Integrative chiropractors and nurse practitioners are often on the front line for patients who walk in after a fall, car crash, sports hit, or work accident with a possible head injury. Their job is not only to help with pain, but also to spot red flags, rule out emergencies, and build a safe, complete care plan. To do that, they rely on a mix of hands-on exams, standardized tests, advanced imaging, and modern non-invasive technologies.
This article explains, in simple language, the main diagnostic tools they use for head injuries and concussions, and how these tools fit together in real integrative practice.
Why head-injury diagnostics matter
Head injuries can range from a mild concussion to life-threatening bleeding in the brain. Symptoms can be obvious (loss of consciousness) or very subtle (mild dizziness, brain fog, neck tension). Because of this, accurate diagnosis is essential to:
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Detect dangerous problems early (like brain bleeds or skull fractures)
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Identify concussion and post-concussion syndrome
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Find hidden neck and spine injuries that often travel with head trauma
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Guide the safest treatment plan and activity restrictions
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Provide documentation for work, school, sports, and legal needs
The World Health Organization notes that diagnostic tools include imaging tests (such as X-rays and CT scans), lab tests, and point-of-care devices that help confirm diagnoses and guide treatment decisions. World Health Organization
Integrative chiropractors and nurse practitioners (NPs) work together in this space by blending neurological and musculoskeletal assessment with medical diagnostics and imaging.
How integrative chiropractors and nurse practitioners work as a team
An integrative clinic combines the strengths of both professions:
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Integrative chiropractors
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Focus on the spine, nervous system, posture, and movement
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Perform detailed orthopedic and neurological exams
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Use tools like X-rays, digital motion X-ray (DMX), and non-invasive scans to assess the spine and soft tissuesINSiGHT CLA+3Injury to Wellness+3Modern Chiropractic Center+3
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Track how spinal issues may worsen headaches, dizziness, and balance problems
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Nurse practitioners
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Take full medical histories and medication lists
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Use standardized neurological scales, such as the Glasgow Coma Scale (GCS)
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Order advanced imaging (CT, MRI) and lab tests when needed
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Rule out serious issues like bleeding, infection, or metabolic problems
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Coordinate care with neurologists, radiologists, and emergency departments
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The California Board of Chiropractic Examiners notes that, after a thorough history and exam, chiropractors may perform or order imaging, such as X-rays, MRIs, CT scans, and lab studies (e.g., blood tests or urinalysis), to confirm their diagnosis and determine whether chiropractic care is appropriate. Chiropractic Board of California. This fits well with NPs who can expand the work-up when symptoms suggest a more severe head injury.
History and symptom screening
Before any test, both providers start with good questions.
Key questions after a head injury
A detailed history usually covers:
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How the injury happened (fall, car crash, sports hit, workplace blow, assault)
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Whether there was loss of consciousness, amnesia, or confusion
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Symptoms like:
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Headache or pressure in the head
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Dizziness or balance problems
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Nausea, vomiting, or visual changes
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Ringing in the ears (tinnitus) or hearing changes
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Neck pain, stiffness, or radiating arm pain
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Cognitive issues (foggy thinking, memory problems, slowed reaction)
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Emotional changes (irritability, anxiety, depression)
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Audiology experts also point out that head injury can cause hearing and vestibular problems, including tinnitus, hearing loss, and balance issues, which may go unnoticed without testing. Audiology Associates
Symptom checklists and self-report tools
Integrative chiropractors and NPs often use:
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Concussion symptom checklists (rating headache, dizziness, sleep issues, etc.)
