Cervical Spine Focused Treatment for Patients With Persistent Concussion Symptoms and Neck Pain

Cervical Spine Focused Treatment for Patients With Persistent Concussion Symptoms and Neck Pain: Pilot Study

Assess the feasibility of recruiting, enrolling and randomizing patients with concussion symptoms and neck pain to receive manual therapy and cervical rehabilitative exercises in addition to standard concussion treatment.

In the usual care workflow provided at the participating concussion clinic, cervical spine rehab is not typically introduced until after week 4. The rationale is that neck pain is often a self-limiting condition that may resolve spontaneously, without the need for specific cervical spine rehab.

This study is chiefly focused on feasibility aims that revolve around developing changes to barriers in workflow issues at the participating concussion clinic, that would allow for earlier introduction of cervical spine rehab.

This is a a single site pilot randomized controlled trial consisting of a total of 40 participants with concussion and neck pain, randomized to one of two groups (n=20 per group):

1. early cervical spine focused treatment combined with standard concussion care.
2. standard concussion care alone for 4 weeks, followed by delayed introduction (after 4 weeks) of cervical spine focused treatment (which is the usual care workflow at our clinical partner site.)

Both groups will receive the combination of cervical spine focused treatment and standard concussion care; the only variation being the timing of the introduction of the cervical spine care.

The primary endpoint will be 4 weeks from start of cervical rehabilitation intervention. The secondary would be the point of discharge. The duration of active participation in the study will be 8 weeks for the participants.

Inclusion Criteria:

• Diagnosed concussion
• Patient endorses neck pain OR difficulty moving their neck (moderate or severe; score of 2 or 3 for items 16 and 25 from concussion CP screen)
• Willingness to be randomized
• 8-90 days post injury
• English Speaking

Exclusion Criteria:

• Previous concussion within the past 6 months
• Prior history of ischemic/vascular events
• Previous treatment for current symptoms
• Prior treatment for neck pain/headaches in the past year
• Workers' compensation claim and/or litigation associated with injury
• Diagnosed substance use disorder
• Prior cervical spine surgery
• Prior fracture and or dislocation/subluxation of the cervical spine
• Diagnosed inflammatory arthritis