Sebelski C.1, Allison J.1
1Saint Louis University, Physical Therapy and Athletic Training, St. Louis, United States
Background: There is an estimated incidence of 1.6 to 3.8 million concussions or mild traumatic brain injuries per year in the United States. In most cases, concussion symptoms resolve within 7-10 days, however, up to 10-30% of individuals develop persistent post-concussive symptoms lasting weeks, months or even years. Risk factors for transition from acute to persistent post-concussion disorder (PCD) include: younger age, female gender, prior concussion history, history of learning disabilities and history migraine headaches. When providing care for an individual with PCD a multimodal approach is recommended, including but not limited to graded exercise, active rest, and pharmaceutical interventions. There are few studies specific to physical therapy intervention during the rehabilitation processes for individuals affected by PCD. This paucity of literature is exaggerated when filtered to manual therapy interventions provided by a physical therapist or other health care practitioner.
Purpose: The purpose of this rapid review was to examine current literature related to manual therapy interventions for adolescent to collegiate-aged individuals with post-concussion disorder (PCD) with persistent headache, neck pain or dizziness.
Methods: Eligible studies included randomized-controlled trials, meta-analyses, prospective and retrospective comparative cohort studies, case series, and case reports examining the use of manual therapy for treatment in adolescent to collegiate-aged individuals with PCD. Standardized search terms were used to search PubMed, Scopus, CINAHL Plus with full text, SPORTDiscus with full text and the Cochrane Library. Grey literature included conference, symposium and website data from the American Academy of Orthopedic Manual Physical Therapists, the North American Institute of Orthopedic Manual Therapy and the Maitland-Australian Physiotherapy Seminars. Inclusion criteria: literature published from 2006 to present, incorporation of manual therapy as defined by the American Physical Therapy Association and participants 13-26 years old. Exclusion criteria: studies specific to acute concussion management and those not including manual therapy interventions. Study level of evidence was assessed using criteria from the Centre for Evidence-Based Medicine, for prospective and therapeutic studies.
Results: 383 studies were retrieved. After duplicates removed, 260 titles/abstracts were reviewed and 30 full text articles were assessed for eligibility. Five of the 30 studies were eligible, and assessed for level of evidence. Four of the studies were case studies/series (level 4 evidence) and one was a randomized controlled trial, (level 1b evidence). One of five studies evaluated the effects of manual therapy intervention in isolation, whereas the remaining four studies utilized a multimodal approach including manual therapy.
Conclusion(s): This rapid review included five studies of individuals with PCD and the associated symptoms of neck pain, headache and dizziness. A multimodal approach, including manual therapy interventions, is an effective way to decrease neck pain, headache and/or dizziness associated with PCD. There is a paucity of literature available at this time specific to manual therapy interventions for those with PCD.
Implications: Based on the limited evidence available, manual therapy interventions are a safe and effective mode of treatment for individuals suffering from PCD. Further investigation is required to validate this conclusion.
Funding acknowledgements: This is unfunded research
Topic: Orthopaedics
Ethics approval: Ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