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Post-concussion symptom scales
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Headache diaries
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Balance or dizziness questionnaires
These tools help:
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Track symptom changes over time
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Decide when to progress the activity
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Communicate clearly with patients, families, employers, or coaches
Neurological and physical examinations
After the history, both providers perform a hands-on exam. The California chiropractic guide explains that a complete diagnostic exam includes general tests such as blood pressure, pulse, and reflexes, as well as specific orthopedic and neurological tests to assess range of motion, muscle tone and strength, and nerve function. Chiropractic Board of California
Typical exam elements
A head-injury-focused exam may include:
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Cranial nerve testing
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Eye movements and pupil responses
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Facial symmetry and sensation
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Hearing and balance-related reflexes
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Motor and sensory testing
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Muscle strength in arms and legs
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Light touch and pin-prick sensation
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Reflexes (biceps, triceps, knee, ankle)
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Cervical spine evaluation
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Range of motion
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Tenderness over joints and soft tissues
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Signs of instability or nerve compression
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Coordination and gait
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Finger-to-nose and heel-to-shin testing
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Walking, turning, and single-leg stance
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Vital signs
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Blood pressure and heart rate (looking for changes that might suggest more serious brain injury or autonomic problems)
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Clinics that specialize in whiplash and auto injuries often stress the value of structured physical exams combined with imaging and special tests to catch injuries that are not obvious at first glance. Modern Chiropractic Center+1
Standardized neurological scales and concussion tools
Standardized tools make head injury assessment more objective and easier to compare over time.
Glasgow Coma Scale (GCS)
The GCS is widely used in emergency and acute settings to rate:
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Eye opening
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Verbal response
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Motor response
Scores help determine how severe the brain injury may be and whether urgent imaging or neurosurgical care is needed. Nurse practitioners use the GCS in urgent care, hospital, and sometimes clinic settings, especially when a patient is seen soon after the injury. Hospital concussion guidelines emphasize that GCS is part of the early evaluation of suspected traumatic brain injury.NYU Langone Health
Sideline and clinic concussion tools
A variety of tools are used in sports, audiology, and brain injury clinics, including:
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Balance Error Scoring System (BESS) – assesses balance deficits that can indicate concussion Audiology Associates
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Standardized Assessment of Concussion (SAC) – brief cognitive and orientation test Audiology Associates
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Acute Concussion Evaluation (ACE) – evidence-based protocol to guide initial evaluation, diagnosis, and follow-up Audiology Associates
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SCAT5 / Child SCAT5 – standardized tools combining symptoms, balance, and neurocognitive tasks (widely discussed in concussion literature, including clinical reviews)
These tools help chiropractors, NPs, audiologists, and therapists detect subtle problems that don’t always appear on CT or MRI scans.
Neurocognitive testing with ImPACT
One of the best-known computerized concussion tests is ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). ImPACT is FDA-cleared and widely used in sports and clinical settings.
According to ImPACT Applications:
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Chiropractors can use ImPACT for patients ages 12–80 (with ImPACT Pediatric for younger children).
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The test includes eight neurocognitive modules that measure:
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Visual and verbal memory
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Reaction time
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Processing speed
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It also features a 21-item symptom scale to track how the patient feels.
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After testing, the software produces a detailed report to guide rehab and return-to-activity decisions.impacttest.com
For integrative chiropractors and NPs, ImPACT:
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Gives objective data that goes beyond “I feel better”
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Helps monitor progress during recovery
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Can be compared to baseline scores (if available) or published norms
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Supports communication with schools, teams, and employers
In clinics like those of Dr. Alexander Jimenez, neurocognitive tools are combined with physical, vestibular, and spinal assessments to form a fuller picture of brain and body function after a head injury. El Paso, TX Doctor Of Chiropractic
Imaging tools – X-rays, CT, MRI, and DMX
Imaging does not diagnose concussion by itself, but it plays a key role in ruling out more serious injuries and identifying associated neck and spine damage.
X-rays
Chiropractic and spine-injury clinics commonly use X-rays to:
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Look for fractures or dislocations
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Check spinal alignment and curvatures
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Compare posture and segmental motion between views
The California chiropractic guide lists X-ray, MRI, CT, and lab tests as common diagnostic studies ordered or performed by chiropractors after history and physical exam. Chiropractic Board of California. Many chiropractic practices highlight the role of X-rays in understanding injuries after car accidents, especially when combined with other advanced tools. Injury to Wellness+2Injury to Wellness+2
CT scans and MRI
Nurse practitioners often order a CT or an MRI when:
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There is a loss of consciousness or a worsening headache
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The patient has repeated vomiting, severe confusion, or new neurologic deficits
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There is concern for skull fracture, brain bleeding, or structural damage
Concussion centers like NYU Langone emphasize that a concussion is mainly a clinical diagnosis, but CT and MRI are essential when red-flag symptoms suggest bleeding, swelling, or serious structural injury.NYU Langone Health
For ongoing symptoms (such as chronic headache, dizziness, or cognitive changes), an MRI can help rule out other conditions and evaluate deeper brain structures.
