The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium.

BACKGROUND: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. HYPOTHESIS: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. RESULTS: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592). CONCLUSION: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

Relationship between Workload, Psychological State and Sleep in Female Soccer Athletes.

This study assessed the multifaceted relations between measures of workload, psychological state, and recovery throughout an entire soccer season. A prospective longitudinal study was utilized to measure workload (GPS training load, RPE), psychological state (mental stress, mental fatigue, and mood), and recovery (sleep duration, sleep quality, and soreness), across ninety observations. Separate linear-mixed effect models were used to assess outcomes of RPE, soreness, and sleep duration. A linear mixed-effects model explained 59% of the variance in RPE following each session. Specifically, each standard deviation increase in GPS load and mental stress in the morning prior to training increased RPE by 1.46(SE=0.08) and 0.29(SE= 0.07) respectively, following that day's training. Furthermore, a significant interaction was found between several predictor variables and chronological day in the season while predicting RPE. Specifically, for each standard deviation increase in GPS load, RPE went up by 0.055 per day across the season suggesting that load had a higher impact on RPE as the season progressed. In contrast, the interaction of day by mental stress, sleep duration, and soreness continued to be stronger as the season progressed. Each linear mixed-effect model predicted a larger amount of variance when accounting for individual variations in the random effects.

Determinants of Intention to Disclose Musculoskeletal Injury in Adolescent Athletes.

CONTEXT: Although research indicates that the key to minimizing the effect of musculoskeletal injury, improving care, and mitigating long-term effects is to improve early injury care seeking, little is known about barriers to early musculoskeletal injury disclosure and care seeking. OBJECTIVE: To identify which determinants predicted sport-related musculoskeletal (MSK) injury disclosure by adolescent athletes. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 564 adolescent athletes (58% male, age = 15.81 ± 1.8 years). MAIN OUTCOME MEASURE(S): Online survey exploring determinants of age, gender, race, socioeconomic status, injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding MSK injury disclosure, intention to disclose MSK injury, and actual behavior of disclosing MSK injury. RESULTS: Of the respondents, 457 (80.2%) reported having sustained ≥1 (mean = 3.2 ± 2.2; range = 1-10) MSK injuries related to sport. Those who endorsed having experienced an MSK injury disclosed not reporting or purposefully hiding 77% of their suspected MSK injuries. Several factors influenced a high intention to disclose MSK injury. Specifically, for each unit increase in total MSK injury knowledge (Exp[ß] = 1.061, ß=0.054, P = .020, 95% CI = 1.031, 1.221) and attitude (Exp[ß] = 1.070, ß = 0.064, P < .001, 95% CI = 1.027, 1.115) score, 6% and 7% increases in the likelihood of a high intention to disclose an MSK injury, respectively, were observed. Moreover, for each unit increase in the social norm score (Exp[ß] = 1.178, ß=0.164, P < .001, 95% CI = 1.119, 1.241), an 18% increase in the likelihood of a high intention to disclose an MSK injury was noted. CONCLUSIONS: Designing interventions geared toward increasing the knowledge of signs and symptoms of MSK injury, improving attitudes surrounding disclosure, and better understanding the social context of disclosing MSK injuries may improve MSK injury disclosure behavior and reduce the associated social and economic burdens of these injuries.

The Identification and Comparison of Factors Affecting Musculoskeletal and Concussion Injury Disclosure.

CONTEXT: Despite the increased risk of musculoskeletal (MSK) injury after a concussion, little is known about the determinants of such a risk. Moreover, the authors of previous reports of increased risk of MSK injury after a concussion have neglected to account for the high level of undisclosed concussions. OBJECTIVE: To explore the association between the intention to disclose a possible concussion and the intention to disclose an MSK injury. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: One hundred seven National Collegiate Athletic Association Division I athletes (females = 79%, age = 19.4 ± 1.4 years). MAIN OUTCOME MEASURE(S): Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and MSK injury disclosure. RESULTS: A significant association between high intention to disclose a concussion and high intention to disclose an MSK injury (χ2 = 19.276, P < .001, Cramer V = 0.482) was observed. Spearman rank correlations suggested no correlation between concussion nondisclosure (25%) and MSK injury nondisclosure (52%). Multivariate binomial regressions indicated that perceived social norms were the strongest determinant (ß = 1.365, P = .002) of high intention to disclose concussion, while attitudes toward MSK injury (ß = 1.067, P = .005) and perceived social norms (ß = 1.099, P = .013) were the strongest determinants of high intention to report MSK injury. CONCLUSIONS: Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were seen between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in intention to disclose MSK injury. As those with high intention to disclose concussion also displayed high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury after a concussion.

