Student athletes from New York Institute of Technology (NYIT) and Long Island University (LIU) who presented to the NYIT Sports Medicine Program with a concussion between November 24, 2015, and January 30, 2018, and who were evaluated by either a family medicine physician (H.Z.) or neurologist were eligible to participate in the study. After a diagnosis of concussion was made, the physician asked the patient if he or she wanted to participate in the study. The NYIT institutional review board approved this study. 

Patients were excluded if they had previous diagnoses of concussions, neurodegenerative conditions, spinal cord injuries, seizures, intractable vomiting, paralysis, or any absolute contraindications to OMT at the time of the inciting injury. 

Eligible, consenting patients completed ImPACT during the first visit (postconcussion); they also consented to providing their preparticipation sports physical (baseline) ImPACT scores. Patients provided a history describing the concussion and past medical information. They answered a questionnaire, which included demographics, date of concussion, and mechanism and force vector. Patients receiving OMT were examined while lying supine by 1 (or 2, when feasible) of 4 physicians (P.S.K., R.A.S., J.D.M. and S.C.Y.) board-certified in neuromusculoskeletal medicine and osteopathic manipulative medicine. The vault hold was used to determine the most predominant SBS somatic dysfunction. Outcome measures were differences in ImPACT scores from baseline to postconcussion. 

Normative ImPACT data ranges for above-average, average, and below-average for each category (visual memory, verbal memory, processing speed, and reaction time) were used to determine whether patients had a new-onset impairment compared with their pre-ImPACT scores.⁵ Nominal values for SBS somatic dysfunction patterns and nonphysiologic or physiologic parameters were compared with the directions of impact for correlations, as well as with the presence of new-onset impairment in ImPACT scores. The directions of impact included front of head, back of head, left and right sides of face, and left and right temporal forces. Φ correlation coefficients were computed for correlations between categorical binary variables, and point-biserial correlation coefficients were computed for the correlations with age using SPSS version 24.0 (IBM), with P<.05, demonstrating statistical significance. 

Of 55 patients who presented with a head injury, 22 were not eligible or declined to participate. Of those who consented to participate, concussion was diagnosed in 16 participants. Patient ages ranged from 18 to 26 years. The study included 10 men (62.5%) and 6 women (37.5%). On physical examination, 11 patients (69%) had nonphysiologic SBS somatic dysfunctions, 9 of which were lateral somatic dysfunctions. Patients were 1.67 times more likely to have a nonphysiologic SBS cranial somatic dysfunction (P=.442). New-onset impairment (below average) from pre- to postconcussion ImPACT scores was found in 3 physiologic (60%) and 8 nonphysiologic (73%) somatic dysfunctions (Table 1). Those with nonphysiologic somatic dysfunctions had new-onset impairments in a mean of 2.13 out of the 4 ImPACT categories, compared with 1.2 in physiologic somatic dysfunctions. Mean changes for verbal memory in physiologic somatic dysfunctions were 22 points worse for right torsions than SBRs. Mean changes in category scales were not significant. Visual memory score changes were −4.2 for physiologic and −21 for nonphysiologic somatic dysfunctions (P=.237). Mean changes for processing speed were −4.17 for physiologic and −7.25 for nonphysiologic strains. Mean changes for reaction time were 0.01 for physiologic and −0.11 for nonphysiologic somatic dysfunctions (P=.162). There were a total of 5 physiologic cranial somatic dysfunctions, 3 SBR somatic dysfunctions, and 2 torsion somatic dysfunctions. Of samples with the same direction of impact, impact onto the back of the head (n=4) was correlated with vertical SBS somatic dysfunctions (Φ correlation coefficient=.655; n=2; P=.006) and negatively correlated with strains around the vertical axis (Φ correlation coefficient=−.667; n=12; P=.005). Otherwise, concussive impacts to similar parts of the head (n<3) were not substantial within the limited sample size (Table 2). 

Comparing the ImPACT scores before and after concussion demonstrated new cognitive impairments, likely resulting from the concussion. The nonphysiologic somatic dysfunctions were 80% lateral strains, where the sphenoid and occiput rotated in the same direction around parallel vertical axes. There were more new-onset cognitive impairments in patients with lateral and nonphysiologic somatic dysfunctions than physiologic somatic dysfunctions. 

The results did not show statistical significance; however, a 69% prevalence of nonphysiologic SBS somatic dysfunctions was observed in patients. No statistically significant difference was found when comparing the vector of impact with the type or direction of cranial somatic dysfunction diagnosed after concussion. However, nonphysiologic SBS somatic dysfunctions were seen more often with anterior-posterior vectors of impact than with left-right forces. 

Although the exact vector of impact forces may help explain the mechanism of injury, 1 limitation is that the variability within our small sample size was too great to characterize consistent somatic dysfunction patterns. Impact to the forehead (n=5) negatively correlated with female gender (Φ correlation coefficient=−0.522; n=6; P=.038), which may have been coincidence or related to a specific sport. Expanding the sample size in future studies may lead to more conclusive results and consistency among diagnoses. 

A second limitation is that this population could have had other traumatic forces from previous injuries, leading to nonphysiologic cranial somatic dysfunctions.^17,18 Treating patients with nonphysiologic cranial somatic dysfunctions after concussion could potentially decrease the severity of symptoms, although future studies that include documenting SBS somatic dysfunctions during the preseason sports physical are necessary. The subjects in another study by our author group demonstrated immediate improvement of concussion symptoms severity after OMT to address somatic dysfunctions throughout the body and not just the cranium.¹⁹ Further studies are needed to establish presence of cranial somatic dysfunctions and severity before and after concussions and the efficacy of OMM treatment. Timely diagnosis and treatment of cranial somatic dysfunctions in patients with concussion may beneficially augment clinical outcomes.²⁰ 

A third limitation is that only mild concussion in college athletes was studied. Recruitment of additional participants or inclusion of more chronic and severe concussions from a wider variety of traumatic events could show more compressions and other nonphysiologic somatic dysfunctions. In addition, only 1 of the 4 physicians performed the SBS examination on a given patient, limiting the study reliability. More physicians and patients could lead to more conclusive results. 

Concussions are a common occurrence in college athletes, and treatment options are limited. Integration of OMT to treat cranial somatic dysfunctions can potentially help manage postconcussion symptoms. Although this study was limited by a small sample size, it demonstrated a potential increase in nonphysiologic SBS somatic dysfunctions and in new-onset cognitive impairments in those with nonphysiologic somatic dysfunctions. Additional studies investigating pre- and postconcussion cranial somatic dysfunctions will improve future integration of OMT into the treatment of patients with concussion. Future studies should also examine the relationships between sport type, vector force, ImPACT scores, and resulting cranial somatic dysfunctions. 

All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.