Presentation on theme: "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."— Presentation transcript:
1Concussion: Manual Therapy to Optimize Environment for Healing Jessica Paparella, DPT
2CASE STUDY #2 IE: 2/2/12Pt is 33 y.o. professional hockey player who suffered a concussion on 12/30/11Mechanism of injury: getting hit in back of helmet with puck during practicec/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 concussionsROS:Head: chronic/recurring right HANeck: right pain/tightness in UT, ↑neck flexion and extension, radiating pain up back of neckNeurological: dizzinessPhysical 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 symptoms5 weeks post concussion
32/6/12Pt enters therapy with “minor soreness after manual tx.”Denies symptoms, except HA↓ mm tightnessRiding BIKE today without increased symptomsc/c: right HA and pain above right eye2/7/12Pt enters therapy with “continued decrease in muscle tightness and HA” with 1/10 painRETURN to GAME 2/26
4CASE STUDY #1 IE: 3/6/12Pt is 27 y.o. professional hockey player who suffered a concussion on 12/20/11c/c: HA, tightness(L>R),limited mobility of neck.ROS:Head: chronic/recurring HANeck: pain/tightness in UT, ↑neck flexion and extensionNeurological: +radic left UEPhysical Findings:Pain: 3-5/10 activity dependent(-) ligaments stress tests+OA dysfunction+ERS mid-low c/s+left elevated first ribHypomobility C3-67 weeks post sx
5RETURN to TEAM and GAME (3/17/12)…which was a WIN 3/7/12Pt enters therapy feeling “better after manual tx last session.” pt points to proximal attachment of SCM as source of discomfort↓ neck painDenies HA3/8/12Pt enters therapy “continuing to feel better after manual therapy; neck feels looser’ and no longer needs mm relaxor during day”3/9/12Pt enters therapy stating “neck feels looser and increased c/s mobility”c/c: UE mm tightness; spasm and anterior c/s mm ache1/10 painRETURN to TEAM and GAME (3/17/12)…which was a WIN
6THE BRAINHighly 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
7CERVICAL SPINE ANATOMY Roles of cranial cervical structures:Provide strong support of skullProtect neural components and vascular structuresProvide muscular attachmentsAllow flexibility/ROM of the C/SShock absorber and “vault” to protect the brainPassage of neurovascular structuresThis area is susceptible to acute dynamic/motion disorders (ie concussion) as well as static/postural disorders (FHP)(Ellis, FFCFMT 2003)
10CERVICAL SPINE: NEUROANATOMY AND VASCULARIZATION Significant blood/venous supply2 Carotid arteries/2 vertebral arteries supply mostof the brainVertero-basilar systemRED FLAGS: distress, diplopia, dilatation, dizziness, dysarthria, drop attacks, distal parasthesias(Ellis, FFCFMT 2003)
11POSTCONCUSSIVE PATHOLOGY Impactdepoliarizationrelease excitatory amino acid (glutamate)increased extracellular K+ (spreading depression is when LOC occurs)Effort to restore homeostasis: hyperglycolisis for ATP- CA2+ influxaxonal swelling decreased CBF
12Can manual therapy optimize an environment for healing? CLINICAL QUESTIONCan manual therapy optimize an environment for healing?
13EVIDENCE BASED MEDICINE Soft tissue mobilization and sub-occipital trigger point releaseDysfunctions 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)****
14EVIDENCE 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”Spinal joint dysfunction: local tenderness, tissue texture change, asymmetry, limitation of segmental motion and altered end-feel(J. Osteopathic Med, 2003)
15EVIDENCE BASED MEDICINE ExerciseLight exercise of affected mm to increase mm blood flow and enhance healing (Tiidus, JOSPT 1997)
16DOES THIS OPTIMIZE AN ENVIRONMENT FOR HEALING?? Sub-occipital release normalize cerebral blood flowSoft tissue mobilization normalizing muscle toneC/S MET To normalize anatomical alignmentTher-ex to increase blood flow and normalize muscle imbalancesDOES THIS OPTIMIZE AN ENVIRONMENT FOR HEALING??
17CASE STUDY #3 SCAT 2 Athlete Name: Matt Sport: Varsity Football Injury Date: 9/30/12Assessment Date:10/2/12Test Classification: Baseline Post-InjuryExaminer: Jessica Tau, ATC
22REFERENCESAmerican Academy of Manual Medicine. Suboccipital Muscle GroupBrain Trauma Research Center. Sports-Related Concussions: Background and SignificanceEllis, Jeffery. Cervical Thoracic Integration. IPA Continuing Education 2003.Fink, Dustin. Concussion Blog. January 2011.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 IInstitute of Physical Art. Proprioceptive Neuromuscular Re-educationJohnson, 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.