This is a summary of part of the work towards a systematic review being undertaken by Brendon Ford – B App Sc (Exercise & Sports Science), M Phty, M Phil (Medicine)
While most concussions will resolve within 3 months, some of these will go on to develop complex presentations such as post concussive syndrome (Langer et al., 2021) and, if subject to repeated concussions, chronic traumatic encephalopathy (Mavroudis et al, 2023). These potential long- term effects of concussion and repetitive head impacts are areas of ongoing public health interest and concern among healthcare professionals, athletes, and the public (Patricios et al., 2023).
Unfortunately, no gold standard diagnostic test for concussion exists. Imaging is unreliable as persistent symptoms don’t necessarily reflect tissue damage (Kennedy et al., 2019). Imaging is further challenged by the prevalence asymptomatic abnormal and variant morphology of the brain (Slobounov et al., 2012).
Given the lack of definitive diagnostic testing, the diagnosis is made clinically using the patient’s symptoms and history. This is difficult given that concussion has a remarkably similar mechanism of injury and symptomology to whiplash associated disorder.
The most common mechanism of concussion is an impact to the head, and this also induces a rapid acceleration/deceleration movement in the neck, however, concussion does not necessarily need to be due to contact. Another mechanism of injury is rapid acceleration/deceleration of the brain inside the cranium associated with whiplash (Rosker et al., 2023). Therefore, it has been suggested that these conditions co-exist in many patients (Rebbeck et al., 2019).
Given the close relationship between whiplash and concussion, it is unsurprising that interventions that target whiplash have been shown to be effective in treating patients diagnosed with concussion. A randomised control trial utilising cervico-vestibular rehabilitation was successful in returning 11/15 patients with concussion to sport compared to 1/14 in the usual care group within 8 weeks of treatment (Schneider et al., 2014).
Whiplash is associated with widespread changes to muscle strength, loss of segmental control and loss of direction specific muscle activation. Whiplash can also impact on eye movements, which can also be associated with onset of symptoms.
Treatment for whiplash involves careful assessment of each of these changes and a targeted treatment to address these impairments. As concussion and whiplash have a large cross-over of symptoms, it is recommended to have concussion assessed for whiplash symptoms to ensure that optimal recovery is achieved.
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