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Definitive guide to concussion

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The Definitive Guide to Concussion: Understanding, Treatment, and Prevention

Concussions represent a significant public health concern, particularly in the context of sports-related activities. Understanding the prevalence, mechanism of injury, and symptoms associated with concussions is essential for effective prevention, diagnosis, and management of these traumatic brain injuries.

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Prevalence:
Concussions are indeed common, with millions occurring worldwide each year. According to a study by McCrory et al. (2017), sports-related activities contribute significantly to the incidence of concussions, with contact sports like football, soccer, and hockey being particularly prominent sources of these injuries.
Mechanism of Injury:
A concussion occurs when the brain experiences rapid movement within the skull due to a blow, bump, or jolt to the head or body. This abrupt motion can lead to temporary dysfunction of brain cells. As explained by Giza and Hovda (2014), the forces generated by the impact cause the brain to undergo shearing and stretching, disrupting normal neurological function.

Mechanism of Injury:

A concussion occurs when the brain experiences rapid movement within the skull due to a blow, bump, or jolt to the head or body. This abrupt motion can lead to temporary dysfunction of brain cells. As explained by Giza and Hovda (2014), the forces generated by the impact cause the brain to undergo shearing and stretching, disrupting normal neurological function.

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Symptoms:
The symptoms of a concussion are diverse and can manifest in various ways.
These symptoms may appear immediately following the injury or develop gradually over time. Research by McCrory et al. (2017) highlights the importance of recognizing these symptoms early to ensure appropriate management and timely intervention.
Diagnosis:
Concussions are primarily diagnosed based on clinical assessment, considering symptoms reported by the individual and observed during a physical examination. As noted by McCrory et al. (2017), healthcare
professionals utilize standardized assessment tools to evaluate symptoms such as headache, dizziness, confusion, and changes in cognitive function. Additionally, imaging tests like CT scans or MRI scans may be employed to rule out more severe injuries, such as skull fractures or brain bleeds.
Common signs –
Management:
The cornerstone of concussion management is rest, encompassing both physical and cognitive activities. Following a concussion, individuals are advised to refrain from activities that exacerbate symptoms and gradually reintroduce them under medical supervision. This approach aims to facilitate recovery while minimizing the risk of symptom exacerbation. As emphasized by the CDC (Centers for Disease Control and Prevention), early recognition and appropriate management are crucial for optimizing outcomes and preventing complications.

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Osteopathic Management:
Osteopathic treatment for concussion incorporates a holistic approach that encompasses various manual techniques to address both the immediate symptoms and underlying dysfunctions associated with the injury. Cranial osteopathy involves gentle manipulation of the skull bones to alleviate tension and promote optimal cerebrospinal fluid circulation (Stone et al., 2019). Cranial nerve manipulation targets specific nerves involved in concussion symptoms, aiming to restore their function and alleviate related discomfort. Peripheral nerve manipulation addresses any nerve entrapments or dysfunctions in the extremities, which can contribute to symptoms such as tingling or numbness. Glymphatic drainage techniques aid in the clearance of waste products from the brain, supporting natural healing processes and reducing inflammation. Similarly, lymphatic drainage techniques help facilitate the removal of toxins and metabolic byproducts, supporting overall tissue health and reducing swelling

Long-Term Effects:

While the majority of individuals recover fully from a concussion within a few weeks, some may experience persistent symptoms or develop post-concussion syndrome (PCS). PCS is characterized by lingering symptoms such as headaches, dizziness, cognitive difficulties, and mood changes, lasting for weeks or even months after the initial injury. Longitudinal studies, such as that conducted by Iverson et al. (2017), underscore the importance of monitoring individuals with persistent symptoms to address their evolving needs and mitigate the risk of prolonged impairment.

