Concussion: Pathophysiology and Osteopathic Treatment

00:01 Concussion is another common presentation for pediatric even adolescent population.

00:08 So concussion is a form of mild traumatic brain injury following a biomechanical force.

00:13 It results in a rapid onset of impairment of neurologic function.

00:18 You don't necessarily have to have full loss of consciousness to have a concussion.

00:24 The CDC actually says that about 3.8 million sports related traumatic brain injuries occur annually.

00:32 So concussion results from a rapid stretch of the brain where the neurons are stretched and that shear causes changes to the brain neurochemistry.

00:42 Usually there's neuronal depolarization, there's local lactic acid accumulation and then that causes decreased cerebral blood flow with the mismatch of cerebral glucose supply and demand.

00:54 So there's generally not a lot of different treatments available for concussion.

00:59 Usually, the recommendation is for people who are concussed, with mild concussion to rest not return to activity until they are free of symptoms.

01:08 A lot of different return to play protocols are out there.

01:12 But, there is a role for potentially integrating osteopathic manipulation to the treatment of concussion.

01:19 And so, again concussion is usually due to some sort of severe force or blow to the body.

01:25 That force usually causes musculoskeletal restrictions.

01:29 A lot of times, patients after concussion may have headache, issues with their neck And so, applying OMT to improve circulation and lymphatic flow can also help with decreasing inflammation and allow patients to heal better.

01:46 So, we want to start by treating the thoracic inlet, apply balanced membranous tension to treat the cranial strain patterns, make sure the cranial base is released by treating the OA and the OM.

02:00 There is a technique called the venous sinus drainage technique which helps to improve circulatory flow throughout the venous sinuses and recently they found that the lymphatic system which helps to drain lymphatic fluid from the brain actually lies within that venous sinus.

02:18 So utilizing this technique may potentially help patients to heal quicker and reduce the inflammation.

02:24 Also remember that you need to take a look and address the sacrum and pelvis.

02:28 There is a core link, dural attachment from the frame and magnum to C2, C3 all the way down to the sacrum.

02:36 And so, I've had patients that had concussion-like symptoms from a really severe sit down fall unto the tail bone because they were so jar and shocking that it went and stretched all the different neurons in the brain.

02:48 So again, each patient is different.

02:51 You want to listen to the history and physical and address somatic dysfunctions that you may find.

02:55 But these are some key areas that you could integrate into your treatment for patients with concussion.

03:01 So in general, following the neurologic, biomechanical and the circulatory lymphatic model, you could look at different pediatric presentations and put them together to develop a good treatment plan to help address our pediatric patients and get them to heal quicker and better.