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:
1 Concussion: Manual Therapy to Optimize Environment for Healing Jessica Paparella, DPT
2 CASE 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
3 2/6/12Pt 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
4 CASE 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
5 RETURN 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
6 THE 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
7 CERVICAL 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)
10 CERVICAL 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)
11 POSTCONCUSSIVE 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
12 Can manual therapy optimize an environment for healing? CLINICAL QUESTIONCan manual therapy optimize an environment for healing?
13 EVIDENCE 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)****
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”Spinal joint dysfunction: local tenderness, tissue texture change, asymmetry, limitation of segmental motion and altered end-feel(J. Osteopathic Med, 2003)
15 EVIDENCE BASED MEDICINE ExerciseLight exercise of affected mm to increase mm blood flow and enhance healing (Tiidus, JOSPT 1997)
16 DOES 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??
17 CASE 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
22 REFERENCESAmerican 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.