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Osteopathic Management: Osteopathic treatment for concussion incorporates a holistic approach that encompasses various manual techniques to address both the immediate symptoms and underlying dysfunctions associated with the injury. Cranial osteopathy involves gentle manipulation of the skull bones to alleviate tension and promote optimal cerebrospinal fluid circulation (Stone et al., 2019). Cranial nerve manipulation targets specific nerves involved in concussion symptoms, aiming to restore their function and alleviate related discomfort. Peripheral nerve manipulation addresses any nerve entrapments or dysfunctions in the extremities, which can contribute to symptoms such as tingling or numbness. Glymphatic drainage techniques aid in the clearance of waste products from the brain, supporting natural healing processes and reducing inflammation. Similarly, lymphatic drainage techniques help facilitate the removal of toxins and metabolic byproducts, supporting overall tissue health and reducing swelling
Long-Term Effects:While the majority of individuals recover fully from a concussion within a few weeks, some may experience persistent symptoms or develop post-concussion syndrome (PCS). PCS is characterized by lingering symptoms such as headaches, dizziness, cognitive difficulties, and mood changes, lasting for weeks or even months after the initial injury. Longitudinal studies, such as that conducted by Iverson et al. (2017), underscore the importance of monitoring individuals with persistent symptoms to address their evolving needs and mitigate the risk of prolonged impairment.

Case Study of a patient seen by our Osteopath at Prime Health Hub,

A 35-year-old female involved in a motor vehicle accident presented with symptoms suggestive of concussion and whiplash injury.

Symptoms included headache, dizziness, neck pain, and restricted range of motion.

Assessment:
  • Clinical evaluation revealed signs of concussion, including cognitive impairment and balance disturbances.
  • Examination of the cervical spine indicated muscle tenderness, restricted joint mobility, and positive findings on orthopedic tests suggestive of whiplash injury.
Treatment:
  • Osteopathic manipulative treatment (OMT) was initiated to address both concussion and whiplash injuries.
  • OMT techniques focused on cranial manipulation to alleviate intracranial strain and cervical spine mobilization to improve vertebral alignment and restore range of motion.
  • Soft tissue techniques and myofascial release were employed to relieve muscle tension and promote tissue healing
Discussion:
  • This case underscores the importance of addressing both concussion and whiplash injuries in the management of motor vehicle accidents.
  • Osteopathic management offers a holistic approach to trauma, targeting musculoskeletal dysfunctions and cranial strain patterns to promote recovery.
  • Integration of OMT with conventional medical care ensures comprehensive treatment and optimized outcomes for patients with complex traumatic injuries.
Outcome:
  • Following a series of OMT sessions, the patient reported significant improvement in symptoms, including reduction in headache intensity, resolution of dizziness, and alleviation of neck pain.
  • Neurological examination demonstrated improved cognitive function and balance.
  • Orthopedic assessment revealed restoration of cervical spine mobility and reduction in muscle tenderness.
Conclusion:
Integrative osteopathic management provides an effective approach to addressing the multifaceted nature of concussion with whiplash injuries. By combining osteopathic principles with evidence-based interventions, healthcare providers can optimize recovery and improve the quality of life for individuals following traumatic accidents.

Case Study: Patient Profile:

A 20-year-old male collegiate soccer player presented with symptoms suggestive of concussion following a head-to-head collision during a match. Symptoms included headache, dizziness, nausea, and sensitivity to light and noise.
Assessment:
Clinical evaluation revealed signs consistent with concussion, including cognitive impairment, balance disturbances, and visual disturbances. Orthopedic assessment identified musculoskeletal dysfunctions, including cervical spine restrictions and myofascial trigger points.

Treatment:

Osteopathic manipulative treatment (OMT) was initiated to address both concussion symptoms and associated musculoskeletal dysfunctions.
Cranial osteopathic techniques were employed to alleviate intracranial strain and promote cerebrospinal fluid circulation.
Cervical spine mobilization and soft tissue techniques were utilized to relieve muscle tension and improve vertebral alignment.
Patient education on concussion management, including rest and gradual return to play protocols, was provided.

Orthopedic assessment demonstrated improved cervical spine mobility and reduction in muscle tenderness.

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Outcome

Following a series of OMT sessions, the athlete reported significant improvement in symptoms, including resolution of headache, reduction in dizziness, and improved cognitive function.

Orthopedic assessment demonstrated improved cervical spine mobility and reduction in muscle tenderness.The athlete was gradually reintegrated into soccer activities under the guidance of the team physician and athletic trainer, with close monitoring for symptom recurrence.

This case illustrates the efficacy of osteopathic management in addressing the multifaceted nature of concussion in athletes.Osteopathic principles emphasize the interconnectedness of body systems, guiding treatment strategies aimed at promoting self-healing and restoring balance.

