Case report: Manual therapies promote resolution of persistent post-concussion symptoms in a 24-year-old athlete

Abstract

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.

Effect of Manual Therapies on Parameters of Postconcussion Symptoms Recovery: A Systematic Review

“…A total of 317 potential articles were extracted from the database search via electronic media. Undergoing the PRISMA screening and eligibility procedure, only 7 articles were included in the qualitative synthesis [16,19,30,31,32,33] The details of the study selection are shown in Figure 1. Out of 7 articles, there were 2 case series [16,33], 4 case studies/reports [19,20,31,32], and only 1 pilot study [30].…”

“…Of 7 studies, 4 included athletic participants [16,19,31,33], and the remaining 3 included non-athletic people [20,30,32]. The total number of participants included in the study was 32, of which 28 were males and 4 were females, from varied age groups ranging from 20 to 70 years.…”

“…Short form-36, also known as the SF-36 QoL survey, was utilized in 2 studies [16,30]. One study used the postconcussion symptoms checklist outcome [31]. balance error scoring system (BESS) was used in 2 studies [19,33].…”

“…balance error scoring system (BESS) was used in 2 studies [19,33]. Headache Impact-6 outcomes were used in 1 study [31]. Visual analog scale/numeric rating scale was utilized in 3 studies [16,32,33].…”

“…Table 2 summarizes the quality of the included studies. The reviewers rated 4 studies [19,20,31,32] in the very low category and 3 studies [16,30,33] in the low category, depending upon the study design.…”