Wednesday, January 29, 2020

Osteopathy For Concussions

By: Darryl Gomes  R. Kin., CAT(C), DOMP, D.Sc.O.


Concussions are often associated with contact sports, due to the forces transmitted between players during a game. As an assistant athletic therapist at Seneca College for 8 years, I treated my fair share of athletes with concussions. It was easily the most frustrating injury to treat, because it was hard to predict when an athlete would be ready to return to their sport.

As an osteopath who treats more of the general public, I am also treating individuals who suffer from concussions in non-sports related manners. Is this surprising? Not really. Concussions can happen at anytime to anyone, and not just athletes. Whether you slip on the ice and hit your head on the ground, bump your head on the lid of your car's trunk or were involved in a car crash, you may have received a concussion.

What Exactly is a Concussion?

A concussion is a traumatic brain injury induced by biomechanical forces (Soomro, Withall, Cohen & Turner, 2018).

Do I Have to Hit My Head to Get a Concussion?

The answer is no. For example, getting rear ended in your car can cause whiplash. The head can move violently forwards and backwards, which causes the brain to impact the inside of the skull which can cause a concussion. Falling on your butt can also cause a concussion, as the force of the impact can travel from the pelvis, up the spine to the head where the brain can impact the skull.


What is Involved with Treating a Concussion Osteopathically?
There are a few areas of the body that I have to assess when treating a person for concussions:
  • Treating the cranium/head is of utmost importance. Your head is made up of 22 bones: 8 cranial bones and 14 facial bones (Anderson & Al Kharazi, 2019). The bones act as a protective case for your brain, and provide attachment sites for the muscles that control the head and face movements. Additionally, the vasculature (blood vessels) and nerves travel along and through various parts of the cranial and facial bones that distribute blood and neurological signals between the brain and various parts of the body. The bones, muscles and vasculature need to work together in order to maintain the health of your brain and body.
  • The entire spine (not just the neck) needs to be assessed for misalignments. Outside of the pain an individual feels in their spine from direct trauma, the spine needs proper alignment in order to maintain the neurological signals to the muscles/organs/glands that they innervate. 
  • The muscles need to be treated in order to remove the muscle spasms that develop from whiplash. The neck is the area where most of the muscles are injured in concussions, but the upper back is also important in maintaining the alignment and support of the neck.
  • The eyes need to be treated, as visual deficits can occur from concussions. Injuries to the occipital lobe of the brain (located at the back of your skull) can affect vision, because this part of the brain is responsible for controlling vision. Also, the muscles that control the eyes are innervated by various cranial nerves. Therefore, eye function can be affected by injuries to the brain. Additionally, the eye muscles need to be working properly (just like any other muscles in your body) in order to work efficiently.

  • The pelvis needs to be centred and balanced, as the sacrum represents the bottom of the spine. Pelvic problems can potentially anchor the sacrum, which can have a direct effect on the top of the spine, which is where your brain is located. 
  • There are other areas of the body that would also need to be treated, and that is usually dependent on the various conditions a person has. However, this is a general outline as to how concussion treatments work osteopathically.

Are There Exercises I Can Do to Get Better?

Yes, there certainly are. The exercises I give help to reinforce the areas that are being treated. For example:
  • Neck exercises: various stretches and strengthening of the neck need to be performed in order to give it better support
  • Upper back exercises: in conjunction with the neck muscles, a lot of the upper back muscles help to stabilize the neck
  • Core exercises: stabilizing the pelvis and lower back requires a person to do Kegel exercises along with stabilizing their TVA (transverse abdominus) muscles before performing things such as planks and bridging
  • Eye exercises: a series of specific tracking and other visual tasks are given in order to improve the eye muscles and overall visual field perception
  • Cardiovascular exercise is also encouraged, so long as it is done at the right time under the proper conditions

How Do I Know if I Can Return Back to Work?

There is a return to work protocol that I follow, which is very similar to a return to play protocol that is used for athletes returning to their sport. The idea is that you gradually get a person doing things (whether it's reading/writing/typing on a computer) a little bit at a time over a few days to see how their body handles the tasks. If the person gets no symptoms, then they can potentially do more tasks for longer. If they experience symptom flare ups, then either their rest time is increased or some tasks are scaled down or removed. A modified schedule can help a person to integrate back into their regular work schedule. For example, working shorter days (say 4 hours) followed by a day off is ideal for allowing the brain and body to acclimate. Eventually, a person can work back up to their regular shifts. This is a general outline, but would be made more specific for every person.

If someone is experiencing concussions symptoms that linger for a long time, I will recommend the person follows up with a certified sports medicine physician. Sports doctors are trained to assess concussions and can determine if any medical imaging or other strategies need to be implemented.

Ultimately, a person has to be able to perform at their pre-concussion abilities without any lingering symptoms in order for them to be healed from their concussion.

If I Get a Concussion, When Should I Come and See You?

The sooner you can come in, the sooner we can start treatment and implement some strategies for your recovery. If you are experiencing symptoms, you should get someone to drive you to the clinic for safety reasons.


If you have any questions about how osteopathy can help you, call the clinic at 905-940-2727 to book a free 15 minute consultation or email me at: darryl@naturopathicfoundations.ca

Feel free to share this blog with someone you know!

Stay active!!

References:

Anderson, B. W., & Al Kharazi, K. A. (2019). Anatomy, Head and Neck, Skull. StatPearls. StarPearls Publishing.

Soomro, M., Withall, A., Cohen, A., & Turner, R. (2018). The evolving definition of Concussion over time. Journal of Science and Medicine in Sport, 21, S96.