The association between contact sport exposure and cervical sensorimotor dysfunction: a scoping review of implications for future musculoskeletal injury risk.

BACKGROUND: While morphological changes to the cervical spine have been observed for over 40 years in response to contact sport participation, little is known about the secondary effects of the cervical impairment on future musculoskeletal injury and disability. OBJECTIVES AND DESIGN: A scoping review was performed to discuss the relationship between contact sport participation and morphological changes to the cervical spine. Moreover, the correlation between morphological changes in the musculoskeletal structures of the cervical spine and resultant deficits in cervical sensorimotor and neuromotor function are discussed. Lastly, how alterations in cervical sensorimotor function may affect overall risk of musculoskeletal injury is discussed. METHODS: The scientific literature was searched in PubMed, Sport Discus, and Web of Science pertaining to contact-sport athletes and/or cervical pathology and the cervicocephalic network. The Asksey and O'Malley's framework and PRISMA for Scoping Reviews were used to conduct and report the following review. Included articles were grouped into three categories: (1) Morphological changes to the cervical spine in contact sport athletes. (2) The role of the neuromotor pathways of the cervical spine in maintenance of postural tone and coordination of the extremities. (3) The correlation between altered cervical sensorimotor function and a resultant increase in musculoskeletal injury risk. RESULTS: Our search identified 566 documents, of which 405 underwent full-text screening, resulting in 54 eligible studies for the review. Widespread cervical sensorimotor dysfunction was observed in contact sport athletes. Independently, cervical sensorimotor function was demonstrated to play a critical role in postural control and limb coordination. However, limited research exists exploring the interaction between contact sport participation and altered cervical sensorimotor function, as well as an associated increase in musculoskeletal injury risk. CONCLUSIONS: Limited evidence exists linking cervical injury and/or observed deficits in cervical sensorimotor and neuromotor function to musculoskeletal injury risk. Longitudinal studies combining imaging measures (e.g., MRI, DEXA), cervical functional test, and prospective injury risk are needed to further explore the correlation between resultant cervical sensorimotor deficits following contact sport impacts and future musculoskeletal injury risk.

Prevalence of Acute Neck Pain Following Sports-Related Concussion in High School Athletes.

OBJECTIVES: To explore the prevalence of acute neck pain in high school athletes following sports-related concussion (SRC) and to examine the role of acute neck pain in modifying or amplifying concurrent concussive symptoms. DESIGN: Retrospective observational. SETTING: High school sporting events. PARTICIPANTS: High school athletes who suffered a sports-related concussion between the 2011 and 2019 academic years academic years from the National Athletic Treatment, Injury and Outcomes Network (NATION) Study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of neck pain (yes/no) along with 33 other commonly reported concussion symptoms, number of symptoms reported, mechanism of injury (contact with person/surface or object), sport type (contact/noncontact), and injury history (first time/repeated injury). RESULTS: One hundred thirty-eight of 401 athletes (33.9%) indicated acute neck pain following SRC. Those with neck pain reported significantly more symptoms overall (M = 13.53, SD = 6.89) relative to their non-neck pain counterparts (M = 8.46, SD = 5.68; t [191.35] = 7.11, P < 0.001). Athletes with SRC due to contact with a surface were significantly less likely to report neck pain than those reported contact with a person. Neck pain, repeated injury, and female sex were significantly associated with a greater number of concussion symptoms in the acute phase. CONCLUSIONS: Our data suggest that acute neck pain is a frequent acute symptom following SRC and signals the necessity for additional screening to seek and identify comorbid cervical pathology. Prospective studies should seek to access the benefit of cervical therapy in the early stages in SRC patients with neck pain to reduce the risk of persistent postconcussion symptoms.