Digital Motion X-ray (DMX)
Digital Motion X-ray (DMX) is a dynamic imaging technology that records real-time movement of the spine while the patient moves. A Modern Chiropractic Center article explains that DMX can reveal subtle ligament injuries and instabilities that static X-rays, CT scans, or MRIs can miss, especially after car crashes. Modern Chiropractic Center
This is especially useful when a head injury is combined with whiplash and upper-cervical trauma.
Ultrasound and other imaging
Some musculoskeletal clinics also use:
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Ultrasound to evaluate soft tissue injuries around the neck and upper back
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Diagnostic fluoroscopy in specific cases
Spine and injury clinics note that combining imaging with physical and neurological exams leads to a more complete and accurate diagnosis. flspineandinjury.com+1
Non-invasive neurological scanning and functional tools
Modern integrative chiropractic care increasingly uses non-invasive technologies to assess how the nervous system and spine function.
Common chiropractic diagnostic technologies
Articles from INSiGHT CLA and Injury 2 Wellness describe several tools: Injury to Wellness+3INSiGHT CLA+3INSiGHT CLA+3
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Surface electromyography (sEMG)
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Measures muscle activity along the spine
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Helps detect abnormal muscle tension patterns after whiplash or head injury
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Thermography / thermal scanning
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Evaluates temperature changes along the spine that may reflect nerve irritation or autonomic imbalance
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Heart rate variability (HRV)
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Assesses how well the autonomic nervous system is adapting to stress
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Important because concussions and neck injuries can affect autonomic balance (heart rate, blood pressure, digestion)
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Computerized posture and balance analysis
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Measures body alignment and center of gravity
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Tracks changes in posture as the brain and neck recover
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These tools are non-invasive and do not replace CT or MRI. Instead, they help:
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Show patients how their nervous system is functioning
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Track changes over time with care
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Guide adjustments, rehab exercises, and lifestyle recommendations
In vitro diagnostics and lab tests
Head injuries are mainly diagnosed with exams and imaging, but lab tests can be important for the full picture, especially when a nurse practitioner is involved.
The World Health Organization defines in vitro diagnostics as tests performed on samples such as blood or urine to detect diseases or monitor health, including those conducted in labs or at the point of care. World Health Organization
In an integrative clinic, an NP might order:
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Complete blood counts and metabolic panels
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To look for anemia, infection, or metabolic imbalance that can worsen fatigue or confusion
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Coagulation studies
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Important for patients on blood thinners after a head injury
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Inflammatory markers or hormone tests
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When chronic symptoms persist and there is concern about systemic inflammation or endocrine disruption
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Lab results won’t diagnose a concussion on their own, but they can help identify other medical conditions that can slow recovery.
Audiology and vestibular assessments
Hearing and balance are closely tied to head injuries. Audiology resources explain that head trauma can damage inner ear structures and temporal lobes, leading to: Audiology Associates
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Hearing loss
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Tinnitus
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Difficulty filtering sounds
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Problems with rapid speech and long conversations
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Balance problems from vestibular damage
To evaluate these problems, audiology clinics may use:
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Comprehensive hearing tests
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Vestibular balance assessments with videonystagmography and posturography
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Balance Error Scoring System (BESS) and Standardized Assessment of Concussion (SAC)
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Acute Concussion Evaluation (ACE) for tracking recovery Audiology Associates
Integrative chiropractors and NPs often refer to audiologists or vestibular therapists when patients have:
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Persistent dizziness or vertigo
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Ringing in the ears after a concussion
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Problems walking in dark rooms or busy visual environments
These findings are then folded back into the overall care plan.
