by Kyla Demers, BSc, CAT(C), DO
As an athletic therapist and osteopath, I utilize manual therapy to improve the mobility of physical structures in order to improve function. Recently, I’ve become very interested in how cranial techniques can complement visual rehabilitation for patients with concussion.
To understand better how structure affects function, think about a beginning snowboarder who falls frequently, catching herself on her outstretched arms. That repeated pressure on the wrists restricts the movement of the carpal bones and radius in the wrist joint.
Without further irritation, the wrist might recover just fine. But if the snowboarder goes back to her office job with the joint functioning poorly, the muscles and tendons in the wrist might become overstressed, causing inflammation. With manual therapy, I can restore mobility by gently separating the radial-carpal bones to create space.
Direct or indirect head impacts or whiplash can lead to mobility restrictions of the head and neck, which can also be addressed with manual therapy. Of course, the skull does not move like a wrist. The cranium is a solid, malleable structure with several bones joined together by teeth-like sutures or joints that serve as shock absorbers. Although the joints may prevent the cranial bones from fracturing on impact, there can still be a certain degree of restriction after head trauma.
Some of the goals of cranial manual therapy are the following:
- Gently distract the joint between the occipital bone and temporal bone to relieve potential pressure on the accessory and vagus nerve, as well as the jugular vein. This can relieve nausea and relax the trapezius muscles that are holding tension in the shoulders.
- Free up space behind the frontal bone and/or around the sphenoid bone to relieve potential inhibition of the cranial nerves supplying the eye muscles.
- Improve circulation to the brain by freeing up the region through which the carotid and vertebral arteries pass. Increased blood flow brings oxygen and glucose (nutrition) to the brain to aid in recovery.
- Promote the body's ability to self-regulate and restore homeostasis.
In my experience, the best concussion care is truly interdisciplinary. Treating only neck pain or only vision in isolation is less effective than working together to help patients reach their full potential. I would encourage optometrists to view athletic or occupational therapists with an eye to collaboration.
For example, if you hear that another practitioner is conducting oculomotor screenings for local athletes, consider that an opportunity to approach that individual for referrals. Together you can make better decisions on how best to rehabilitate injured athletes and get them back to seeing well and feeling well as soon as possible.
For more information:
Kyla Demers, BSc, CAT(C), DO, is an athletic therapist and osteopath in Montreal, Canada, where nonphysician osteopathy is common. She will be speaking on the role of osteopathic cranial techniques in concussion care at the NORA annual conference, Sept. 19-22, 2019, in Scottsdale, Ariz. For schedule and registration, visit https://noravisionrehab.org/about-nora/annual-conference. For more information about osteopathy and manual therapy, consult the Canadian Federation of Osteopathy (osteopathy.ca) or the World Health Organization benchmark for osteopathy. In the U.S., where osteopaths are physicians who specialize in a wide range of areas, it may be helpful to look for a DO who focuses on osteopathic manipulative treatment (OMT, visit DoctorsThatDO.org).
Disclosure: Demers reports no relevant financial disclosures.
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