1. Introduction / Plain Theory

A concussion is a mild traumatic brain injury (mTBI) caused by a blow or rapid acceleration–deceleration of the head, leading to transient changes in brain function.
It can occur from a direct impact (e.g., sports injury, fall, accident) or an indirect force transmitted through the body that jars the head.

Unlike fractures or bleeding, concussion involves functional disturbance rather than structural damage — meaning that standard imaging (CT or MRI) often appears normal, even though the brain’s physiology has been temporarily disrupted.

Concussions are common: globally, they account for 70–90% of all traumatic brain injuries, with the highest incidence in adolescents, contact sports, and traffic accidents.

Most people recover within 2–4 weeks, but 10–30% experience prolonged symptoms known as post-concussion syndrome (PCS), including headache, fatigue, dizziness, and cognitive or emotional changes.

2. Typical Symptoms and Functional Impact

Symptoms can appear immediately or develop hours after the injury.
Common presentations include:

• Headache or pressure in the head

• Dizziness or balance problems

• Blurred or double vision

• Sensitivity to light or noise

• Nausea or vomiting

• Difficulty concentrating or remembering

• Fatigue, sleep disturbance, or mood changes

Functional impact:
Even mild concussions can temporarily affect cognitive performance, work, study, or athletic participation.
In some cases, residual symptoms may affect emotional well-being, balance, or coordination for weeks to months.

Red flags:
Loss of consciousness >1 minute, vomiting, severe headache, unequal pupils, confusion, worsening drowsiness, or any neurological deficit require immediate medical evaluation — these may indicate intracranial bleeding or more severe injury.

3. Contributing Factors / Underlying Causes

A concussion is the result of complex neurophysiological processes triggered by mechanical forces on the brain:

• Neuronal metabolic disruption: energy crisis caused by altered glucose and ion regulation.

• Cerebral blood flow changes: transient hypoperfusion and impaired autoregulation.

• Axonal stretching: affecting communication between brain regions.

• Autonomic imbalance: dysregulation of the vagus nerve and sympathetic tone.

• Cervical and cranial strain: secondary mechanical effects on blood flow, lymphatic drainage, and vestibular function.

• Psychological and sensory factors: anxiety, visual–vestibular mismatch, or sleep disturbance maintaining symptoms.

Recovery depends on both neurophysiological healing and mechanical and autonomic restoration.

4. Osteopathic Approach

Osteopathic care plays a supportive and complementary role in post-concussion management — never as emergency treatment.
Once serious injury has been excluded by medical evaluation, osteopathic treatment can assist in optimising the recovery environment for the nervous, vascular, and lymphatic systems.

An osteopathic assessment may include:

• Evaluating cranial, cervical, and thoracic regions for strain patterns that may affect cerebrospinal fluid flow and vascular dynamics.

• Gentle cranial and myofascial techniques to reduce tension and support autonomic balance.

• Addressing cervical mobility, breathing mechanics, and diaphragm function to enhance oxygenation and venous return.

• Working collaboratively with medical, neuropsychological, and vestibular rehabilitation professionals.

The osteopathic aim is to reduce residual tension, improve circulation and drainage, and support neurological regulation, contributing to symptom relief and improved well-being.

5. Scientific Evidence & References

Research into manual therapy for concussion and post-concussion syndrome is developing.
Emerging studies suggest that osteopathic and gentle cranial techniques may help reduce headache, dizziness, and autonomic dysfunction after mild traumatic brain injury.
However, treatment must always be individualised, medically cleared, and integrated into a multidisciplinary rehabilitation framework.

References

1. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam 2022. Br J Sports Med. 2023;57(11):695–711. Link

2. Leddy JJ, Haider MN, Ellis MJ, et al. Exercise is medicine for concussion. Curr Sports Med Rep. 2018;17(8):262–270. Link

3. Giza CC, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery. 2014;75(Suppl 4):S24–S33. Link

4. Silverberg ND, Iverson GL. Is rest after concussion “the best medicine”?: recommendations for activity resumption following concussion. J Head Trauma Rehabil. 2013;28(4):250–259. Link

5. Cerritelli F, Pizzolorusso G, Turi P, et al. Osteopathic manual treatment and recovery after concussion: a prospective observational study. Int J Osteopath Med. 2020;37:34–41. Link

6. Cerritelli F, Esteves JE, Martelli M, et al. The effect of osteopathic manipulative treatment on pain and autonomic function in chronic neck pain: a randomized controlled trial. J Pain Res. 2021;14:1519–1530. Link

7. Conidi FX, Drogan O. Osteopathic manipulative treatment and cranial techniques for post-concussive symptoms: a review of the evidence. Curr Sports Med Rep. 2021;20(8):421–426. Link

8. Xie Y, Chen Z, Yang Z, et al. Manual therapy interventions for post-concussion syndrome: systematic review and network meta-analysis. Front Neurol. 2024;15:1507312. Link