Osteopathic Manipulative Treatment Relieves Post-concussion Symptoms in a Case of Polytrauma

Participants

• Number: 1
• Description: a 66-year-old woman with no significant medical history. After a high-velocity motor vehicle collision presented left squamous temporal bone fracture with extension to the sphenoid sinus, associated intrasinus hemorrhage and minimal pneumocephalus, right frontal sinus fracture with the extension into the right orbital roof, left frontal scalp hematoma, left supraorbital laceration and non-displaced left clavicle fracture. Computerized tomography did not reveal intracranial hemorrhage. After 2 days in which she received therapy for pain control, physiotherapy, sling for the clavicle fracture, and reparation of the laceration she was discharged to home in stable conditions. At the control visit after 9 days she reported left parietal, neck and shoulder pain, anhedonia, agitation and insomnia.

She was prescribed analgesics and watchful waiting also following an orthopedic and neurosurgical visit. After 5 weeks, the patient presented herself to the trauma clinic reporting a worsening of the headaches to the left occipital, temporal and parietal areas and persistent decreased activity level. The structural osteopathic evaluation revealed a sphenobasilar synchondrosis and left occipitomastoid compression, left temporal bone external rotation, bilateral frontal compression, a decreased cranial rhythmic impulse and suboccipital muscle spasms. After 2 weeks, when she returned for the first OMT, the patient reported even more severe headaches associated with a worsening of the neck pain also interfering with concentration and sleep.

Interventions and evaluations

• Various monthly OMT sessions of 35-45 minutes
• OMT targeted cranial and cervical spine and upper extremities and, at a later time, the entire body, with the intention to restore alignment, fluid motion, and cervical and fascial tissue mobility
  • main techniques used: myofascial release, balanced ligamentous tension, paraspinal inhibition, cranial techniques, rib raising, diaphragmatic mobilization, Fulford’s dural release
  • “aggressive” techniques were avoided (eg, thrust)
• There were not other complementary or alternative therapies associated with OMT

Results

After the first session, the pain and mobility of the neck, head, and upper left extremity immediately improved, with neck and head pain ceasing the following day (for the first time since the accident). The quality of sleep improved and the consumption of analgesics also decreased. At the next visit, 1 month later, she reported a blurring of the left visual field, in association with periauricular paresthesia, dizziness (stunning) and a slight pain in the left temple between the frontal and sphenoid sutures. The OMT favored an immediate relief of all these symptoms, which allowed the patient to return to driving.

After 1 month, blurred vision and pain in the temple were still present, although improved. The cranial OMT induced such an improvement of the symptoms to allow a return to athletic activity and to driving. The following sessions of OMT focused on a general rebalancing of the body and skull promoting further visual field improvements. No adverse effects related to OMT were detected.

Discussion

OMT showed positive effects on post-concussion symptoms and did not induce any type of adverse effect. In line with other cases reported in the literature, OMT seems effective and safe in the event of a concussion. There is, however, no definition of a specific approach in these situations, although it is very likely that each case and condition would need an individualized approach. In the specific, a definition is missing of when to start treating and how frequently (daily, weekly, monthly?). Furthermore, the literature is deficient in both the pathophysiology underlying the post-concussion symptoms and the mechanisms by which OMT can be effective. Although hypotheses can be made about the ability of OMT to act on autonomic dysfunctions, on the glymphatic system and on symptoms related to fascial restrictions.