Clinical observations from Dr. Alexander Jimenez, DC, APRN, FNP-BC
Dr. Alexander Jimenez practices in El Paso, Texas, as a dual-scope clinician—both Doctor of Chiropractic and Family Practice Nurse Practitioner. His website describes a clinic that focuses on personal injury, auto injury care, whiplash, complex sports injuries, and traumatic brain injuries, with dedicated sections on imaging, diagnostics, clinical neurology, and neurophysiology. El Paso, TX Doctor Of Chiropractic
From his published materials and integrative practice model, several clinical themes stand out:
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Integrated spine and brain focus
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Many head-injured patients also have cervical and thoracic spine trauma, including ligament injuries and postural shifts.
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Dr. Jimenez emphasizes careful spinal imaging and motion assessment to understand how neck misalignment can worsen headaches, dizziness, and nerve pain. El Paso, TX Doctor Of Chiropractic+1
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Use of advanced imaging and diagnostics
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His site highlights categories such as “Imaging & Diagnostics,” “Clinical Neurology,” and “Clinical Neurophysiology,” reflecting a strong focus on correlating imaging (X-ray, MRI, and occasionally dynamic studies like DMX) with functional exam findings. El Paso, TX Doctor Of Chiropractic+1
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Personal injury and medico-legal documentation
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Because many of his patients come from auto accidents and work injuries, Dr. Jimenez’s clinics pay special attention to detailed documentation, including imaging, neurocognitive findings, and physical-function testing, which can support both recovery and legal processes. El Paso, TX Doctor Of Chiropractic
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Functional medicine and whole-body assessment
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His platform also integrates functional medicine, acknowledging that systemic inflammation, hormonal imbalances, and gut-brain interactions can affect recovery after head and spine trauma. El Paso, TX Doctor Of Chiropractic
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In this kind of integrative setting, a patient with a head injury may receive:
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A neurological and musculoskeletal exam from the chiropractic side
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Neurocognitive and vestibular screening (for balance, memory, and reaction time)
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Spinal imaging (X-ray, DMX when indicated) and referrals for CT or MRI when red flags are present
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Lab testing and systemic evaluation under the nurse practitioner scope
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A combined treatment plan that includes spinal adjustments, rehabilitative exercise, lifestyle changes, and referrals to neurology, audiology, or psychology when needed
Putting it all together: building a comprehensive treatment plan
Once the data are collected—history, physical findings, test scores, imaging, and lab results—integrative chiropractors and NPs create a personalized care map.
How the findings guide treatment
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Normal imaging + concussion signs
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Focus on concussion management, pacing, cognitive rest, and gradual return to activity
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Chiropractic care may address associated neck strain and postural issues
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Neurocognitive tests like ImPACT monitor progress impacttest.com+1
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Imaging showing cervical ligament or alignment problems
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Spinal adjustments, traction, and corrective exercises are used to restore alignment and reduce nerve irritation
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Non-invasive neuro-scans (sEMG, thermography, HRV) track nervous system changes over time INSiGHT CLA+2INSiGHT CLA+2
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Abnormal balance, vestibular, or hearing tests
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Vestibular rehabilitation and audiology care are added
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Care is coordinated so patients do not over-exert the brain early in recovery Audiology Associates+1
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Abnormal lab results or systemic concerns
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NPs may adjust medications, address metabolic issues, and refer to other specialists
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Functional medicine strategies (nutrition, sleep, stress management) support healing El Paso, TX Doctor Of Chiropractic+1
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Throughout care, the ongoing use of standardized scales (such as symptom scores, ACE, BESS, and SAC) and periodic imaging or scans allows the team to track whether the patient is truly improving or needs a change in strategy. Audiology Associates+1
When to seek emergency care instead of clinic care
Integrative chiropractors and nurse practitioners are trained to recognize red-flag symptoms that require immediate emergency care, such as:
