Early Management of Cervical Impairments and the Incidence of Delayed Recovery in Adolescents With Acute Concussion

Objective To determine if concussed adolescents with positive cervical findings on examination provided with early cervical treatment demonstrate recovery time and incidence of persistent post-concussive symptoms (PPCS, recovery = 30 days) comparable to those without cervical findings.

Background Cervical impairments resulting from concussive injury are historically associated with longer recovery times. Concomitant cervical injuries may result in symptoms that overlap with concussion, including headache, dizziness, tinnitus, sleep disturbances, and blurred vision. Current recommendations include assessment of the cervical spine; however, there is limited evidence for the effect of immediate cervical intervention on recovery.

Design/Methods Retrospective case-controlled study. Patients included adolescents with acute concussion presenting with (n = 132, 14.99 ± 1.9 years, 58% male, 5.70 ± 3.3 days since injury) and without (n = 138, 14.85 ± 1.8 years, 65% male, 6.13 ± 3.4 days since injury) cervical findings on physical exam. Patients were assessed with the Buffalo Concussion Physical Examination (BCPE), Neck Disability Index (NDI) and Post-Concussion Symptom Scale (PCSS) instruments. Groups were separated based on positive or negative cervical findings on the BCPE. Cervical impairments were addressed by physicians specializing in concussion management using a clinical algorithm. Mild impairments were managed conservatively (over-the-counter analgesics, warm/cold compresses, and/or neck stretching exercises). Patients with moderate or greater impairments were assessed by a physical therapist at the initial clinic encounter and given specific cervical interventions.

Results Physician-observed cervical findings had moderate agreement with self-reported function on the NDI (? = 0.414, p < 0.001). Patients with cervical findings reported greater symptom severity on the PCSS (37.9 ± 22.1 vs 30.8 ± 20.2, p = 0.011); however, there was no significant difference in recovery time (34.44 ± 33.2 vs 34.81 ± 39.0 days, p = 0.933) or incidence of persistent symptoms (39% vs 35%, p = 0.511).

Conclusions In this group of adolescents, cervical impairment managed early after concussion was not associated with prolonged recovery. Early management of cervical impairments may reduce the development of PPCS. Prospective evaluation is warranted.