Notes from See The Line 2016
This year has been my third year attending the annual See The Line Concussion Research Symposium. Every year there is something new that I learn and someone brings up old information that I have forgotten, so here I put together some of my notes so massage therapists can have a reference page if they are looking to get into working with a patient population who have suffered a concussion or is suffering from post-concussion syndrome.
What is a concussion?
A concussion is a brain injury caused by a complex physical process affecting the brain, induced by biomechanical forces.
Clinical symptoms of concussion
The most commonly reported symptoms are occipital headache, blurry vision, nausea, dizziness, balance problems, a “foggy feeling,” difficulty with concentration, difficulty with memory, fatigue, confusion, drowsiness, and irritability. Clinically these symptoms fall into four major categories:
1. Somatic: Headaches, nausea, vomiting, balance and or visual problems, and sensitivity to light and noise
2. Emotional: Sadness to the point of depression, nervousness, and irritability
3. Sleep disturbance: Sleeping more or less than usual and having trouble falling asleep
4. Cognitive: Difficulty concentrating, troubles with memory, feeling mentally slow or as if in a fog that will not lift
Why helmets don't prevent concussions
Cervicogenic headaches and massage therapy
There is actually no reliable way to tell if the symptoms are coming from your neck or from your concussion. Concussion is an injury that typically resolves quite quickly in most people (symptoms generally disappear for 80-90% of patients within 7 to 10 days), however whiplash symptoms can linger for up to a year or more. Early interventions reduces the risk of cervicogenic headaches developing into chronic post concussion headaches, but, do not attempt to treat the concussion directly, instead treat the impairments that may be related to or irritating, based on patient-specific assessment findings and patient tolerance.
Manual therapy techniques applied to muscles, surrounding connective tissue, peripheral 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, Suboccipitals, Upper trapezius, Splenius Cervicis Splenius Capitis Levator Scapula, Rhomboids, Temporalis, Occipitofrontalis, Corrugator Supercilii, Masseter, Sternocleidomastoid (SCM), Scalene Muscle Group.
Become a resource for patients
Evidence based practice is the cornerstone of symptom management, the most important part of the health care professional’s involvement in managing concussions is ongoing education regarding signs and symptoms of concussion. There is still no “silver bullet” that exists for concussion rehabilitation, however Massage Therapists can be a valuable resource for patients that have suffered a concussion. It is important to remind patients:
- Changes in the definition and management of concussions have occurred
- A concussion is not a structural injury, but biochemical in nature - no objective measures to diagnose concussion
- Time to heal is variable, the severity of injury is not known until symptoms resolve
- Importance of rest from aggravating activities
- Whiplash injuries often accompany concussions, treating whiplash symptoms can often improve outcomes in patients who suffer a concussion
- What works for one person may not work for another
Links for the Curious
Arendt-Nielsen, L., Castaldo, M., Mechelli, F., & Fernández-De-Las-Peñas, C. (2016). Muscle Triggers as a Possible Source of Pain in a Subgroup of Tension-type Headache Patients? The Clinical Journal of Pain.
Burns, S. (2015). Concussion Treatment Using Massage Techniques: A Case Study. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. (Open Access)
Dewitte, V., Peersman, W., Danneels, L., Bouche, K., Roets, A., & Cagnie, B. (2016). Subjective and clinical assessment criteria suggestive for five clinical patterns discernible in nonspecific neck pain patients. A Delphi-survey of clinical experts. Manual Therapy.
Ellis, M. J., Leddy, J., & Willer, B. (2016). Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach. Frontiers in Neurology. (Open Access)
Ferragut-Garcías, A., Plaza-Manzano, G., Rodríguez-Blanco, C., Velasco-Roldán, O., Pecos-Martín, D., Oliva-Pascual-Vaca, J., . . . Oliva-Pascual-Vaca, Á. (2016). Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of the Tension-Type Headache: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation.
Marshall, C. M., Vernon, H., Leddy, J. J., & Baldwin, B. A. (2015). The role of the cervical spine in post-concussion syndrome. The Physician and Sportsmedicine.
Morin, M., Langevin, P., & Fait, P. (2016). Cervical Spine Involvement in Mild Traumatic Brain Injury: A Review. Journal of Sports Medicine. (Open Access)
Schneider, K. J. (2016). Sport-Related Concussion: Optimizing Treatment Through Evidence-Informed Practice. Journal of Orthopaedic & Sports Physical Therapy.