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Worsening or severe headache
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Repeated vomiting
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Weakness, numbness, or difficulty speaking
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Seizures
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One pupil is larger than the other
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Increasing confusion, agitation, or unusual behavior
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Loss of consciousness that is prolonged or recurrent
In these cases, the NP or chiropractor will arrange urgent transfer to an emergency department, where CT or other hospital-level diagnostics can be done right away. Concussion guidelines from major centers emphasize this division of care—clinic-based management for stable patients and emergency evaluation for dangerous or worsening symptoms. NYU Langone Health+1
Conclusion
Head injuries are complex, and no single test can tell the full story. Integrative chiropractors and nurse practitioners combine:
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Careful history and symptom tracking
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Neurological and orthopedic exams
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Standardized tools like the Glasgow Coma Scale, BESS, ACE, and SAC
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Computerized neurocognitive testing, such as ImPACT
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Imaging (X-ray, CT, MRI, DMX) to rule out serious injury and reveal spine problems
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Non-invasive neurological and postural scanning
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Audiologic, vestibular, and lab assessments when needed
In practices like Dr. Alexander Jimenez’s integrative clinic in El Paso, these tools are woven together to create personalized, evidence-informed care that looks at the brain, spine, and whole body—not just one symptom at a time. impacttest.com+3El Paso, TX Doctor Of Chiropractic+3Modern Chiropractic Center+3
If you or someone you love has suffered a head injury, seeking out a team that includes both an integrative chiropractor and a nurse practitioner can provide a thorough diagnostic work-up and a safer path back to normal life.
References
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California Board of Chiropractic Examiners. (n.d.). A consumer’s guide to chiropractic care. https://www.chiro.ca.gov/publications/chiro_consumer_guide.pdf Chiropractic Board of California
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ImPACT Applications, Inc. (2025). Chiropractor’s role in concussion management. https://impacttest.com/chiropractors-role-in-concussion-management/ impacttest.com
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Injury 2 Wellness Centers. (n.d.). Revolutionizing injury diagnosis: Advanced chiropractic tools explained. https://injury2wellness.com/revolutionizing-injury-diagnosis-advanced-chiropractic-tools-explained/ Injury to Wellness
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Injury 2 Wellness Centers. (n.d.). Innovative injury assessment techniques in modern chiropractic care. https://injury2wellness.com/innovative-injury-assessment-techniques-in-modern-chiropractic-care/ Injury to Wellness
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INSiGHT CLA. (n.d.). Neurological scanning technology for chiropractic diagnosis. https://insightcla.com/blog/neurological-scanning-technology-for-chiropractic-diagnosis/ INSiGHT CLA
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INSiGHT CLA. (n.d.). The future of non-invasive diagnostics in chiropractic practices. https://insightcla.com/blog/the-future-of-non-invasive-diagnostics-in-chiropractic-practices/ INSiGHT CLA
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Modern Chiropractic Center. (n.d.). The crucial role of digital motion X-ray (DMX) in accurate post-car crash injury diagnosis. https://modernchiropracticcenter.com/blog/accurate-post-car-crash-injury-diagnosis/ Modern Chiropractic Center
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NYU Langone Health. (n.d.). Diagnosing concussion. https://nyulangone.org/conditions/concussion/diagnosis NYU Langone Health
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Audiology Associates. (n.d.). Hearing loss & TBI – Recognizing and evaluating head injury. https://www.audiologyassociates-sr.com/hearing-loss/hearing-loss-tbi/ Audiology Associates
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World Health Organization. (n.d.). Diagnostics – Global. https://www.who.int/health-topics/diagnostics World Health Organization
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Florida Spine & Injury. (n.d.). How do chiropractors diagnose injuries? https://www.flspineandinjury.com/blog/how-do-chiropractors-diagnose-injuries flspineandinjury.com
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Jimenez, A. (n.d.). El Paso, TX chiropractor Dr. Alex Jimenez DC | Personal injury specialist. https://dralexjimenez.com El Paso, TX Doctor Of Chiropractic
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and the jurisdiction in which they are licensed to practice. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and to identify relevant research studies that support our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol. To discuss the subject matter above further, please contact Dr. Alex Jimenez or us at 915-50-0900.
Dr. Alex Jimenez, DC, MSACP, CCST, IFMCP*, CIFM*, ATN*
Email: coach@elpasofunctionalmedicine.com
Licensed in: Texas & New Mexico*
