Main Article Content
Post-Concussion Syndrome, Craniocervical Junction
Objective: To describe the chiropractic management of 6 consecutive patients with post-concussion syndrome and to discuss the importance of correcting and maintaining the alignment of the craniocervical junction in post-concussion syndrome.
Clinical Features: Six patients ranging in age from 39 to 82 had history of post-concussion syndrome, each with a duration of at least 6 weeks. Confirmation of a head/neck trauma leading to a concussion was established with each patient. Baseline concussion status was determined using the Rivermead Post-Concussion Questionnaire, the Neck Disability Index, the Headache Disability Index and the Dizziness Handicap Inventory. Previous treatments for concussion among the 6 patients included physiotherapy, vestibular therapy, massage therapy, cranio-sacral therapy, over-the-counter medications and LyricaTM.
Intervention and Outcome: The patients received low-force chiropractic spinal adjustments to the upper cervical spine using the NUCCA protocol over a 12-week period. There were improvements in many of the indices assessed among all 6 patients. This was confirmed at week 6 and week 12 of treatment.
Conclusion: This case series demonstrated improvements in post-concussion syndrome in all 6 patients. The results observed in this case series suggest an encouraging relationship between intervention in the upper cervical spine and reduction in the long-term effects of concussion in some patients that requires further study.
2. McCrory P, Johnston K, Meeuwisse W et al. Summary and agreement statement of the second International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005;39:196-204
3. Langlois JA, Rutland-Brown W, Wald MM. The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview. J Head Trauma Rehabil. 2006;21(5):375-378
4. Centers for Disease Control and Prevention, Facts about concussion and brain injury: Where to get help, www.cdc.gov/headsup/pdfs/providers/facts_about_concussion_tbi-a.pdf, p.5
5. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Version 2010
6. Sigurdardottir S, Andelic N, Roe C, Jerstad T, Schanke AK. Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: a prospective study. Brain Inj 2009;23(6):489-497
7. Strunk RG, Hawk C. Effects of chiropractic care on dizziness, neck pain, and balance: a single-group, pre-experimental, feasibility study. J Chiropr Med 2009;8(4):156-164
8. Burcon M. Cervical specific protocol and results for 300 ?meniere’s patients, 6th international symposium on meniere’s disease. Kyoto International Conference Center, Japan; 2010?
9. Jamison JR. ?Insomnia: does chiropractic help? J Manipulative Physiol Ther 2005;28(3):179-186 ?
10. ?Bronfort G, Haas M, Evans R, Leininger B, Triano J. Effectiveness of manual therapies: the UK evidence report.?Chiropr Osteopat 2010;25;18:3
11. Taylor CS, Mangano FT. Craniocervical abnormalities. In: Kountakis SE, editor. Encyclopedia of otolaryngology, head and neck surgery. New York: Springer Reference; 2013: 619–628 ?
12. Marshall CM, Vernon H, Leddy JJ, Baldwin BA. The role of the cervical spine in post-concussion syndrome. Phys Sportsmed 2015;43(3):274-284
13. WHO guidelines on basic training and safety in chiropractic. Geneva: World Health Organization, 2005:4?
14. Broglio SP, Surma T, Ashton-Miller JA. High school and collegiate football athlete concussions: a biomechanical review; Ann Biomed Eng 2012; 40(1):37-46 ?
15. Spitzer WO, Skovron ML, Salmi LR et al. Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining whiplash and its management. Spine 1995;20:1S-73S ?
16. Treleaven J, Jull G, Atkinson L. Cervical musculoskeletal dysfunction in post-concussional headache. Cephalgia 1994;x:273-257 ?
17. Woodfield HC, Gerstman BB, Olaisen RH, Johnson DF. Interexaminer reliability of supine leg checks for discriminating leg-length inequality. J Manipulative Physiol Ther 2011;34(4):239-246 ?
18. Woodfield HC, York C, Rochester RP et al. Craniocervical chiropractic procedures- a precis of upper cervical chiropractic. J Can Chiropr Assoc 2015;59(2):173-192? ?
19. Owens EF Jr, Hart JF, Donofrio JJ, Haralambous J, Mierzejewski E. Paraspinal skin temperature patterns: an interexaminer and intraexaminer reliability study. J Manipulative Physiol Ther 2004;27(3):155-159 ?
20. Roy R, Boucher JP, Comtois AS. Validity of infrared thermal measurements of segmental paraspinal skin surface temperature. J Manipulative Physiol Ther 2006;29(2):150-155
21. Woodfield HC, Gerstman, BB, Hart J. Examiner reliability in analysis of orthogonal radiographs-phase 2 (abstract). Poster presentation. J Chiropr Educ 2014;28(1):101
22. Woodfield HC, Hart JF, Jacquemin PB. Inter-examiner reliability in analysis of orthogonal radiographs. Poster presentation. J Chiropr Educ 2014;29(1):108
23. Eyres S, Carey A, Gilworth G, Neumann V, Tennant A. Construct validity and reliability of the Rivermead Post-Concussion Symptoms Questionnaire. Clin Rehabil 2005;19(8):878-887
24. Vernon H, Mior S. The Neck Disability Index: A study of reliability and validity. J Manipulative Physiol Ther 1991;14:409-415
25. Jacobson GP, Ramadan NM, Aggarwal SK, Newman CW. The Henry Ford Hospital Headache Disability Inventory (HDI). Neurology 1994;44(5):837-842
26. Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116(4):424-427
27. Thomas MD, NUCCA Protocols and Perspectives 1st edition, National Upper Cervical Chiropractic Research Association, 2002
28. Woodfield HC, Hasick DG, Becker WJ, Rose MS, Scott JN. Effect of atlas vertebrae realignment in subjects with migraine: an observational pilot study. BioMed Research International 2015 Article ID?630472
29. Marshall CM, Vernon H, Leddy JJ, Baldwin BA. The Role of the cervical spine in post-concussion syndrome. Phys Sportsmed 2015;43(3):274-284
30. Lucas S, Dikmen S, Braden C et al. Natural history of headache after traumatic brain injury. J Neurotrauma 2011; 28(9):1719–1725
31. Lucas S, Hoffman JM, Bell KR, Dikmen S. A prospective study of prevalence and characterization of headache following mild traumatic brain injury. Cephalgia 2014;34(2):93-102
32. ?Palmer JP, Dickholtz MD. Improvement in radiographic measurements, posture, pain and quality of life in non-migraine headache patients undergoing upper cervical chiropractic care: a retrospective practice-based study.?J Vert Sublux Res?2009 Jun;1:1–11
33. ?Haldeman S., Dagenais S.,?Cervicogenic headaches: a critical review.?Spine J 2001;1(1):31–46
34. Nilsson N.,?The prevalence of cervicogenic headache in a random population sample of 20–59 year olds. Spine 1995;?20(17):1884–1888
35. Hagen K, Einarsen C, Zwart JA, et al. ,?The co-occurrence of headache and musculoskeletal symptoms amongst 51,050 adults in Norway.?Eur J Neurol 2002;9(5):527–533
36. Duhaime AC, Beckwith JG, Maerlender AC et al. Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article. J Neurosurg 2012;117(6):1092–1099
37. Lau B, Kontos A, Collins MW et al. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Dizziness a predictor of a protracted recovery. Am J Sport Med 2011;39:2311–2318
38. Reid SA, Callister R, Snodgrass SJ, Katekar MG, Rivett DA. Manual therapy for cervicogenic dizziness: long-term outcomes of a randomized trial. Man Ther 2015;20(1):148-156
39. ?Humphreys BK, Peterson C. Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6-month follow-up. Chiropr Man Therap 2013;21:3
40. Broglio SP, Collins MW, Williams RM, Mucha A, Kontos A. Current and emerging rehabilitation for concussion: a review of the evidence. Clin Sports Med 2015;34(2):213-231
41. Palmer J, Upper Cervical Monograph. 1990;4(9):1,5-7
42. Eriksen K, Upper cervical subluxation complex: a review of the chiropractic and medical literature. Baltimore, MD; Lippincott Williams and Wilkins 2003
43. ?Seaman DR, Winterstein JF. Dysafferentation: a novel term to describe the neuropathophysiological effects of joint complex dysfunction. A look at likely mechanisms of symptom generation.?J Manip Physiol Ther?1998;21(4):267–280
44. Iverson GL, Gardner AJ, Terry DP et?al. Predictors of clinical recovery from concussion: a systematic?review. Br J Sports Med 2017;51:941–948