A chiropractic protocol in examining and healing concussions in sports
This case study concerns “Logan,” who was a high school sophomore in the spring of 2018. While playing varsity soccer, she was hit on the side of her head with the soccer ball and immediately went down on the field.
She did not lose consciousness but was experiencing a severe headache with dizziness and nausea. She was seen at the local hospital’s emergency room, where a CT scan was performed and was negative for any internal bleeds. The ER physician stated she did have a concussion and it would take rest and time. If the symptoms persisted she was given instructions to follow-up with her primary care physician.
Primary MD care results
Two weeks later, Logan was still having intense headaches that were aggravated with light exposure and sound. She was having difficulty in school and had to leave during various times of the day to go home and rest. The ongoing symptoms prompted her mother to take her to the family doctor.
The primary care physician did a thorough history and neurological examination on Logan. He stated she was still experiencing concussion-related symptoms and she was told it would take rest and time for her to feel better.
Over the next month, even though she was out of school and not doing any workouts for either basketball or soccer, her symptoms were not going away. Her mother contacted the family doctor who referred her for a neurological consultation.
The neurologist performed a routine neurological examination consisting of balance, muscle strength, and reflex testing. He once again told her the symptoms were residuals from the concussion and she was to stay in a dark and quiet room for most of the day and it would take rest and time for her brain to heal.
Logan spent the summer of 2018 in her bedroom where she kept the lights off and the curtains closed so as not to let any sun in that would increase her headaches. She followed everyone’s instructions and slept almost 18 hours per day. The headaches, the balance problems, the sensitivity to light and sound did not go away and school was starting in a week.
She was now becoming very anxious about keeping her 4.0-grade point average and the possibility of not being able to play basketball or soccer her junior year.
Back to school
The fall semester of her junior year starts and during the first week of classes, she has to leave by her third hour because of the headaches and sensitivity to light and sound.
The anxiety level increases and she is now not sleeping well and starting to become depressed. Her mother is becoming very concerned because she is seeing her daughter slipping away and becoming someone she doesn’t recognize anymore.
While grocery shopping, the mother runs into another mother whose daughter, Lindsey went through a concussion and was not recovering because she was given the rest and time recommendations. Logan’s mother was given my name because I had successfully treated Lindsey for her concussion and was able to return her to participate in basketball and soccer during her senior season. Logan’s mother called and made an appointment that same day.
Chiropractic concussion exam and care
I am the Gaylord High School’s team chiropractor for girls varsity basketball, and I knew Logan before she sustained the concussion. She was an energetic scrappy defensive player that always had a smile on her face. The girl before me on this first visit was not the person I knew. She was slumped down in the chair with what I call the “thousand-yard stare,” looking totally defeated.
Cervical Spine Examination — During the cervical spine examination, she told me no one had asked or done anything to her neck and upper back. She said her neck was sore and tight and she felt like she could not get a full breath of air due to her upper back being very tight.
Her active and passive range of motion was severely limited with exquisitely tender areas in the suboccipital muscles bilaterally. Her balance with feet together, standing on one foot, and tandem stance with eyes closed was horrible. Finger to nose testing revealed overshooting the nose bilaterally.
Education and Reassurance — Before any care was given, I educated both Logan and her mother on what happened with the concussion, and that now she was a Post-Concussion Syndrome patient. Reassurance was given that she would feel better and basketball season was going to happen for her. Even though I cannot measure it, I do believe the anxiety level dropped by 50% by educating and reassuring her.
Treatment — Treatment consisted of long Y-axis distraction manipulations to C1 utilizing the cervical headpiece on my table. I worked the suboccipital muscles aggressively and with applications of heat and electrical muscle stimulation, we began to see improvement.
The most important aspect of our treatment approach was getting her up and moving. We performed a Buffalo Treadmill Test to see at what time her symptoms set in, and then we based our active rehabilitation program on those results. I instructed Logan to stop going to a dark room and start living again. Everything in moderation, but she was to have exposure to light and sound. Within two weeks her headaches had been reduced by 50%, and she was able to attend school for the entire day.
At the end of a month of care, she was once again getting “A’s” and was looking like the Logan I had originally known. The slumping was gone, the defeated look was replaced with a confident aura, and the thousand-yard stare was absent.
Back to competition
Logan was able to play basketball and soccer in her junior year and was once again a 4.0 student. On the day she was released from care, her mother broke down in tears and thanked me for bringing her daughter back to her.
There exists across the country many Logans, who need chiropractic care for concussions in sports and post-concussion syndrome symptoms. As the only neurological health care profession, we as chiropractors can make a difference in these patient’s lives.
TED A. ARKFELD, DC, MS, is a 1988 graduate of Northwestern College of Chiropractic where he also received his Bachelor of Science degree in Human Biology. He earned his Master of Science in Biomechanical Trauma from Lynn University in Boca Raton, Fla. For the past 18-years he has been the volunteer team chiropractor for Gaylord High School football, basketball, and soccer where he has treated numerous sports-related injuries and concussions. In December of 2018 his clinic became the second chiropractic office in the nation to achieve certification in the diagnosis and management of concussions and post-concussion syndrome through Complete Concussion Management, Inc. He can be contacted at firstname.lastname@example.org