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Sports Medicine

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01-09-2021 | Traumatic Brain Injuries | Systematic Review

The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review

Authors: Kelly Cheever, Jane McDevitt, Jacqueline Phillips, Keisuke Kawata

Published in: Sports Medicine | Issue 9/2021

Abstract

Background

Patients with cervicogenic symptoms following a concussion have shown a disproportionate rate of delayed symptom resolution. However, the prevalence of cervicogenic symptoms in the acute stages following a concussion and the percentage of those patients who continue on to suffer delayed symptom resolution is poorly described in the literature.

Objectives

To provide a comprehensive report on the clinical prevalence, diagnostic methods, and potential treatment options for cervicogenic symptoms that are elicited during acute and chronic phases following a concussion.

Methods

Electronic searches were conducted in PubMed, SPORTDiscus, ICL, CINAHL and PEDro, from inception to May 2020, to identify original research articles on concussion involving cervicogenic symptoms. We assessed each included article for risk of bias, methodological quality, level of evidence and evidence quality. The articles were categorized into three topics: (1) prevalence of post-concussion cervicogenic symptoms; (2) diagnostic testing for cervicogenic symptoms, and (3) treatment techniques for cervicogenic symptoms.

Results

The initial review resulted in 1443 abstracts, of which 103 abstracts met the inclusion criteria of our research. After the review of full text, 80 articles were excluded, which resulted in a total of 23 articles for this systematic review. Prevalence of cervicogenic symptoms in the acute stages ranged from 7 to 69% and increased to 90% in patients experiencing persistent post-concussive symptoms. Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58–6.38 times. Patient-reported outcome measures (e.g., Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire) can identify patients with cervicogenic symptoms that should be further differentiated by clinical testing. Lastly, treatment using graded cervical manual therapy has shown to reduce time to symptom resolution and medical clearance.

Conclusions

Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of PPCS. Several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use. More randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.

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Title: The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review
Authors: Kelly Cheever
Jane McDevitt
Jacqueline Phillips
Keisuke Kawata
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keywords: Traumatic Brain Injuries
Neck Pain
Published in: Sports Medicine / Issue 9/2021
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI: https://doi.org/10.1007/s40279-021-01469-y

At a glance: The STEP trials

Springer Medicine

The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review

Abstract

Background

Objectives

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

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