Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification
William J. Moreau, DC, DACBSP, CSCS,
Dustin C. Nabhan, DC, DACBSP, CSCS, RMSK,
Taylor Walden, BA
United States Olympic Committee,
Colorado Springs, CO
OBJECTIVE: The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic.
METHODS: A 21–item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors.
RESULTS: Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool–3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%).
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CONCLUSION: This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool–3 as a sideline assessment tool.
Key indexing terms: Brain concussion, Chiropractic
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The prevention and treatment of injuries and disorders related to sport participation are practiced by many types of health care providers. The current level or standard of training in the detection and management of head injury by each profession is unknown and has yet to be mandated by any government or health-related agencies. In sports, the evaluation and management of concussion in all populations are important because concussion is a common occurrence with the potential for serious adverse effects if managed incorrectly both acutely and over the course of an individual’s life span.  The 2009 incidence of sports and recreational concussive injuries in children (under the age of 19) that were treated in US emergency departments is estimated by the Centers for Disease Control and Prevention (CDC) to represent almost 250,000 concussions or traumatic brain injury.  Many sports-related concussions are known to be managed outside the emergency department setting, making the actual incidence difficult to estimate.  As a result, the total number of injuries should be expected to be much higher than the reported incidence from the CDC reports. 
There are several variables that support that the actual number of concussive injuries is much higher than currently reported.  Some of the variables include the following:
The culture of placing the team’s needs before the individual athlete’s needs. Individual athletes may misinterpret the importance of sport to the point of playing with a head injury to avoid letting their team and teammates down. It is well recognized that athletes may cover their injury as well as the injury of their teammates. [4, 5]
Many sporting activities take place without the presence of a trained health care provider to assess and manage head injuries. Reported concussion incidence has been shown to increase with greater education of the sporting community. 
Nationwide reporting systems for sports medicine personnel to record concussive injury, regardless of the level of sports participation, do not capture all incidences of concussion. 
The current definition and methodologies of detecting concussion may miss subclinical head injury.