Published August 26, 2014
Yet, determining which condition a patient has experienced is critical because courses of treatment are very different, says Leddy, senior author on the study.
“Based on our research, we concluded that some patients who have been told they’ve suffered a concussion — and whose symptoms persisted for several months — may actually have suffered a neck injury rather than, or in addition to, a concussion,” says Leddy.
“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.
“The symptoms for both conditions are so nonspecific that it’s really hard to make a diagnosis based on them,” he explains, “so we had to find another way to discriminate between them.”
His research was based on information about symptoms provided by 128 patients treated at the University at Buffalo’s Concussion Management Clinic, a joint effort between the Department of Orthopaedics and the Department of Psychiatry.
To determine which patients had probably sustained a concussion and which more likely had a neck injury, patients were evaluated on a graded treadmill test developed by Leddy and co-author Barry S. Willer, PhD, professor of psychiatry.
The researchers correlated patients’ treadmill test results to their responses on a detailed questionnaire about symptoms.
“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.”
He notes that more research should be done on larger samples.
“Because a concussion is a brain injury, we thought that cognitive symptoms would be more likely associated with concussions,” says Leddy.
“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.”
Both groups reported experiencing headache, dizziness, blurred vision, poor concentration and memory deficits.
Leddy says patients who think they’ve had a concussion — and whose symptoms have not diminished after several months — should be examined for neck and vestibular injury by a sports medicine physician, neurologist or physiatrist, a rehabilitation medicine specialist.
Leddy says 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.
“I think a lot of practitioners listen to the symptoms and just chalk it up to concussion,” he says, “but if they also examine the neck in these patients, they might discover that a neck injury is involved — and that’s a treatable problem.”
“The treatment for a neck injury is actually to be more active, to do physical and vestibular therapy, whereas after a concussion, exercise must begin slowly and incrementally after a period of rest,” Leddy notes.
The study, “Brain or Strain? Symptoms Alone Do Not Distinguish Physiologic Concussion From Cervical/Vestibular Injury,” has been published in the Clinical Journal of Sport Medicine.
In addition to Leddy and Willer, co-authors are: