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Concussion: Manual Therapy to Optimize Environment for Healing Jessica Paparella, DPT.

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Presentation on theme: "Concussion: Manual Therapy to Optimize Environment for Healing Jessica Paparella, DPT."— Presentation transcript:

1 Concussion: Manual Therapy to Optimize Environment for Healing Jessica Paparella, DPT

2 CASE STUDY #2 IE: 2/2/12 Pt is 33 y.o. professional hockey player who suffered a concussion on 12/30/11 – Mechanism of injury: getting hit in back of helmet with puck during practice – c/c: right side HA, right neck pain, mm spasm, dizziness, sensitivity to light/noise, irritability, and inability to complete exertion testing (ie: bike) – PMH: right orbital fx 11/10, hip labral repair 1/10, 2-3 dx concussions ROS: – Head: chronic/recurring right HA – Neck: right pain/tightness in UT, neck flexion and extension, radiating pain up back of neck – Neurological: dizziness Physical Findings: – Pain: 3/10 activity dependent – (-) ligaments stress tests – +lateral head deviation right /holding pattern – +tightness/hypertonicity right anterior/middle scalene, UT/levator, sub-occipital mm – +OA dysfunction – +AA dysfunction – +FRS mid-low c/s – **pressure point right orbital region 40 secx3 relieved symptoms

3 2/6/12 – Pt enters therapy with minor soreness after manual tx. – Denies symptoms, except HA – mm tightness – Riding BIKE today without increased symptoms – c/c: right HA and pain above right eye 2/7/12 – Pt enters therapy with continued decrease in muscle tightness and HA with 1/10 pain RETURN to GAME 2/26

4 CASE STUDY #1 IE: 3/6/12 Pt is 27 y.o. professional hockey player who suffered a concussion on 12/20/11 – c/c: HA, tightness(L>R),limited mobility of neck. ROS: – Head: chronic/recurring HA – Neck: pain/tightness in UT, neck flexion and extension – Neurological: +radic left UE Physical Findings: – Pain: 3-5/10 activity dependent – (-) ligaments stress tests – +OA dysfunction – +ERS mid-low c/s – +left elevated first rib – Hypomobility C3-6

5 3/7/12 – Pt enters therapy feeling better after manual tx last session. pt points to proximal attachment of SCM as source of discomfort – neck pain – Denies HA 3/8/12 – Pt enters therapy continuing to feel better after manual therapy; neck feels looser and no longer needs mm relaxor during day 3/9/12 – Pt enters therapy stating neck feels looser and increased c/s mobility c/c: UE mm tightness; spasm and anterior c/s mm ache 1/10 pain RETURN to TEAM and GAME (3/17/12)…which was a WIN

6 THE BRAIN Highly sensitive to hypoxic states: the brain does NOT store energy so it relies on a continuous blood flow for oxygen and glucose to live/function

7 CERVICAL SPINE ANATOMY Roles of cranial cervical structures: 1.Provide strong support of skull 2.Protect neural components and vascular structures 3.Provide muscular attachments 4.Allow flexibility/ROM of the C/S 5.Shock absorber and vault to protect the brain 6.Passage of neurovascular structures (Ellis, FFCFMT 2003)



10 CERVICAL SPINE: NEUROANATOMY AND VASCULARIZATION Vascularization – Significant blood/venous supply – 2 Carotid arteries/2 vertebral arteries supply most of the brain – Vertero-basilar system (Ellis, FFCFMT 2003)


12 CLINICAL QUESTION Can manual therapy optimize an environment for healing?

13 EVIDENCE BASED MEDICINE Soft tissue mobilization and sub-occipital trigger point release Dysfunctions can be reduced thus returning the body to a system of balance and efficient function through the appropriate application of techniques of STM and functional mobilization (IPA 2010) * * * *

14 EVIDENCE BASED MEDICINE Muscle Energy Technique (MET) –MET is a manual medicine procedure that has been described as a gentle form of manipulative therapy effective for treating movement restrictions of both the spine and extremities (J. Osteopathic Med, 2003)

15 EVIDENCE BASED MEDICINE Exercise – Light exercise of affected mm to increase mm blood flow and enhance healing (Tiidus, JOSPT 1997)

16 Sub-occipital release normalize cerebral blood flow Soft tissue mobilization normalizing muscle tone C/S MET To normalize anatomical alignment Ther-ex to increase blood flow and normalize muscle imbalances DOES THIS OPTIMIZE AN ENVIRONMENT FOR HEALING??

17 CASE STUDY #3 SCAT 2 Athlete Name: Matt Sport: Varsity Football Injury Date: 9/30/12 Assessment Date:10/2/12 Test Classification: Baseline Post-Injury Examiner: Jessica Tau, ATC

18 Pre-Treatment #1 Post-Treatment #1

19 Pre-Treatment #1 Post-Treatment #1 105

20 Post-Treatment #1 Post-Treatment #2

21 Post-Treatment #1 Post-Treatment #2 5 4

22 REFERENCES 1.American Academy of Manual Medicine. Suboccipital Muscle Group Brain Trauma Research Center. Sports-Related Concussions: Background and Significance Ellis, Jeffery. Cervical Thoracic Integration. IPA Continuing Education Fink, Dustin. Concussion Blog. January Giza, et al. The Neurometabolic Cascade of Concussion. Journal of Athletic Training 2001; 36(3) Grady, Matthew. Concussion in the Adolescent Athlete. Current Problems in Adolescent Health Care 2010; 40: Institute of Physical Art. Functional Orthopedics I Institute of Physical Art. Proprioceptive Neuromuscular Re-education Johnson, Gregory. Soft Tissue Mobilization. IPA Continuing Education; McKee, et al. TDP-43 Proteinopathy and Motor Neuron Disease in Chronic Traumatic Encephalopathy. Journal of Neuropathology Experimental Neurology 2010; 69(9) Moser, et al. Neuropsychological Evaluation in the diagnosis and management of sports related concussion. National Acadamy of Neuropsychology 2007; Signoretti, et al. The Pathology of Concussion. American Academy of Physical Medicine and Rehabilitation 2011; Tiidus, Peter. Manual Massage and Recovery of Muscle Function Following Exercise; a literature review. Journal of Orthopedic and Sports Physical Therapy 1997; 25(2) Toledo, et al. The young brain and concussion; Imaging as a biomarker for diagnosis and prognosis. Neuroscience and Biobehavioral Reviews 2012; USA today online. Concussion Statistics. October 11, 2012.

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