Graded cervical (neck) manual therapy may reduce risk of persistent symptoms for patients with neck pain

By Sravya Valiveti. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A systematic review published in Sports Medicine found that post-concussion cervicogenic (neck) symptoms were prevalent in patients experiencing acute and chronic symptoms following a concussion. Across the studies, 7-69% of patients had neck symptoms when their concussion was acute, while this prevalence jumped to 90% in those already experiencing persistent post-concussive symptoms (PPCS). Study authors Cheever et al. found that “Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58–6.38 times.” Graded cervical manual therapy was found to “reduce time to symptom resolution and medical clearance.”

Researchers emphasize that a proactive approach is necessary for early intervention, which includes identifying patients experiencing cervicogenic symptoms and further differentiating symptoms using clinical tests. Without timely diagnosis and effective symptom management, patients are at an increased risk of developing persistent post-concussive symptoms (PPCS). 

The authors conducted an initial search to identify original research studies on cervicogenic symptoms associated with concussion. Using the 23 articles selected for this systematic review, the authors assessed the prevalence of cervicogenic symptoms and identified diagnostic testing tools and current treatments used in cervicogenic symptom management. The included studies used the Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire categories to identify those experiencing cervicogenic symptoms. Treatment consisted of administering graded cervical manual therapy, which reduced the time needed for recovery. 

Researchers note that “several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use.” There is an increased need for practitioners to be well-informed on the availability of existing diagnostic tools to ensure patients are referred for appropriate cervicogenic treatment techniques. 

In addition, Cheever et al. conclude that “randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.”