Research is ever-changing on the assessment, management, complexities and concerns of concussions, persistent concussions, chronic traumatic encephalopathy and return-to-learn/activity.

Other conditions can also occur from the same mechanism of injury as concussions, including whiplash, peripheral vestibular ocular (VO) conditions and benign paroxysmal positional vertigo. Some of these studies are revolutionary with thousands of subjects, while others are small case studies exploring abnormalities or niche specialties. DCs are positioned to play a pivotal role in the management of chiropractic concussion care. However, your role can be limited by your scope of practice depending on what state you practice in and your specialty.

Assuming the proper scope of practice, a DC may manage the symptoms of a concussion and commonly associated conditions from the initial examination on the field of play to a full return-to-learn/activity. However, even if DCs have this wide scope, they may still be required to pursue additional continuing education demonstrating they know, understand and can manage all the complexities of head injuries before they can legally clear athletes for return-to-play depending on their state’s legislative requirements. For example, this may be phrased, “Licensed healthcare provider trained in the evaluation and management of concussion” or “Licensed healthcare provider who has within the preceding five years been specifically trained in the evaluation and management of concussions and other head injuries.” Adding to the complexity, these regulations may only exist for youth, high school and/or collegiate sport organization. It is pertinent DCs understand all aspects of their state’s legislative requirements before managing chiropractic concussion care.

Available resources on concussion care

The International Conference on Concussion in Sport provides a good overview and foundation for the current concussion research,¹ although each specific topic, such as the acute assessment of concussion, in-office assessment of concussion, associated conditions that may occur during the same mechanism of injury, return-to-learn/activity, prevention strategies, etc., are complex and ever-evolving subjects. In 2022, the International Conference on Concussion in Sport presented attendees an overview of assessment tools available along with a review of literature for topics surrounding concussion management. Providers should be familiar with the utilization of these resources and the summary of research presented. Additionally, it would be beneficial for DCs who do not have prior experience using these resources and tools to attend continuing education events focused on their implementation to ensure they are conducting the tests and assessments properly. Once DCs master these fundamental skills, specialty trainings from organizations, such as the American Academy of Neurology, ImPACT Applications Inc., portions of the Certified Chiropractic Sports Physician program offered at various chiropractic institutions, Neuro-Optometric Rehabilitation Association and other specialty organizations are worth the investment for providers seeking additional specialization.

Oftentimes, the best approach to a complex condition is a team of specialists. For example, a sports DC or athletic trainer (ATC) may implement pre-season baseline testing. That same individual is hopefully the same provider present when an acute concussion occurs. Once diagnosed, the concussed athlete should be seen in the clinic for a thorough assessment, potentially with a neurologist, especially if symptoms persist, to ensure no other conditions are present.

It is not uncommon for an athlete to have several conditions at once. For example, a patient may have a concussion, whiplash, a peripheral VO condition and preexisting anxiety that is worsened by the injury. Being an expert in spinal musculoskeletal conditions, the DC may choose to manage only the whiplash, while co-managing the other conditions with an experienced specialist and having a medical doctor complete the final return-to-activity clearance. The DC may also choose to manage the concussion, whiplash and peripheral VO condition, and complete all necessary steps for appropriate return-to-learn/activity while co-managing the patient with their existing mental health provider. Either method or a combination of other management strategies is appropriate assuming the DC has the necessary scope and expertise to manage all the conditions, provide clearance for return-to-learn/activity and ensure the patient receives appropriate care.

Final thoughts on chiropractic concussion care

A DC can function as an overarching provider working with various specialties to coordinate care and guide an individual to the return-to-activity process, or as a specialist managing musculoskeletal components as part of a head injury healthcare team. To do so, they must understand their state-specific scope of practice limitations, and, if they desire further specialization work to obtain the knowledge and skills necessary to be proficient in the desired specialties.

JORDAN KNOWLTON-KEY, DC, serves as the chiropractic sports physician at the Lake Placid United States Olympic and Paralympic Training Center, where he works primarily with biathlon, bobsled/skeleton and luge competitors. His passion for sports chiropractic and adventure sports led him to pursue several additional degrees/certificates to follow patients through each step of their recovery. He possesses a Master of Exercise Science, an EMT license and an Alpine Ski Patroller certification; he is also a Diplomate of American Chiropractic Board of Sports Physicians®, International Certified Sports Chiropractic and Certified Strength and Conditioning Specialist. He can be reached at drjordanknowltonkey@gmail.com or peaksportschiropractic.com for questions/inquiries.

Reference

1. Patricios JS, et al. Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport-Amsterdam. October 2022. Br J Sports Med. 2023;57(11):695-711. PubMed. https://pubmed.ncbi.nlm.nih.gov/37316210/. Accessed May 29, 2024.