The Autonomic Nervous System and (Your Symptom Here)

People will often seek care at my Boulder physical therapy practice for symptoms after concussion, including dizziness, headache, and balance difficulties.

I recently had the honor of speaking at The American College of Sports Medicine’s annual conference in Boston, MA. The topic was Autonomic Nervous System (ANS) Dysfunction in Concussion Rehabilitation. As I learned, and taught, about the role of the ANS in concussion symptoms, I realized that many common symptoms for which people seek physical therapy treatment are influenced by the ANS.

ANS Definition

“The autonomic nervous system is a component of the peripheral nervous system that regulates involuntary physiologic processes including heart rate, blood pressure, respiration, digestion, and sexual arousal. It contains three anatomically distinct divisions: sympathetic, parasympathetic, and enteric.”

Very simply, the sympathetic (fight/flight) and parasympathetic (rest/digest) are 2 branches of the ANS that work together to ensure homeostasis, regulation, and appropriate responses to internal and external changes.

ANS imbalance (also known as dysregulation, dysfunction, or dysautonomia)

With injury, illness, or trauma, and frequently after concussion, an imbalance occurs within these symptoms. The result is often high sympathetic (fight/flight) activation in response to daily stimuli, including lights, noise, and exercise.

    Common symptoms that result from ANS imbalance

    It is common to experience dizziness, pain, fatigue, headache, balance difficulties, anxiety, exercise intolerance, and fatigue when there is imbalance of the autonomic nervous system.

    How can PT help?

    A physical therapist trained in concussion rehabilitation and nervous system regulation techniques can provide the following treatments:

    • Manual Therapy for the spine including the neck
    • Vestibular and Oculomotor training
    • Exercise training and progression
    • Balance training
    • Pain (and other symptom) Neuroscience Education
    • Cognitive-Behavioral Therapy including graded exposure to activities, goal setting, and relaxation techniques

    What can I do for myself?

    How to improve your ANS function:

    • Deep breathing
    • Gentle movement
    • Self care (sleep, diet, progressive exercise)
    • Mantras – rewire neural circuitry with positive messages to brain

    To learn more about concussion rehabilitation, click here.

    If you are experiencing symptoms associated with ANS imbalance including pain, headache, dizziness, balance difficulty, or low exercise tolerance, you may benefit from individualized physical therapy with Dr. Sarah Burkhardt.

    Schedule Now

    or email sarah@seatosummitpt.com with any questions!

    (From Left: Dr. Sarah Burkhardt, Dr. Eric Bubar, Jenna Kniceley, SPT, Dr. Sherrie Ballantine-Talmadge)

    References

    1. WaxenbaumJA, Reddy V, Varacallo M. Anatomy, Autonomic Nervous System. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539845/#  
    2. Quatman-Yates, et al. (2020). Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 50. CPG1-CPG73. 10.2519/jospt.2020.0301. Siengsukon CF, Al-Dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Phys Ther. 2017;97(8):826-836. doi:10.1093/ptj/pzx057
    3. RobertsonMK, McLoughlin J. The role of the physiotherapist in concussion. S Afr J Physiother. 2024;80(1):2013. Published 2024 Apr 30. doi:10.4102/sajp.v80i1.2013
    4. Silverberg, ND, Iverson, GL, Cogan, A, et al. The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation. Volume 104. Issue 8. 2023. Pages 1343-1355. 
    5. Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam. October 2022. British Journal of Sports Medicine 2023;57:695-711.
    6. http://leg.colorado.gov/sites/default/files/2019a_1208_signed.pdf?utm_medium=email&,utm_source=govdelivery