Published: Journal of Orthopaedic & Sports Physical Therapy, 2019 Volume:0 Issue:0 Pages:1–31 DOI: 10.2519/jospt.2019.8547
Study Design
Prospective case series.
Background
Persistent post-concussion symptoms can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent post-concussion symptoms.
Objectives
To assess people with persistent symptoms following a concussion to determine if the neck has also been injured, and evaluate the potential for the neck to contribute to their symptoms.
Methods
A consecutive series of participants (n=20) referred for neck assessment were prospectively recruited from two providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead post-concussion symptoms questionnaire, neck disability index, dizziness handicap inventory); patient-reported measures of headache, dizziness and neck pain; physical examination findings and details of co-morbidities.
Results
Participants were a mean of 7.5 weeks post-concussion (median 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including: moderate-severe neck disability index scores (mean 33.4, SD 9.5), frequent neck pain (85%), frequent moderate-severe pain on occiput-C4 segmental assessment (85%), positive flexion-rotation test (45%), and muscle tenderness (50-55%).
Conclusion
Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognise as they have the potential to contribute to persistent post-concussion symptoms, and may respond to neck treatment. J Orthop Sports Phys Ther, Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547