Reduced Injury Prevalence in Soccer Athletes Following GPS Guided Acclimatization.

GPS technology has been used to retrospectively correlate injury risk to changes in training load, however the use of GPS technology to plan and monitor training load over an acclimatization period to prevent musculoskeletal injury remains unexplored. This article reports the utility of GPS technology to help develop and monitor incremental increases in training load while transitioning from off-season to in season to reduce musculoskeletal injury. A series of daily minimum standards were established based on observed training loads in year 1 to gradually acclimate soccer athletes over a 5-week period prior to competition season in year 2. Daily check-ins with GPS data were used to ensure athletes met the standards to safely reach the expected training load of a competitive season. Following the 5-week GPS guided training program a lower overall prevalence of injury (Year 1: 92.6% (95%CI = 75.7-100) vs. Year 2: 55.2% (95%CI = 35.7-73.6)) (p = .002) and overall injury rate (Year 1: 8.1/1000 exposure hours (95%CI = 5.2-12) vs 4.6/1000 exposure hours (95%CI = 2.7-7.5) in year 2 (p = .08)) was observed. The observed reduction in injury prevalence and incidence demonstrates how GPS data can be used to proactively design and monitor preventative chronic training load acclimatization programs.

Effects of COVID-19 pandemic and quarantine period on physical activity and dietary habits of college-aged students.

The coronavirus disease 2019 (COVID-19) pandemic led to sudden extreme changes in lifestyle, potentially causing adverse changes in physical activity, sedentary behavior, and dietary habits. The objective of the study was to investigate the effects of COVID-19 quarantine on physical activity, dietary habits, and food insecurity among college students who were impacted by the quarantine periods and campus closures. The findings of the study will provide preliminary evidence on dietary, physical activity, and sedentary behavior changes induced by the pandemic among college students. Participants (n â€‹= â€‹403) completed a cross-sectional self-report online questionnaire, evaluating the physical activity, sedentary behavior, and dietary behaviors before- and during-COVID-19 campus closures (March-May 2020). Sociodemographic and descriptive information was also obtained from each participant. Wilcoxon signed-rank test was used to assess changes in physical activity, sedentary behavior, and dietary habits. McNemar's test was used to compare food insecurity changes. Data were presented as median and interquartile range. A total of 291 participants who met the inclusion criteria were enrolled in the study (college-aged, 18-24 years). Physical activity decreased at vigorous (2 days/week to 1 day/week, p â€‹< â€‹0.001), moderate (4 days/week to 1 day/week, p â€‹< â€‹0.001), and light (4 days/week to 2 days/week, p â€‹< â€‹0.001) intensity levels, while sedentary behavior increased (4 â€‹h/day to 7 â€‹h/day, p â€‹< â€‹0.001) from pre-to during-COVID-19 quarantine period. Frequencies of meals at home and alcohol consumption increased (Z â€‹= â€‹-3.911 and Z â€‹= â€‹-4.022, p â€‹< â€‹0.001), while frequency of fruit consumption decreased (Z â€‹= â€‹-2.116, p â€‹< â€‹0.001) from pre-to during-COVID-19 quarantine period. Daily alcohol intake also increased during COVID-19 quarantine period (Z â€‹= â€‹-4.442, p â€‹< â€‹0.001). Lastly, the percentage of individuals reporting food insecurity significantly increased during COVID-19 quarantine (p â€‹< â€‹0.001). College-aged students in quarantine significantly decreased physical activity participation and increased sedentary behavior. Changes in dietary habits were observed, including increased meals at home, alcohol consumption, and decreased fruit consumption. Food insecurity also doubled among college-aged students during quarantine. Public health strategies to attenuate these changes in lifestyle habits should be implemented during a global pandemic.

The Role of Cervical Symptoms in Post-concussion Management: A Systematic Review.

