Concussion and Osteopathic Manipulation

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What is osteopathic manipulative treatment (OMT)?

Osteopathic manipulation is a form of treatment performed by D.O. (Doctor of Osteopathy) physicians. This diagnostic and treatment modality of treatment is used as an extension or complement to conventional medical training. The goal of manipulation is to help “reset” the body and allow the body to promote self-healing. Manipulation primarily focuses on musculoskeletal dysfunctions and anatomical relations of the body; it is specifically a highly used tool for back pain, neck pain, sports injuries, and headaches. Osteopathic manipulation uses multiple types of treatment from myofascial releases, soft tissue techniques, muscle energy, high velocity-low amplitude (“Cracking”), counterstain, facilitated positional release, and cranial release. With the myriad of treatment options the use of osteopathic manipulation is a great additive tool to classical treatments that physicians may use to help facilitate the body’s natural healing processes.

How is OMT useful for concussions and concussion symptoms?

A concussion is a traumatic event to the brain, which alters the brain processes and can manifest in a multitude of symptoms. The most common symptoms are headache, neck pain, vestibulo-ocular dysfunction, fatigue, mood lability and cognitive decline from baseline. Cervical symptoms including neck pain, muscular spasm, and chronic cervicogenic headaches are very common in patients with Post Concussive Syndrome (PCS) or concussion with prolonged symptoms.  Chronic cervicogenic headaches are usually secondary to musculoskeletal cervical dysfunction caused by the traumatic head/neck injury.  Manipulation in concussion patients would be primarily focused on cranial and cervical spine dysfunction. A thorough evaluation of the cranial bones, cervical vertebral bodies, neck and shoulder musculature, and cranial rhythmic impulse (CRI) would be performed. The cranial rhythmic impulse is a measurement of the primary respiratory mechanism, which is an oscillation of the body’s response moving through inhalation and exhalation phases. The CRI is an important osteopathic finding as it can elude information about the sphenobasilar synchondosis of the skull which is not directly palpable.

Based on key findings of somatic dysfunctions, the physician will first treat findings that correlate to the patient’s most debilitating symptoms as the key lesion. This is performed in this order because many times multiple symptoms can be secondary to the key lesion. Each found lesion or somatic dysfunction can be treated and response to treatment will be graded by the patient.

The goal of the treatments are to relieve the patient of most, if not all, of their presenting symptoms, which will minimize the load on the brain and allow for maximal time of healing. In effect, this ideally will help reduce recovery time and improve patient outcomes.

What kind of response can be expected?

Most patients will find that the benefits of manipulation to be temporary solutions to symptoms. In particular, patients with cervicogenic type post concussion syndrome can propel their recovery by addressing some of their specific cervical dysfunction that may be causing a multitude of secondary symptoms. Patients are always welcomed and encouraged to return for manipulation as needed. Due to current lack of published research, there is no true protocol for concussion symptom management currently. Also, due to every patient’s symptomology being different patients will have varying treatments and responses to the treatment. However, there are multiple case studies and pilot projects showing the use and effectiveness of concussion treatment. Therefore, osteopathic manipulative treatment is to be used as an additive treatment to the primary treatment and Zurich guidelines to help facilitate the body and brain’s healing.

By Arka Chaudhury and Mo Mortazavi MD

Concussions and Osteopathic Manipulative Treatment: An Adolescent Case Presentation
Resolution of Concussion Symptoms After Osteopathic Manipulative Treatment: A Case Report
Recording the Rate of the Cranial Rhythmic Impulse