Chiropractic Management of Post-concussion Headache and Neck Pain In a Young Athlete and Implications For Return-To-Play
SOURCE: Topics in Integrative Health Care 2011 (Oct 7); 2 (3)
Mark T. Pfefer, RN, MS, DC, Stephen R. Cooper, DC,
Angela M. Boyazis
Director of Research,
Cleveland Chiropractic College
Objective: Each year there are an estimated 1.6 to 3.8 million sports-related brain injuries; 136,000 of which occur in young athletes in the course of high school sports. The purpose of this article is to discuss the management and outcome of a post-concussive headache and neck pain in a young athlete and implications for return to play.
Clinical Features: A 16-year-old male athlete presented to a chiropractic clinic complaining of neck pain and daily headaches from a concussion while playing football 5 weeks previously.
Intervention and Outcome: A short course of diversified-type cervical and thoracic manipulation was applied with significant relief after the second treatment and resolution of symptoms after 5 visits performed over 2 weeks. The athlete was able to participate in a graduated return to play. Three months post-SRC the athlete was able to return to full game play symptom free.
Conclusion: Chiropractors who see athletes in their practices should be aware of SRC and return to play guidelines.
Introduction
Recently attention has been focused on sports-related concussions (SRC), in part due to the untimely concussion-related deaths of high school athletes, cognitive problems in professional football players, and head injuries sidelining professional hockey players for extended periods of time. Understanding the signs and symptoms of SRC and appropriate return-to-play recommendations is imperative to the safety of all athletes and young athletes in particular.
Each year in the United States, there are an estimated 1.6 to 3.8 million sports-related brain injuries; [1] 136,000 of which occur in young athletes in the course of high school sports. [2] However, these statistics may be grossly underestimated. McCrea and colleagues [3] found over half of a sample of high school football players did not report a head injury, even though it had occurred. One of the reasons for this is a failure of athletes to recognize their injury as significant. Delany and coworkers [4, 5] found that only 18.8% to 23.4% of concussed players in the Canadian Football League, and Canadian university football and soccer players realized they had sustained a concussion. Another factor in the underestimation of SRCs is the reporting of head injuries to untrained personnel, such as coaches or parents, who in turn may fail to recognize a concussion. [3, 6, 7]
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Concussion has been defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” and may or may not involve loss of consciousness (LOC). [8-10] Another definition that may be more clinically useful is, “a trauma-induced alteration in mental status.” [11] Several common features of SRC include: [8-10]
- May be caused by an impulsive force that is transmitted to the head either direction or indirectly.
- Rapid onset and spontaneous resolution of transient neurological impairment.
- Acute symptoms are that of a functional disturbance rather than a structural injury.
- Involve a graded set of clinical syndromes that may or may not involve LOC. These syndromes typically resolve sequentially.
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Unfortunately, the outcome of the case study for Sidney Crosby hasn’t been as good as expected. He is out again indefinitely with post-concussion type symptoms.
Hi John
Sorry to hear that Sidney is struggling. It’s a sad truth that a small percentage of patients are resistant to correction. This is especially true in folks with histories of repeated head trauma, and I suspect he falls in that category.
Great article, thanks for sharing. With TBI and PCS patients I have seen utilized the fMRI study which appears to document more succinctly the neuro deficit where present.
One also cannot overlook TBI in auto accident injury and it’s implication for patients involved in sports.
Since chiropractors may be the first practitioner to see a young patient that may have had a concussion we should be aware of the Sport Concussion Assessment Tool, SCAT 3 (pdf). Also, the latest McRory consensus statement on concussion in sport can be found here.
Thanks for the update, John!