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OMT Minute  |   June 2018
Osteopathic Cranial Manipulative Medicine in the Setting of Concussion
Author Notes
  • From the Touro University College of Osteopathic Medicine-CA in Vallejo. 
  • Financial Disclosures: None reported. 
  • Support: This video was produced by Touro University College of Osteopathic Medicine-CA 
  •  Address correspondence to Chris Warren, OMS IV, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. Email: christopher.warren@tu.edu
     
Article Information
Emergency Medicine / Neuromusculoskeletal Disorders
OMT Minute   |   June 2018
Osteopathic Cranial Manipulative Medicine in the Setting of Concussion
The Journal of the American Osteopathic Association, June 2018, Vol. 118, e41-e42. doi:https://doi.org/10.7556/jaoa.2018.088
The Journal of the American Osteopathic Association, June 2018, Vol. 118, e41-e42. doi:https://doi.org/10.7556/jaoa.2018.088
Web of Science® Times Cited: 1
  
OMT Minute: Osteopathic Cranial Manipulative Medicine in the Setting of Concussion
eVideo. Jordan Keys, DO, demonstrates the venous sinus drainage technique to manage concussion symptoms, including headaches, dizziness, sleep disturbances, and difficulty concentrating.
Concussions represent a clinical diagnosis and process that is usually self-limiting. Symptoms of concussions include headaches, dizziness, sleep disturbances, and difficulty concentrating. Standard treatment focuses on symptom control via medications and mental rest. 
Although the exact pathophysiology of concussions is not known, several mechanisms contribute to the clinical symptoms seen in concussions, including a disturbance in cellular function. Patients who have sustained concussions are subject to membrane disruption from the acceleration and deceleration forces. This disruption leads to an influx of ions and an accumulation of excitatory neurotransmitters, such as glutamate. 
In addition to the standard of care, osteopathic diagnosis and treatment can be an effective tool in assessing and managing concussion symptoms. Owing to the mechanism of injury sustained in concussions, cranial and extracranial somatic dysfunction may result. These dysfunctions may be amenable to osteopathic manipulative treatment (OMT) techniques, including those techniques (eg, osteopathic cranial manipulative medicine [OCMM]) directed at enhancing physiologic mechanisms for improvement of intracranial drainage. 
In the video, we demonstrate the venous sinus drainage technique. There are regional variations in how this technique is taught regarding sequencing and sinuses addressed (including applying treatment to the occipital condyles and straight sinus). Before applying this technique, it is best to open up terminal drainage points, such as the thoracic outlet and occipitoatlantal and cervical regions. The goal of venous sinus drainage is to enhance the flow of venous blood through the venous sinuses to exit the skull through the jugular foramen returning to the central venous circulation. Huard1 observed that compared with sham therapy, the group receiving venous sinus drainage demonstrated improvement in hemodynamics at the cranial base as measured by ultrasonography. 
Osteopathic diagnosis and treatment involves assessment of the whole patient. Patients who have sustained concussions may have multiple areas of somatic dysfunction. There is no single correct technique to perform when treating a patient with a concussion using OMT; however, venous sinus drainage technique may be beneficial. Recent research describing the glymphatic system and evidence that biomarkers for traumatic brain injuries are transported in the glymphatic vessels may indicate a pathway by which OCMM works. More research is needed on how OCMM may facilitate healing and improve symptoms in patients who have sustained a concussion. (doi:10.7556/jaoa.2018.088) 
Acknowledgments
Special thanks to Jeff Reedy for contributions in video production and editing. 
Resources
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OMT Minute: Osteopathic Cranial Manipulative Medicine in the Setting of Concussion
eVideo. Jordan Keys, DO, demonstrates the venous sinus drainage technique to manage concussion symptoms, including headaches, dizziness, sleep disturbances, and difficulty concentrating.