Canadian RMT Fall 2017 CanRMT_Fall_17_FINAL | Page 21

See Through the Fog
S
gaining clarity of the complex world
of concussion management
By Conor Collins
ince Sidney Crosby first sat out an NHL season,
the word “concussion” took on a whole new
meaning. The number of research papers grew
exponentially and awareness for the injury
increased in popularity in both mainstream
media and medicine.   
For many of us this is was not a surprise. For years medical
professionals have been aware that a concussion is in fact an
injury, a brain injury. 
 A concussion is defined by the Ontario Neurotrauma
Foundation as, “a complex pathophysiological process affecting
the brain, induced by biomechanical forces”. While this
definition offers a general overview of the condition, it does
not outline the potential list of symptoms, treatments and
presentations involved in this incredibly complex injury.  
As research continues, the fact remains massage therapists
continue to play an integral role in concussion management.
With increased involvement, there is a need for a better
understanding of how to serve patients in the recover y process.
This article hopes to provide an education on common trends
within the concussion community and how the massage
therapist can improve patient outcomes.  
Acute concussions, with an early diagnoses and intervention
result in very favourable patient outcomes. In fact, research
shows that 85%-90 of concussions will resolve within 7-10 days.
Of the remaining 15%, recovery times range from weeks to years
in length.   
A common questions asked during this period is “how
much complete rest should a patient take?” During the most
recent consensus statement on concussion, in Berlin, experts
concluded complete rest should not exceed 24-48 hours, at
which time patients can begin a tailored return to activities
protocol. During the acute phase of the injury, symptoms that
take priority include post concussive headache, sleep hygiene
and accompanying or emerging mood disorder.  
Massage therapists are often called upon to help manage the
above symptoms, with headache being the most common. As
such, the importance of headache recognition by the massage
therapist plays in integral role in patient recovery.   
The most common type of headache suffered after a
concussion is a tension headache. Tension headaches originate
in the autonomic nervous system and are perpetuated by
the metabolic crisis of a brain injury. Tension headaches
are typically bi-lateral, “stabbing or throbbing” in nature
and aggravated by increased physical exertion, or cognitive
stress beyond a patient’s threshold. Tension headaches lend
themselves to treatments that are focused on relaxation, with
the primary goal of decreasing the sympathetic nervous system’s
affect on post concussion symptoms. 
The second most common type of headache suffered is a
cervicogenic headache. Cervicogenic headaches are typical
uni-lateral, consistent to one side of the neck, head or face and
recreated by neck movement and/or palpation. These headaches
are typically caused by the associated whiplash injury that
accompanies a concussion. A cervicogenic headache requires
a treatment whose goals include improving range of motion,
tissue tone and quality.  
It’s important to note that tension headache can often be
misclassified as a cervicogenic headache. This may be the
most important understanding for massage therapists treating
concussion populations. Aggressive treatments without an
understanding of headache type, may lend itself to increasing
the patients symptoms. 
Outside of clinical skill, the most valuable thing to offer
patients is education. This includes dispelling the myths that
exist within the concussion community. Exercise previously
thought to be negative now plays an important role in the
recovery process. Leddy et al. have done extensive research
on sub-symptom threshold exercise and it’s benefit on patient
recovery.  
The world of rehabilitative therapy offers both vestibular
and ocular rehabilitation to help patients manage a multitude
of symptoms and return them to pre-injury status. While these
methods still require more rigorous research, early case studies
show promise in their role in patient management.  
Concussion is a scary word. As massage therapists involved
more than ever in the recovery process it’s important to offer
patients support. Re-assure them that there is plenty of new
evidence to help their recovery. Search your community to
provide patients with resources and most importantly be aware
of current advancements in research to provide the best patient
outcomes possible.  

FALL 2017
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