A solid conk on the head does not require you to be a professional football player. Over 3 million people worldwide suffer from a concussion, also referred to as mild traumatic brain injury, each year. Some are the result of car accidents, while others are the result of falls or taking a header on the sports field. After a concussion, multimodal rehabilitation and physical therapy strategies for long-term concussion recovery are supported by current clinical practice protocol, which has included cervical dysfunction and vestibular ocular care and exertional activity without a specific intervention sequence.

Now in a recent study, Columbia University, New York scientists led by Professor Christopher Wong;  Dr. Samantha Vargas, Dr. Tessia DeMattos, together with Dr. Lauren Ziaks and Dr. Chelsea Brown from the Park City Hospital, Utah sought to describe clinical and patient-reported outcomes for patients with post-concussion symptoms following a rehabilitation strategy that addressed cervical dysfunction and benign paroxysmal positional vertigo during the first three weeks of injury, followed by integrated vision and vestibular treatment. The team used existing data from 4-5 years ago in a concussion clinic, and patients examined within the first three weeks after injury began with treatment for cervical dysfunction integrated with visual and vestibular therapy, which is consistent with extended concussion recovery and published in the International Journal of Sports Physical Therapy.

This retrospective cohort study has concluded that patients who received physical therapy, including manual therapy and exercise for cervical dysfunction and benign paroxysmal positional vertigo in the first three weeks after a concussion, cervical range of motion returned to normal for more than half of the patients. In addition, Vestibular system impairment represented by a clinical measure of balance ability, vestibulo-oculomotor symptoms, and the subjective patient-reported outcome vision function improved significantly for them whereas, saccades did not change. However, Benign Paroxysmal Positional Vertigo resolved for everyone diagnosed before the therapy.

In this critical study, Professor Wong and colleagues showed that a post-concussion syndrome rehabilitation protocol, which includes treatment of cervical dysfunction and benign paroxysmal positional vertigo during the first three weeks of injury, followed by integrated visual and vestibular therapy improves clinical and patient-reported outcomes.

Professor Wong said that: ‘The interconnectedness of the systems makes sequencing care to address musculoskeletal function before the 3-week post-concussion recovery window in a clinical approach that then integrates vision and vestibular system function a promising approach for concussion recovery.’ This study will help develop a better-preferred treatment sequence in the clinical practice guidelines for patients with post-concussion syndrome.

Journal Reference

Wong, C. K., Ziaks, L., Vargas, S., DeMattos, T., & Brown, C. (2021). Sequencing and integration of cervical manual therapy and vestibulo-oculomotor therapy for concussion symptoms: retrospective analysis. International journal of sports physical therapy16(1), 12. 10.26603/001c.18825

Christopher Kevin Wong, PT, PhD


Dr. Wong is the Curriculum Director of the Clinical Residency in Orthopedic Physical Therapy, Associate Director of the Program in Physical Therapy, and Professor of Rehabilitation and Regenerative Medicine at Columbia University Irving Medical Center. He teaches and researches orthopedics, orthotics and prosthetics topics, and continues in clinical practice as a certified Orthopedic Clinical Specialist since 2000. His research has been presented at national and international physiotherapy, physiatry, and prosthetics conferences and published in over 50 articles and textbooks.

Lauren J. Ziaks, DPT

Lauren Ziaks has a doctorate in physical therapy from Northeastern University and specializes in integrative concussion rehabilitation for Intermountain Healthcare. Her specialities include vision therapy, vestibular rehabilitation therapy, and the management of dysautonomia. 

Chelsea Brown, PT, DPT

Chelsea Brown has a doctorate in physical therapy from Northeastern University and has developed a clinical interest in post concussion management. She works in an outpatient clinic in the greater Boston area specializing in vision therapy and vestibular treatments.

Main image Credit: Milius007 from Pixabay