Treatment intervals in treating concussion

[Christine Reesor]

I have 3 interested clients with concussion history, and I would appreciate feedback on a few items.

Client 1, early 20s, minimal symptoms. Concussion ~ 2 mos ago without LOC. She had a medical evaluation afterwards without CT. She plans to play rugby, so this is more about preventing further injury. She has a limited time frame where I could evaluate and treat. Is it reasonable to do an evaluation and begin treatment on the same day and then repeat in a day or two? I would not be able to treat her again for a few months after that because she goes off to college.

Client 2, late 20s. Concussion after bike accident about 6 months ago. Migraines, fatigue, brain fog since then. Is it reasonable to do an evaluation and begin treatment on the same day and then repeat in a day or two if that will be the only potential contact for a few months? He lives on the opposite coast from me. I will refer to a west coast colleague, if possible, though there is no one in his area. I want to make sure this window of opportunity is a step in the right direction for him.

Client 3, early 20s. Hx of bike accident 2 months ago with LOC and concussion, T12-L1 transverse fx on R. Hx of 2 prior concussions in High School during sports without LOC. She now has noise sensitivity, headaches, minimal pain. Any recommendations in treating healed T12-L1?

[Freda Yako Malott]

Hi Christine
You can always treat the day of assessment, as long as they are not too over stimulated. If they are overstimulated, you at least might be able to treat long bones of lower extremity to start. If you would like to be/need to be cautious proceeding with treatment, you can schedule shorter treatments with higher frequency. (30 min treatments every other day for example). If you are trying to get as much treatment done in a short period of time, then it would almost be a requirement that the client refrain from much physical stimulation (concussion protocol, no exercise, no visual stimulation, etc). They would also need to hydrate, take an epsom salt bath, etc to maximize rest and healing. I would caution you to try this if the client is in fragile condition, as they may not be able to tolerate much treatment anyway. Be sure to caution the client that they may feel very rough because of all the changes in a short period of time.
You can treat the healed transverse fracture like any other primary restriction – treat when it indicates and check the vectors. You may have to be treat locally in many vectors because of the fx, and be sure to check the surrounding structures, as it was not injured in isolation. You may want to be observant to the opposite side of the fx, as it may have more injury there than you may suspect.
And of course, although they have head trauma, it will be necessary to treat the whole body and not only concentrate on the cranium. I often find that after I treat the cranium, I need to go lower in the body, then return to the cranium to continue the release, look for the back and forth and layering of the injuries. Also be sure to treat intraorally, as there is often primary restrictions that need to be treated, such as the pterygoid process, nasal septum, maxilla, etc.

[Christine Reesor]

Thanks, Freda. This is helpful feedback.

[Mike Grafstein]

Christine,
I would highly recommend that you rugby player go through the return to play protocol.
Many concussions may show no signs of symptoms from doing vor Cancellation testing, horizontal and gaze testing as well horizontal sacchade testing.
They need to be thoroughly evaluated and progressed with non contact activity, physical exertion, hand eye coordination without contact before return play. Symptom free in the clinic does not gaurantee symptoms free on the field. I would suggest you download the SCAT 5. Hopefully the team or club she plays has a a return to play protocol. The last you want is second impact syndrome where death is possible. You may want to look up Rowan’s Law. Female rugby player hid her concussion symptoms. and died after receiving a second blow a week or two after the first one. http://www.sportphysio.ca/wp-content/uploads/SCAT-5.pdf.
Hope this helps.

[Christine Reesor]

Thanks, Mike. These visits did not all materialize, but I am more ready when they do!

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