Persistent post-concussion symptoms are associated with more cranial and upper cervical mobility restrictions as measured by manual clinical evaluation

Introduction There are approximately 1.7–3.8 million sport concussions annually in the United States with twenty percent presenting persistent symptoms. However, few studies examine manual therapy as a part of the clinical assessment in concussions. Our purpose was to investigate the prevalence of cranial bone and upper cervical mobility restriction in persistent post-concussion symptoms.Methods Twenty-one adults with persistent post-concussion symptoms (PCS), 11 with a history of concussion (CHx) and 12 controls (Ctl) participated. An osteopath assessed cranial bones and C0-C1-C2 mobility using a standard protocol to determine the number of restrictions. An athletic therapist assessed participants on the Post-Concussion-Symptom-Scale, King–Devick, Tandem Gait Test, Sensory Organization Test, and Vestibulo-Oculo-Motor-Screening. Assessments were blinded to group assignment. We used a one-way ANOVA to assess group differences and a Pearson Correlation to assess relationships between variables.Results PCS (8.24 ± 4.25) had a higher mean number of restrictions compared with the Ctl (2.92 ± 3.8), (p = .003). There was a significant relationship between the number of restrictions and Post-Concussion-Symptom-Scale severity (r = 0.333, p = .027) and Vestibulo-Oculo-Motor-Screening vestibular score (r = 0.305, p = .044). There was no significant association between the number of restrictions and the number of symptoms (r = 0.283, p = .062), visual (r = 0.267, p = .079) and total Vestibulo-Oculo-Motor-Screening score (r = 0.293, p = .054). There was no relationship with King–Devick, Tandem Gait Test, and Sensory Organization Test.Conclusion Number of restrictions was significantly higher in the PCS group compared to the Ctl group. Additional investigation is warranted to refine the location and magnitude of restrictions with the type and severity of symptoms.