Our bodies have an automatic system that controls hundreds of involuntary processes, like breathing, heart rate, digestion, sexual response, and metabolism. This ancient system, called the autonomic nervous system (or ANS for short) has two parts: the sympathetic or “fight-or-flight” pathway, and the parasympathetic or “rest-and-digest” pathway.

Traumatic brain injury and concussions, like many serious injuries, causes the ANS to ramp up the protective “fight or flight” reaction. The body rushes nutrients to the injured area, fires up the immune system to deal with injured tissues, keep us on high alert, blunts our pain response, sends our blood pressure and heart rate soaring, makes our breathing rapid and shallow, and pours glucose into the body to enable us to flee if the threat comes back. Functions deemed not essential for immediate survival are drastically reduced: digestion, sexual function, and sleep are among the first victims.

The body cannot stay in this state for very long before our health starts to suffer. Even though the system is designed to return itself to balance, sometimes injuries overwhelm its ability to turn off the “fight or flight” reaction. Concussions frequently throw the ANS into disarray, causing a host of seemingly mysterious and debilitating symptoms. I call this imbalanced state “injury shock”.

Sometimes this imbalance becomes chronic. This state of perpetual stress can have potentially catastrophic health consequences. Chronic “autonomic dysfunction” is one of the most common, persistent, and disabling consequences of concussions.

For over a hundred years, osteopathic physicians have been designing and refining effective techniques to address autonomic dysfunction and restore the autonomic nervous system to balance. With our reverence for the vagus nerve - the major nerve of the ANS - along with the diaphragm, ribs and the breath, we have numerous techniques for healing ANS problems.

It’s very common for people who have had a concussion or TBI to have an overactive sympathetic response. It is not your imagination or because you are weak that you can’t sleep, have trouble eating, are irritable and angry with your family, have heart palpitations, or are depressed. It’s common and there are sound physiological reasons for it. Many times there are structural causes of autonomic problems, which you can read about below. By addressing restrictions in the ribs and the diaphragm, for example, osteopathic physicians can help restore healthy breathing. We also can take pressure off compressed nerve bundles along the spine whose irritation makes people feel like they are still under attack.

There are some things you can do yourself to calm your agitated nervous system. Practices like yoga, meditation and swimming (because of its breathing requirements) are excellent at helping the ANS put itself back into balance. I talk about this in more detail in Healing Pain and Injury.

•MEDITATION with a focus on the breath is an excellent way to help restore natural breathing patterns. If you don’t know how to meditate, there are many helpful classes and APPS available to help you.

•YOGA is masterful at helping the diaphragm relax and in restoring normal breathing patterns. It also can help restore the calming parasympathetic nervous system.

• SWIMMING is helpful because of its ability to restore a normal breathing pattern. I advise my patients to swim with a mask and snorkel if they have a sore neck.

•WALKING IN NATURE can be very soothing as well.

•THE SIMPLE ACT OF RHYTHMIC BREATHING can reset the autonomic nervous system. Dr. Andrew Weil has developed a practice called “4-7-8” breathing in which you inhale for a count of 4, hold your breath for a count of 7, and exhale for a count of 8 (imagining you are exhaling through a straw can help). It is recommended you try this for 4 breaths, twice a day, to start.

•There are APPS available that help the heart regain its normal rhythm, known as Heart Rate Variability. HEART MATH is probably the best known, but there are many others.

•There are APPS available that help the heart regain its normal rhythm, known as Heart Rate Variability. HEART MATH is probably the best known, but there are many others.

Autonomic problems sometimes need the help of a skilled practitioner. Sometimes,all the yoga, swimming, and meditation in the world is not enough. If a structural problem is contributing to your stress, an osteopathic practitioner or skilled manual medicine practitioner trained in treating the nervous system can help.


Here are some of the structural problems that can contribute to ongoing Injury Shock: