Study Looks at Overlap Between Symptoms of Concussions and Neck Injuries

By Ellen Goodman

Athletes and others reporting cognitive difficulties after a head injury are usually diagnosed as having had a concussion. But is it really a concussion? A new study published by University at Buffalo medical faculty finds that many of the same symptoms are common to concussions and to injuries to the neck and/or balance system, known collectively as cervical/vestibular injuries.

The research was based on responses about symptoms from 128 patients – some of whom were professional athletes – who were being treated at UB’s Concussion Management Clinic in the School of Medicine and Biomedical Sciences.

It was published online ahead of print last week in the Clinical Journal of Sport Medicine.

The purpose of the study was to determine how to distinguish between concussion injury and neck injury, based on symptoms.

“Based on our research, we conclude that some patients who have been told they’ve suffered a concussion, and whose symptoms persist for several months may actually have suffered a neck injury, rather than a concussion, or in addition to a concussion,” says John J. Leddy, MD, clinical professor in the UB Department of Orthopaedics and senior author.

He embarked on the study based on his experience as director of the UB Concussion Management Clinic.

“I’d seen enough patients in our clinic, some previously diagnosed with post-concussion syndrome, who continued to experience symptoms even after passing our treadmill test, which indicates full recovery from concussion,” says Leddy, who sees patients through UBMD, the physician practice plan of the UB medical school.

“The symptoms for both conditions are so nonspecific that it’s really hard to make a diagnosis based on them,” Leddy continues, “so we had to find another way to discriminate between them.”

To determine which of the respondents had probably sustained a concussion and which more likely had a neck injury, the UB researchers used the graded treadmill test developed by Leddy and co-author Barry Willer, PhD, UB professor of psychiatry.

“The treadmill test helps us make a first delineation between what I call physiologic concussion and other possible causes of cognitive symptoms,” says Leddy.

“Because a concussion is a brain injury, we thought that cognitive symptoms would be more likely associated with concussions,” he says. “Surprisingly, that didn’t turn out to be the case. People who have had neck injuries can also have problems with concentration and with memory. They feel like they’re in a fog, which is exactly what people report after concussion.”

Symptoms reported by both groups were headache, dizziness, blurred vision, poor concentration and memory deficits.

Patients in both groups filled out a detailed questionnaire concerning their symptoms. These responses were then correlated to their treadmill test results.

“Then we did some sophisticated statistical analysis,” says Leddy. “Even when we looked at the data in multiple ways, there was really no way to separate out the two groups based on their symptom patterns alone.”

Determining which condition a patient has experienced is critical, Leddy explains, because courses of treatment are very different.

“The treatment for a neck injury is actually to be more active, to do physical and vestibular therapy, to have a more active intervention, whereas after a concussion, exercise must begin slowly and incrementally after a period of rest,” he says.

Leddy notes that more research should be done on larger samples concerning concussion and neck injury.

In the meantime, he says, patients who think they’ve had a concussion and whose symptoms have not diminished after several months, should instead be examined for neck and vestibular injury by a sports medicine physician, a neurologist or a physiatrist, a specialist in rehabilitation medicine.

“I think a lot of practitioners listen to the symptoms and just chalk it up to concussion,” he adds, “but if they also examined the neck in these people, they might discover that a neck injury is involved and that’s a treatable problem.”

Physical symptoms specific to neck injuries include tenderness, neck spasms, reduced motion and reduced perception of where the head is in relation to the body, Leddy explains.

Co-authors with Leddy and Willer are John G. Baker, PhD, UB Department of Nuclear Medicine; Asim Merchant, MD and Jason Matuszak, MD, of the UB Department of Family Medicine; John Picano, an MD candidate at UB and Daniel Gaile, PhD, of the UB Department of Biostatistics.

The UB Concussion Management Clinic is a joint effort between the Department of Orthopaedics and the Department of Psychiatry.

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Seau Possible Entry into HoF Will Help Concussion Awareness

The concussion issue may get a lot more attention this November if the late Junior Seau gets named a semifinalist for the Pro Football Hall of Fame.

Seau, the former San Diego Charger linebacker who took his life while suffering from chronic traumatic encephalopathy, was named one of 113 early nominees for enshrinement in an announcement yesterday.

Seau would have to be be inducted posthumously as he took his own life on May 2, 2012 at the age of 43.

Seau’s family filed a wrongful death lawsuit against the National Football League in January of 2013.

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ECNL Club Bans Repetitive Heading Drills for 13U and Younger Teams

There are some 60 or so soccer clubs that make up the Elite Clubs National League (ECNL), which is the most prestigious grouping of youth soccer clubs in the nation.header

At least one of those clubs, Lone Star SC, has taken it upon itself to ban repetitive heading drills in practices. The club, which is based in Austin, communicated the following to parents on its concussion page:

“Effective Sept the 1st, 2014, Lonestar Soccer Club is implementing an indefinite ‘ban’ on repetitive heading practices for all U’13 and younger teams. All coaches at the Recreational, JR. Academy and Select Levels of play will be responsible for ensuring the successful implementation of this ban. Please note that heading the ball is a part of the game of soccer, and heading the ball is not being ‘banned’ completely at these age groups, just any form of repetitive ‘heading’ practice exercises, e.g. players in pairs serving the ball to each other repetitively, over and over again to perform headers. Examples of scenarios where you could still see heading in training sessions, from players at the U13 and younger age groups include, but are not limited to: Any small sided or full sided game, crossing and finishing sessions, set piece exercises.”

The club also discussed the importance of baseline testing on its “concussion page,” and the fact that it is exploring “optional” testing for players. For more, visit: http://www.lonestar-sc.com/UserFiles/files/PDF’s%20Fall%202014/LSC%202014-15%20Concussion%20%26%20′Baseline%20Testing’%20Policy%20.pdf

 

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