strong cervical component, and recovery stalls when the neck is left untreated. Addressing the concussion in isolation, without restoring cervical mobility, ligamentous integrity, and neuromuscular control, leaves the patient symptomatic even after the brain has had time to heal.

When manual therapy, vestibular training, neurological rehabilitation, and biofeedback are integrated with cervical treatment and co-managed psychological support, post-concussion syndrome can resolve, cognitive function can be restored, and patients can return to full duties with confidence. This case illustrates how a coordinated, multi-modal TRIPT approach delivered early can address both the brain and the neck together, rather than choosing one over the other.

Concussion and Cervical Instability After MVA: A Combined Recovery