Focused Clinical Question: In concussed patients, are signs and symptoms of cervical dysfunction a cause for delayed symptom resolution and return to play? Clinical Bottom Line: Based on the results of this Critically Appraised Topic, there is some evidence to suggest that the presence of cervical symptoms and cervical dysfunction following sport-related concussion elevates a patient’s risk of delayed recovery and return to play.
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Diagnosis and Treatment of Cervical Pathology Following a Sport-Related Concussion: A Critically Appraised Topic
Kelly M. Cheever, Jane McDevitt, and Jacqueline Phillips
Prescription Medication for Posttraumatic Headache Following Concussion: A Critically Appraised Topic
Karlee Burns, Ryan Tierney, and Jane McDevitt
Clinical Question: In individuals with posttraumatic headache following concussion, what impact does medication have? Clinical Bottom Line: Prescription medications may be beneficial for those suffering posttraumatic headache following concussion by decreasing headache symptoms and improving cognitive function, though long-term outcomes were similar between those taking and not taking medications.
Increasing Hamstring Range of Motion via Plantar Myofascial Release: A Critically Appraised Topic
Alexandra Finley and Jane McDevitt
Context: The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question: In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line: The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh.
Memory Impairments Associated With Mild Traumatic Brain Injury: A Critically Appraised Topic
Karlee Burns, Leah Sanford, Ryan Tierney, and Jane McDevitt
Clinical Question: Do sports-related mild traumatic brain injury in adolescents and young adults produce changes that can be identified with functional magnetic resonance imaging that are associated with memory impairment? Clinical Bottom Line: After sport-related mild traumatic brain injury, functional magnetic resonance imaging identified inconsistent structural changes (e.g., cortical thickness changes, brain activation patterns), and negative performance changes in memory function (e.g., lower neuropsychological scores) in adolescents and young adults 9 days to more than a year following injury.
Exploring the Relationship Between Musculoskeletal Injury and Clinical Outcome Measures of Cervical Sensorimotor Function
Kelly M. Cheever, W. Geoffrey Wright, Jane McDevitt, Michael Sitler, and Ryan T. Tierney
The objective of this study was to explore the correlation between preseason measures of cervical sensorimotor function and musculoskeletal injury rates across a contact sport season. The authors hypothesized that athletes with higher sensorimotor dysfunction at baseline would be more likely to suffer an injury. The authors further hypothesized that contact sport participation would lead to greater changes in cervical sensorimotor function across a sport season compared with noncontact controls. Forty-nine collegiate club athletes (26 rugby and 23 noncontact controls) participated in a cohort study. Low positive correlations between baseline sign and symptom severity (r = .383), and score (r = .344), and cervical joint position error (r = .385–.425) and time loss injury were observed. Combining sign and symptom severity score and the neck reposition error predicted musculoskeletal injury status with 80.8% accuracy (area under the curve = 0.80, p = .003). The results suggest preseason deficits in cervical sensorimotor function may be related to future musculoskeletal injury risk. Sign and symptom severity score, Neck Disability Index score, and cervical joint position error can help identify athletes requiring more comprehensive cervical spine assessment that may benefit from preventative intervention.
