Concussion is a HOT topic these days. Cervical pain and dysfunction can be a common associated injury in our concussion population. Furthermore, there can be an overlap in symptoms in neck injury and concussion injury. As such, it is important that we include assessment of the cervical spine into the assessment of our concussion patients. If you are looking for a good read, and some great suggestions on assessment/treatment, may we suggest reading:
Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy(13), 2-11.
See below for a short summary of the article. We challenge you to incorporate these type of assessments in not only your neck pain patients, but as well as considering the use (when appropriate) in your concussed athletes
It should not come as a surprise that cervical spine pain and dysfunction can lead to disturbances in several areas, including cervical joint position sense, postural stability, and oculomotor control. There is a decent body of evidence to suggest that specific treatments to the cervical spine (DNF training, acupuncture, manual therapy) translate to improvements in cervical proprioceptive awareness, vertigo, and standing balance in individuals with neck pain. Furthermore, training programs focusing on things such as gaze stability, cervical position sense, and eye/head coordination can result in improvements in cervical pain and dysfunction WITHOUT localized treatment to the cervical spine.
What does this mean to us?
Clinical assessment of sensorimotor control disturbances should be worked into the management of our neck-pain patients. To have the best results, a multimodal approach is crucial in the treatment of these individuals. Assessment and management of the following areas should be included:
- Cervical position sense
- Oculomotor assessment (gaze stability, eye follow, saccadic eye movement, eye/head coordination)
- Postural stability
- Vestibular tests
The author suggests that in all areas where disturbances or abnormalities are noted, a home exercise program should be provided and completed 2 to 5 times per day, as long as exacerbation of neck pain or headaches does not occur (although temporary aggravation of dizziness can be acceptable).