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A reminder for post concussion care

This article is a great reminder to not forget the rest of the body with treatment after concussion. Often with a concussion you need to evaluate and treat the spine for associated and concurrent injury.

I think often we can get so wrapped up in monitoring and following the concussion symptoms we can over look things that may be associated with the initial injury or compensation that may be causing symptoms.
Anna J. Hartman MS, ATC, CSCS, PMA-CPT


  • Anna,
    Great post and a really good article. It really is easy to get tunnel vision when dealing with concussions. I personally have not had any neck injuries directly related to the initial contact that caused the concussion, plenty of fractured orbital bones, but no C-spine injuries to date. What do you think is the best course of action if there is C-spine involvement and the patients headaches are immediately better, do you progress the concussion protocol or do you stay the course regardless?
    Have you personally encountered any patients that have suffered from concussions that have had cervical issues that may have been the cause of the lingering headaches?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Regarding the understanding of concussion I really like this short video explanation

    Have you watched it?
  • Audric,

    If there is cervical or cervicothoracic dysfunction associated with concussion I would treat that concurrently as long as it did not aggravate their concussion symptoms. If their symptoms were only headache and was resolved with treatment to their spine I would still follow protocol of concussion based on other objective measurements such as the SAC, BESS, a neurocognitive test, etc. If the diagnosis was only based on symptoms and the headache was their only symptom and it was resolved, then after 24hrs I would do a exertion test prior to clearing them to be sure it was from the spine and not the brain.

    With that said, this highlights the importance of taking a full evaluation of the athlete that sustains the concussion to have proper objective and subjective measures to use in returning an athlete to play as well as properly diagnosing the concussion and ruling out symptoms using differential diagnosis that may be similar to a concussion but caused by somewhere else like the cervical or thoracic spine.

    In my setting I do not see many acute concussions, but many athletes that have had past concussions and present with cervical, thoracic, vestibular, and breathing dysfunctions that likely were caused from the initial injury or poor rehabilitation after injury.

    I currently have 1 athlete (see her on and off, as she see's various other practitioners as well) that had a concussion mountain biking 3yrs ago and has constant headaches of 6-7/10 pain level and now chronic pain syndrome from a concurrent upper cervical spine injury.


    Thanks for sharing the video, I have seen it in the past and it is good.

    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Anna

    Thank you for your insight. I noticed you mentioned that you have had athletes with lingering issues due to poor rehabilitation after injury. What might you have added to their return to play protocols to minimize or eliminate some of these dysfunctions?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Audric,

    Most of the athletes I come across did not do anything besides rest during there post-concussion rehabilitation.

    The athlete I mentioned specifically did not see anyone for evaluation or treatment immediately after injury, not until her headache persisted for many months did she seek care.
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
  • Anna

    Were these athletes removed from participation by an AT , sat themselves out , or sat themselves out and just returned on their own accord? Do you know of that information off the top of your head as I am curious to why they only rested?
    Audric Warren MS, ATC, CAFS, NASM-PES, NASM-CES
  • Hi Anna,

    I couldn't agree more with you. If rest is the only tool in your concussion treatment arsenal, you are missing part of the picture. I find if you are not getting good resolution of symptoms at 2-3 weeks, you need to be looking for other areas that may have been exasperated by the concussion. Even earlier if you find a cervical, sleep disturbance or migrane problems.

    The UPMC/ImPACT group has done a good job of establishing clinical trajectories to key in on conditions that can prolong the concussion symptoms. They are cervical, migraine, ocular, vestibular, cognitive fatigue and anxiety/mood. I have found by identifying these pathways and getting the individual to right doctor or rehab specialist for pharmacological, specialized rehab, behavior modification and exercise therapies, the complex concussions resolve more quickly and completely.

    I am lucky to be in the Chicago area with good access to concussion specialists who fully understand these treatments. Unfortunately, from what I here this is not always the case in many areas. ImPACT does offer good webinars and online courses for MDs, ATCs and PTs for their trajectory therapies.
  • Hi Tom,

    That is great to know ImPACT has webinars that cover some of these topics. I too have great access to concussion specialists in Phoenix, which I am very grateful for and have learned a lot from!
    Anna J. Hartman MS, ATC, CSCS, PMA-CPT
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