In our recent blog post about concussion, we discussed how post-concussion syndrome could be successfully managed with specific Neuro-Structural Chiropractic Care. Now I would like to share one of my recent concussion cases.
Case Study: Concussion
Patient: 15 year-old girl
Chief complaint: Constant headache, neck pain and dizziness after a concussion 2+ months ago
Back Story: The high school athlete sustained a concussion in Feb during a soccer game. At the ER, she was diagnosed concussion and was prescribed Ibuprofen. Her mom was proactive, and quickly got her involved in several rehab programs and therapies. By the time she saw me, she had gone through about 10 weeks of physical therapy, vestibular training, vision therapy, massage and chiropractic care. At that time, her neurocognitive testing (ImPACT test) had improved, but she continued to have constant headache on the top of her head, average 2-4/10 pain, and 6/10 at its worst. She also continued to have dizziness and neck pain.
Results
After 2 visits, her headache was gone for the first time in 11 weeks, and because of that, her emotional irritability also improved.
During the first month of specific Neuro-Structural Chiropractic Care, she was also undergoing speed and agility training prescribed by her MD a couple times a week. The problem was the jolting movements in this training always left her dizzy for quite some time after.
After we tweaked her vestibular exercises and gave her only a couple very specific eye exercises to do at home, she had no dizziness for the first time in weeks, and continued to be headache-free.
After 1.5 months of treatment (12 visits), she had no headache, dizziness or neck pain, and was cleared by her MD to return to play.
Discussion
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Realistic expectation of recovery timeline
This is somewhat counterintuitive, but research has shown that young athletes recover from concussion more slowly than older athletes. (1) If your child sustains a concussion, this is what you can expect. It is unlikely for the child to return to play within a couple days (2.5% probability). Most adolescent athletes make their way back to the sports within about a week (71.3% chance). (2) However, if your child is not able to return to play within 10 days, there is a good chance that he/she will have a prolonged recovery, which is the case for the girl in our case study. In this case, seek professional help as soon as possible.
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Not all vestibular rehabs are the same.
Many of my post-concussive patients are slightly apprehensive when they hear vestibular rehab, because in their experience, the exercises often make them dizzy and they feel awful afterwards. But then they thought to themselves, I have to feel worse before I feel better, right? WRONG. When your rehab makes you feel worse afterward, this is a good indicator that the intensity and/or duration of the exercises are too much for your brain to handle. Less is more. Again. Less. Is. More.
Conclusion
- If your child had a concussion, and was cleared by his/her physician to go home. Rest him/her for the first week. If he/she is not able to return to play after the first 7-9 days, seek professional help.
- Although research suggests that the chance of return to play beyond 21 days post concussion does not increase, we beg the differ by what we see clinically. With the right therapies, the child can still make a relatively smooth recovery.
References:
- Nesmith JD. Sports concussion in the child and adolescent athlete. J Ark Med Soc. 2010 Nov;107(6):111-4. [PubMed]
- McKeon JMM, et al. Trends in concussion return-to-play timelines amon ghighscholl athletes from 2007 through 2009. J Athl train. 2013 Nov-Dec;48(6):836-843. [PubMed]
About the Author
Dr. Lily Semrow is a Board Certified Chiropractic Neurologist who focuses on Neuro-Structural Correction. She has a B.S. in Nutrition and a doctorate in Chiropractic. She has a passion for serving families, and helping people who could not get better through traditional and alternative means.