Cervical Range of Motion and Pericranial Muscle Tenderness in Patients With Persistent Post-Concussion Symptoms: A
Laura Westh Stenbro1, Line Amalie Hellemose, Simple Futarmal Kothari
1Author Affiliations: Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark (Ms Stenbro and Drs Hellemose, Kothari, Nielsen, and Eggertsen); Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Ms Stenbro and Drs Hellemose, Kasch, and Nielsen); Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark (Dr Kothari); Scandinavian Center for Orofacial Neurosciences, Aarhus University, Aarhus, Denmark (Drs Kothari); and Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (Dr Kasch).
Objectives:
To examine the active cervical range of motion (aCROM) in 15- to 30-year-old patients with high levels of persistent post-concussion symptoms (PCS) 2-6 months after a mild traumatic brain injury (mTBI) compared with healthy individuals. Additionally, we examined the association between aCROM, the severity of PCS (measured by the Rivermead Post-Concussion Symptom Questionnaire [RPQ]), and the pericranial tenderness score (pTTS).
Setting:
A research outpatient clinic at a rehabilitation hospital in the Central Denmark Region. Patients were recruited by referral from general practitioners or emergency departments.
Participants:
Young individuals (aged 15-30 years) with high levels of PCS (n = 108) within 2-6 months after a direct head trauma. Reference data of aCROM was obtained from a published study conducted on healthy individuals (n = 100) (aged 20-29 years).
Design:
Cross-sectional study using baseline data from a randomized controlled trial examining the effect of a non-pharmacological intervention for PCS.
Main Outcome Measures:
aCROM measured using a CROM 3 device, pTTS, and RPQ-score.
Results:
Patients with PCS had a 5% lower mean total aCROM compared with a published reference mean on healthy individuals (mean group difference [95% confidence interval] = -19°[-31; -7.0], P = .002). The reduction in aCROM was primarily driven by a subset of individuals (n = 12). A significant negative correlation was found between total pTTS and total aCROM ( ρ = -.43, P < .001). There was no significant correlation between the RPQ score and the total aCROM (r = -0.12, P = .214).
Conclusion:
The findings indicate that concomitant cervical impairment may exist in a subset of patients with PCS. A clinical implication could be to include systematic neck examination in patients with mTBI to ensure accurate diagnosis. However, further research is necessary before implementing this information into regular clinical practice.
