Massage Therapist and Their role in concussion management
Current best practices for concussion management emphasizes early intervention, which can lessen symptoms and promote recovery, leading to a better outcomes. Concussions need to be properly identified and treated to minimize patients suffering and reduce the life disturbance caused by concussions and post- concussion syndrome. The gold standard for acute concussion recovery is physical and cognitive rest.
Immediate Steps a Massage Therapist can take to incorporate concussion management into their practice
Massage Therapy may be recommended by physicians as part of the concussion management treatment plan. Develop confidence in your approach, when patients come in with a concussion they are in vulnerable state, they want a healthcare practitioner they can trust their health to. Patients are looking for reassurance in ability to get better. It is important to use a biopsychosocial approach to pain in order to appreciate the complex and special needs of this demographic. Take time to set up your room so there are options available for patients that are experiencing photosensitivity (sight sensitivity) and phonosensitivity (sound sensitivity). Be aware of hypersensitivities and irritability.
When working with an athlete who has suffered a concussion here are some questions to keep in mind.
- Was this your first concussion?
- Have you been assessed by a physician yet?
- What symptoms are you currently experiencing?
- What is your goal with massage therapy?
- What special precautions do you need? ie. positioning, lighting and sound.
Patients with chronic headache pain may often receive Botox injections, these injections can have side effects that massage therapists should be aware of, I would never directly massage over an area treated within 72hrs. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), trouble breathing, trouble swallowing.
Treating Cervicogenic Headaches
Patients often present with cervicogenic headaches resulting from undiagnosed whiplash suffered at the time of the concussion. Early therapeutic intervention will reduce the risk of cervicogenic headaches developing into chronic post concussion headaches. Left untreated myofascial pain can produce a sensitization phenomenon in the central nervous system resulting in chronic pain. A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance.
Manual therapy techniques applied to muscles, surrounding connective tissue, irritated nerves and soft tissue interface can yield good therapeutic results. Muscles to keep in mind while assessing and treating athletes who have suffered a concussion include, but are not limited to
- Upper trapezius
- Splenius Cervicis
- Splenius Capitis
- Levator Scapula
- Corrugator Supercilii
- Scalene Muscle Group.
Massage Therapists as healthcare professionals can be a valuable resource for patients. When someone has suffered a concussion for the first time they may not have the energy and the resources to seek out the best care. This is often where our role as a healthcare provider can come into place by having a referral list and educational resources available for patients. I recommend having a referral list including Physicians, Physiotherapists and Chiropractors who specialize in concussion management.