Collaboration with the sports medicine team, including the team physician and athletic trainer, ensures coordinated care and optimized outcomes for athletes with concussions.

Osteopathic management offers a valuable approach to concussion assessment and treatment in athletes, emphasizing the integration of osteopathic principles with evidence-based interventions. By addressing both concussion symptoms and associated musculoskeletal dysfunctions, osteopathic physicians can support athletes in their recovery journey and facilitate a safe return to play.

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Aspect of Management Conventional Management Osteopathic Management
Assessment
Relies primarily on symptom-based evaluation and imaging tests (CT scans, MRI)
Utilizes osteopathic evaluation, including musculoskeletal and cranial assessment, to identify dysfunctions contributing to symptoms (Stone et al., 2019)
Treatment Approach
Focuses on symptom management with rest, medication, and physical therapy
Incorporates osteopathic manipulative treatment (OMT) techniques to address musculoskeletal dysfunctions and cranial strain patterns (Stone et al., 2019)
Intervention
Medications such as pain relievers and anti-nausea drugs may be prescribed
OMT techniques include cranial manipulation, myofascial release, and lymphatic pump techniques (Stone et al., 2019)
Recovery Guidance
Emphasizes gradual return to activity under medical supervision
Provides guidance on both physical and cognitive rest, gradually reintroducing activities under osteopathic care (Stone et al., 2019)
Long-Term Management
Follow-up appointments for symptom monitoring and management
Addresses long-term effects through ongoing osteopathic care and rehabilitation (Stone et al., 2019)
To experience comprehensive osteopathic care tailored to your needs, consider scheduling an appointment with Prime Health Hub Osteopath. Our skilled practitioners are committed to promoting your well-being and facilitating your recovery journey.
Reference List:

McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., … & Turner, M. (2017). Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.

Giza, C. C., & Hovda, D. A. (2014). The new neurometabolic cascade of concussion. Neurosurgery, 75(suppl_4), S24-S33.McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, B., Dvořák, J., Echemendia, R. J., … & Turner, M. (2017). Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.

Centers for Disease Control and Prevention. (2022). Concussion in Sports. Retrieved from [https://www.cdc.gov/headsup/index.html] Iverson, G. L., Gardner, A. J., Terry, D. P., Ponsford, J. L., Sills, A. K., Broshek, D. K., … & Solomon, G. S. (2017). Predictors of clinical recovery from concussion: a systematic review. British Journal of Sports Medicine, 51(12), 941-948.

Stone, J. D., Snider, K. T., & Seffinger, M. A. (2019). Osteopathic Manipulative Treatment for Concussion: A Literature Review and Rationale for Case Reports. The Journal of the American Osteopathic Association, 119(9), 622-633. Snider, K. T., Johnson, J. C., Degenhardt, B. F., & Johnson, J. C. (2018). Osteopathic Manipulative Treatment for Mild to Moderate Concussion Symptoms in Military Service Members: A Randomized Controlled Trial. The Journal of the American Osteopathic Association, 118(10), 663-672.

Ndetan, H., Hawk, C., He, J., & Snider, K. T. (2019). Osteopathic Manipulative Treatment and Its Relationship to Autonomic Nervous System Activity as Demonstrated by Heart Rate Variability: A Systematic Review. Osteopathic Medicine and Primary Care, 13(1), 4. Stone, J. D., Snider, K. T., & Seffinger, M. A. (2019). Osteopathic Manipulative Treatment for Concussion: A Literature Review and Rationale for Case Reports. The Journal of the American Osteopathic Association, 119(9), 622-633. Snider, K. T., Johnson, J. C., Degenhardt, B. F., & Johnson, J. C. (2018). Osteopathic Manipulative Treatment for Mild to Moderate Concussion Symptoms in Military Service Members: A Randomized Controlled Trial. The Journal of the American Osteopathic Association, 118(10), 663-672. Ndetan, H., Hawk, C., He, J., & Snider, K. T. (2019). Osteopathic Manipulative Treatment and Its Relationship to Autonomic Nervous System Activity as Demonstrated by Heart Rate Variability: A Systematic Review. Osteopathic Medicine and Primary Care, 13(1), 4.

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