BACKGROUND: Patients with cervicogenic symptoms following a concussion have shown a disproportionate rate of delayed symptom resolution. However, the prevalence of cervicogenic symptoms in the acute stages following a concussion and the percentage of those patients who continue on to suffer delayed symptom resolution is poorly described in the literature. OBJECTIVES: To provide a comprehensive report on the clinical prevalence, diagnostic methods, and potential treatment options for cervicogenic symptoms that are elicited during acute and chronic phases following a concussion. METHODS: Electronic searches were conducted in PubMed, SPORTDiscus, ICL, CINAHL and PEDro, from inception to May 2020, to identify original research articles on concussion involving cervicogenic symptoms. We assessed each included article for risk of bias, methodological quality, level of evidence and evidence quality. The articles were categorized into three topics: (1) prevalence of post-concussion cervicogenic symptoms; (2) diagnostic testing for cervicogenic symptoms, and (3) treatment techniques for cervicogenic symptoms. RESULTS: The initial review resulted in 1443 abstracts, of which 103 abstracts met the inclusion criteria of our research. After the review of full text, 80 articles were excluded, which resulted in a total of 23 articles for this systematic review. Prevalence of cervicogenic symptoms in the acute stages ranged from 7 to 69% and increased to 90% in patients experiencing persistent post-concussive symptoms. Neck pain at initial evaluation increased risk of developing persistent post-concussive symptoms (PPCS) by 2.58-6.38 times. Patient-reported outcome measures (e.g., Neck Disability Index, Dizziness Handicap Inventory, and Rivermead Post-Concussion Questionnaire) can identify patients with cervicogenic symptoms that should be further differentiated by clinical testing. Lastly, treatment using graded cervical manual therapy has shown to reduce time to symptom resolution and medical clearance. CONCLUSIONS: Cervicogenic symptoms are prevalent in the acute and chronic stages following concussion, which if not diagnosed appropriately increase the likelihood of PPCS. Several clinical tests are available to help differentiate cervicogenic symptoms; however, lack of awareness and hesitation by practitioners limits their use. More randomized controlled trials are necessary to evaluate the effectiveness of cervical specific treatment programs for PPCS.

Certified Athletic Trainers' Use of Cervical Clinical Testing in the Diagnosis and Management of Sports-Related Concussion.

CONTEXT: Despite evidence implicating cervicogenic symptoms in the development of persistent postconcussion symptoms, factors that influence utilization of cervical clinical tests to identify cervicogenic symptoms following concussion are poorly understood. OBJECTIVE: Explore barriers to the utilization of cervical clinical testing in multifaceted concussion evaluation. DESIGN: Cross-sectional. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 122 athletic trainers (AT) (age = 42.6 [6.4] y; female = 51.6%; 52% >10 y of clinical practice; 68% master's degree or greater; 35% treated a minimum of 15 concussions/y). MAIN OUTCOME MEASURE(S): Perceived importance, clinical experience, number of concussions treated, utilization of cervical clinical tests following nonspecific cervical pathology and following concussion, comfort with cervical treatment modalities following a concussion, and recommendation for cervical-specific therapy to treat persistent postconcussion symptoms. RESULTS: Ordinal logistic regression revealed perceived importance had the strongest positive impact on AT's likelihood of high utilization of cervical clinical testing following concussion (95% CI, .17 to .99; P = .005), while clinical experience (95% CI, -.43 to .29; P = .71) and number of concussions treated/y (95% CI, -.21 to .31; P = .71) had no bearing. Moreover, low comfort with cervical treatments following a concussion (95% CI, -2.86 to -.26; P = .018) and low utilization of cervical clinical testing following nonspecific cervical pathology (95% CI, -7.01 to -3.39; P ≤ .001) had a strong positive impact on high utilization of cervical clinical testing following concussion. Two logistic regression models demonstrated how recommendations for cervical-specific therapy in persistent post-concussion symptom patients could be predicted based on (1) cervical test utilization and (2) perceptions and clinical experience with 79% and 78%, respectively. CONCLUSIONS: Perceived importance played a major role in utilization of cervical clinical test following concussion. ATs who utilized common cervical treatments when dealing with non-concussive injuries were more likely to utilize those same treatments to treat comorbid cervical pathology following a concussion.

Differences in cervical kinesthesia between amateur athletes with and without a history of contact sport participation.

