A 27-year-old man presented to the clinic with a 2-day history of dizziness, nausea, fogginess, and a “blowing sensation in the ear.” Symptoms started 3 days earlier after a fall while snowboarding without a helmet, during which he hit the left posterior aspect of his head. The patient denied loss of consciousness but admitted to a headache, nausea, dizziness, and tinnitus after the fall. He described his dizziness as “the room was spinning.” He denied vomiting, visual changes, or memory loss.
The patient had an unremarkable medical history and denied a history of migraines, attention problems, anxiety, or depression. The patient denied taking medication, including over-the-counter pain medication, after the accident.
In the clinic, the patient appeared uncomfortable. His vital signs were within normal limits, and physical examination findings, including that of the cardiopulmonary system, were unremarkable. A neurologic examination revealed pupils equally round and reactive to light and extraocular muscles full without evidence of nystagmus. Cerebellar signs were absent, sensation was intact in all extremities, and he was able to ambulate without assistance. The remainder of the examination findings were nonfocal.
An osteopathic structural examination revealed a right sphenobasilar synchondrosis torsion, an inferior vertical strain, left temporal bone externally rotated; C3 extended, rotated, and sidebent left; C4-5 extended, rotated, and sidebent right; right first rib inhalation dysfunction; T2-3 flexed, rotated, and sidebent right; L4 extended, rotated, and sidebent left; and a left unilateral sacral flexion. The patient was also evaluated with the SOT on the SMART Balance Master because of his balance complaints.
Figure 1 provides a schematic drawing of the sensory conditions assessed by the SOT. On the basis of the patient’s history of trauma and the physical examination findings, mild concussion was diagnosed.
The patient consented to receive a single 25-minute session of OMT for his concussion symptoms. Techniques included balanced membranous tension, cranial bone lifts, venous sinus drainage, balanced ligamentous tension of the thoracic outlet, muscle energy and myofascial release to the cervical and upper thoracic spine, and high-velocity, low-amplitude to the cervical, thoracic, lumbar, and sacral spine segments.
Immediately after treatment, the patient reported resolution of the dizziness, tinnitus, and nausea. He denied further sensation of the room spinning. The SOT showed an increase in the composite equilibrium from 76 before treatment to 81 after treatment. The equilibrium score in conditions 4 and 5, which are associated with the visual and vestibular aspects of balance, improved the most after treatment (
Figure 2). One week after treatment, the patient returned for a follow-up visit and denied any symptoms. No further follow-up was documented.