Impairment to neck function
Over the last few years, there appears to be a greater level of awareness and interest in concussion and the changes which occur in the body post-concussion. In this 3 part article, I would like to discuss Persistent Post-Concussion Symptoms (PPCS) and how the neck may be involved. As a member of the public, you may have noticed an increased level of concern for people who have been concussed, this may be particularly evident when you have been watching sport. The most obvious change over the last few years with concussion and sport is as soon as an individual has suffered from a concussion they are immediately removed from the sporting ground and remain off the ground for a period of time. From this point, before the individual returns to the field, they are required to pass a certain amount of medical testing. This regularly occurs in contact sports as with our football codes, but also occurred most recently in The Ashes in September 2019 when Australian Captain and number one test batsman Steve Smith was ruled out of the team for the fourth test due to a blow to the head.
In clinical practice concussion and post-concussion presentations occur in both adults and children and are caused by a wide variety of traumas including sport, motor vehicle accidents, incidental collisions, and assaults. These incidences can initially appear quite mild and innocuous however closer examination can reveal more profound and developed symptoms.
My discussion today isn’t particularly focused on the details of concussion, however, I would like to discuss how the neck may be affected in people who suffered from a concussion and how PPCS can manifest in people’s necks.
In a study conducted in America on April 2019 and published in the Internal Journal of Sports Physical Therapy, an analysis was conducted on 73 children and adolescents who received physical therapy following a concussion1. From this group, the participants were assessed and divided into 4 main categories based upon exactly what type of neck impairment they were suffering.
The main categories were:
- Postural impairment 99%,
- Myofascial impairment (muscles and other soft tissue) 98%,
- Joint mobility impairment 86%
- Muscles strength impairment 62%
As can be seen by the categories above the majority of the 73 participants had some kind of impairment to their neck, with a high percentage having multiple impairments. In fact, 90% of the patients demonstrated impairments in at least three out of four main impairment categories described above, whereas 55% demonstrated impairments in four of the main impairment categories.
This particular study indicates a significant percentage of PPCS patients present with some dysfunction in their neck and therefore PPCS requires accurate assessment of a patient’s neck function. Additional studies such as these indicate that these neck-related findings are important to recognise as they have the potential to contribute to persistent post-concussion symptoms (PPCS), and may respond to neck treatment2
Once this assessment has been performed these patients require targeted treatment to assist in the correction of the issues described above.
As a Chiropractor, we commonly treat patients with neck related complaints after a concussion and have experience in dealing with patients with postural issues, joint, and soft tissue restrictions and other mobility issues.
In the second part of my article, I will discuss how PPCS can affect the quality of life of the individual involved in particular children and adolescents.
1.Tiwari D et al. Characterisation of cervical spine impairments in children and adolescents post-concussion. Int J Sports Phys Ther. 2019 Apr;14(2):282-295.
2.J Orthop Sports Phys Ther, Epub 1 Jun 2019.