Cervical spine and vestibulo-ocular screening in elite female athletes with a history of concussion

Female athletes are more susceptible to sports-related concussions and experience greater and prolonged symptomatology. Changes in the cervico-vestibular systems have been observed in the acute phase post-concussion, but it is unknown if residual impairments persist in the following 12 months.

To determine if there was an association between baseline screening of the cervical spine, vestibular and oculomotor systems in female athletes with and without a history of concussion.

Cross-sectional study.

94 elite and pre-elite female athletes participating in soccer, water polo and rugby-7s were recruited from the Queensland Academy of Sport, Australia. Athletes completed the Sport Concussion Assessment Tool (SCAT6), Vestibular/Ocular Motor Screening (VOMS), and assessment of the cervical spine (manual examination and joint proprioception). History of concussion (yes/no) in the last 12 months was self-reported.

A history of headaches, findings on manual examination of the cervical spine (altered segmental mobility and tissue resistance) and symptom provocation on the VOMS were significantly different between groups for those with and without a history of concussion (all p < 0.05). Unadjusted odds ratios were 4.2 (95 % CI: 1.3-13.4) for history of headaches, 3.8 (95 % CI: 1.2-11.8) for abnormal VOMS and 3.2 (95 % CI: 1.1-9.3) for increased tissue resistance on manual examination of the cervical spine, suggesting that players with these findings on clinical examination are more likely to have a history of concussion.

The results of this study suggest that athletes with a history of concussion should undergo manual assessment of the cervical spine and vestibulo-ocular system screening regardless of baseline self-reported symptom profile.