Objective: Identify cervical sensorimotor function differences between amateur athletes with and without a history of contact sport participation. A secondary aim of the study was to explore the association between neck reposition error and previously identified injury risk factors.Design: Cross-sectional.Participants: 27 amateur campus recreation sport athletes with a history of contact sport participation and 20 amateur campus recreation sport athletes with no history of contact sport.Main Outcome Measures: Baseline signs and symptoms (S/S) number and severity, Neck Disability Index, total neck reposition error, maximum reposition error, cervical range of motion, and cervical isometric strength were then compared between independent factor groups (contact vs. non-contact).Results: Amateur sport athletes with a history of contact sport exposure exhibited 25.2% more total neck reposition error and 24.6% more maximum neck reposition error than athletes with no history of contact sport participation. S/S number (r2 = .12, F(2,44) = 6.2, p = .017) and S/S severity (r2 = .14, F(2,44) = 5.6, p = .02) were significantly correlated with total neck reposition error.Conclusions: Athletes with a history of contact sport participation exhibited greater cervical spine reposition error. The degree to which these sensory position-sense deficits increase risk of injury and long-term quality of life is unknown, but should be explored in future studies.

Clinical Changes in Cervical Neuromuscular Control Following Subconcussive Impacts.

CONTEXT: Increased injury rates following concussive injury have been attributed to decreased neuromuscular coordination frequently documented following a concussion. However, altered integration between the vestibular system and oculomotor pathways following impacts at subconcussive thresholds implicate all sports-related impacts not just those at a concussive threshold in future musculoskeletal injury. While, several studies have explored the utility of vestibular and oculomotor clinical testing to detect altered neuromuscular control and then correlated those alterations to future injury risk, no research has explored the use of cervical clinical tests in the same capacity. OUTCOME MEASURES: Cervical joint position error test, Neck Disability Index and head acceleration. INTERVENTIONS: Soccer headers, fatigue protocol, soccer headers + fatigue. OBJECTIVE: To explore the clinical utility of a novel clinical approach to measuring changes in cervical neuromuscular control following subconcussive impacts in a controlled lab environment. PARTICIPANTS: 40 current female colligate club soccer athletes were recruited. Inclusion criteria included between the age of 18 and 25 and a minimum of 4-year soccer heading experience. SETTING: Laboratory.  Design: A repeated-measures design with 4 groups was utilized to test the hypothesis. RESULTS: A 65%, 54%, and 49% increased error was observed following the soccer heading, fatigue only, and soccer heading + fatigue interventions, respectively. Meanwhile, the controls saw a 6% decrease in neck position error. Concussion: While, cervical joint position error testing was sensitive to decreased neuromuscular coordination following soccer heading, it was not specific enough to rule out an exercise effect in the absence of subconcussive impacts. Further research is warranted to explore the clinical utility and specificity of cervical joint position error testing to measured alterations in supraspinal processing following subconcussive impacts, and how these alterations may lead to decreased coordination and movement of the body during sports-related task.

The effect of an interval fatigue protocol on Vestibular/Ocular Motor Screening (VOMS) performance.

Objective: The purpose of this study was to examine the effect of a fatigue protocol on Vestibular/Ocular Motor Screening (VOMS) performance.Design: Within subjects, repeated measures, crossover.Methods: Fifteen healthy, physically-active participants (22.20 ± 1.424 years) completed 2 sessions under 2 conditions. A pretest VOMS, condition protocol, and a posttest VOMSwere performed. The control condition consisted of rest, while the experimental consisted of a fatigue protocol.Results: The primary outcome measures were VOMS performance scores and Near Point of Convergence (NPC) measurements. Statistically significant interaction effects for NPC, F(1,14) = 9.38, p = .008, and total VOMS score, F(1,14) = 10.96, p = .005 were observed. For NPC, posttest (9.12 ± 4.99 cm) was significantly different, t(14) = -2.60, p = .021, than pretest scores (7.12 ± 3.19 cm). For total VOMS score, posttest experimental scores (4.93 ± 5.12) were significantly different, t(14) = -3.06, p = .009, than pretest severity scores (1.73 ± 3.67).Conclusions: Significant increases were found in total VOMS and NPC scores following exertional fatigue. Exertional fatigue affects symptoms associated with vestibular, and/or ocular motor system assessments. Clinicians should use the VOMS with caution immediately following activity and allow time for recovery from acute fatigue.

Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation.

