Concussion Treatment in Hockey Player

As part of my coursework and requirements to become a Diplomate of the American Chiropractic Board of Sports Physicians, I was required to write an abstract about a case I have worked on. Here is the abstract:

CONCUSSION MANAGEMENT UTILIZING SPINAL MANIPULATION, CERVICAL JOINT REPOSITIONING, AND PROPRIOCEPTION EXERCISE

HISTORY: Twenty year-old male hockey player presented for treatment following a concussion one week prior. Athlete was checked from behind and hit his head into boards during play. Patient’s initial symptoms included headaches and nausea. Nausea improved the following day but patient reported increased light and sound sensitivity. He had not been able to reduce symptoms at rest and could not progress in return-to-play protocol.

PHYSICAL EXAM: Active range-of-motion decreased in cervical flexion, extension, and right rotation with palpatory tenderness in right suboccipital and splenius muscle groups. Patient’s initial cervical joint reposition testing at 60cm showed a >10cm error from a central point after right rotation and a 10cm error after left rotation. Cranial nerve exam unremarkable. Other related neurological and orthopedic tests were unremarkable. Upper extremity strength was 5/5 bilaterally. 

DIFFERENTIAL DIAGNOSIS: Sports-related concussion, cervical sprain, cervicogenic headache, cervical subluxation, and migraines

TESTS AND RESULTS: No advanced imaging or testing was performed.FINAL/WORKING DIAGNOSIS: Sports-related concussion

TREATMENT PLAN: Treatment included full spine chiropractic adjustments, manual therapy to the suboccipital and cervical paraspinal muscle groups. Further treatment protocols included proprioceptive drills together with cervical range of motion to exercise deep neck musculature in transverse and sagittal planes.RELEVANCE OF CASE: Chiropractic adjustments and proprioceptive exercises could be a viable treatment for sports-related concussion, particularly if joint reposition testing shows significant loss of proprioception.

At the ACBSP annual symposium, I presented my abstract and fielded questions from colleagues. Lots of great discussion and ideas surrounding how to improve upon this case in the future. Concussion has always been a passion topic for me and is the reason I started seeing a chiropractor many years ago. I am continually trying to expand my knowledge and skills in the area of concussion. I hope to be an asset to athletes and families who have someone unfortunate enough to experience a concussion and help them return to their sport or activity quickly and safely.

If you or someone close to you struggles with concussion or post-concussion symptoms regularly (headache, neck pain, eye disturbances, balance issues, sensitiviy to light and noise, sleep or mood changes) have them contact our office and schedule to see Dr. Hayward!