Vestibular and oculomotor testing is emerging as a valuable assessment in sport-related concussion (SRC). However, their usefulness for tracking recovery and guiding return-to-play decisions remains unclear. Therefore the purpose of this study was to evaluate their clinical usefulness for tracking SRC recovery. Vestibular and oculomotor assessments were used to measure symptom provocation in an acute group (n=21) concussed≤10 days, prolonged symptoms group (n=10) concussed ≥16 days (median=84 days), healthy group (n=58) no concussions in >6 months. Known-groups approach was used with three groups at three time points (initial, 2-week and 6-week follow-up). Provoked symptoms for Gaze-Stabilization (GST), Rapid Eye Horizontal (REH), Optokinetic Stimulation (OKS), Smooth-Pursuit Slow (SPS) and Fast (SPF) tests, total combined symptoms scores and near point convergence (NPC) distance were significantly greater at initial assessment in both injury groups compared to controls. Injury groups improved on the King-Devick test and combined symptom provocation scores across time. The acute group improved over time on REH and SPF tests, while the prolonged symptoms group improved on OKS. A regression model (REH, OKS, GST) was 90% accurate discriminating concussed from healthy. Vestibular and ocular motor tests give valuable insight during recovery. They can prove beneficial in concussion evaluation given the modest equipment, training and time requirements. The current study demonstrates that when combined, vestibular and oculomotor clinical tests aid in the detection of deficits following a SRC. Additionally, tests such as NPC, GST, REH, SPS, SPF OKS and KD provide valuable information to clinicians throughout the recovery process and may aid in return to play decisions.

Understanding the complete pathophysiology of chronic mild to moderate neck pain: Implications for the inclusion of a comprehensive sensorimotor evaluation.

BACKGROUND: Inconsistencies in the literature concerning the effect of neck pain have led to a lack of understanding concerning the complete pathophysiology of neck pain. While the effect of neck pain on motor function as measured by active range of motion and isometric neck strength is well documented the effect of neck pain on sensory measures such as tactical acuity and neck reposition error (NRE) remain poorly understood. OBJECTIVE: The purpose of this study was to evaluate a combined sensorimotor evaluation to explore the potential benefits of incorporating both sensory and motor task into a physical evaluation of neck pain suffers to gain an added knowledge of the complete pathophysiology of their health status. METHODS: A cross-sectional study that measured neck joint reposition error, tactical acuity, neck isometric strength and range of motion in 40 volunteer participants (22 pain, 18 control). RESULTS: A statistically significant increase in NRE in flexion (2.75∘± 1.52∘ vs. 4.53∘± 1.74∘ and in extension (3.78∘± 1.95∘ vs 5.77∘± 2.73∘ in participants suffering from neck pain was observed. Additionally, the dermatome C5 was found to be the most affected. No differences were found in neck strength or neck range of motion between healthy controls and patients with chronic moderate neck pain.

Cervical Injury Assessments for Concussion Evaluation: A Review.

BACKGROUND: A concussion is a complex pathophysiologic process that is induced by biomechanical forces and affects the brain. Cervical injuries and concussion can share similar mechanisms and nearly identical symptoms or causes. Therefore, symptoms or causes alone may be insufficient to differentiate between patients with a concussion and patients with cervical injuries. OBJECTIVE: To demonstrate the homogeneous causes and symptoms observed in patients with a concussion and patients with cervical injury and to provide information on clinical tests that can differentiate cervical injury from pathologic conditions of vestibular or central origin. SUMMARY: Given that concussion and cervical injury share similar causes and symptoms, this information alone may be insufficient to diagnose a concussion. Clinical assessments, such as the cervical joint-reposition error test, smooth-pursuit neck-torsion test, head-neck differentiation test, cervical flexion-rotation test, and physical examination of the cervical spine, can be performed after a head and neck pathomechanical event to identify the presence of cervical injury. Differentiating between a concussion and cervical injury is clinically vital for timely and appropriate evidence-based treatment. CONCLUSIONS: Specific clinical tests should be used after a head and neck pathomechanical event to differentiate between symptoms due to a concussion and cervical injury. Continued research on the clinical utility of the 5 identified cervicogenic tests is also recommended.