In this episode of Ask Concussion Doc with Dr. Cameron Marshall, DC, we discuss the role of acupuncture in concussion management and manual therapy, the Sport Concussion Assessment Tool – 5th Edition (or SCAT5), and a recent study from the University of Toronto on the potential benefits of early intervention of aerobic exercise following concussion injury.
Acupuncture and Manual Therapy in Concussion Management
Dr. Marshall recently posted a video showing how acupuncture can be used in concussion care – particularly when the issue is determined to be cervical spine-related. Dr. Marshall sometimes uses these techniques as an adjunct to manual therapy. Keep in mind that the approach to management may vary on a case-by-case basis.
In some scenarios, acupuncture is used as a tool to help with treatment protocols, specifically, if a muscle is not responding well to active release therapy and soft tissue work. Acupuncture can be used to help a certain muscle relax, allowing a trained practitioner to potentially achieve better results with manual therapy of the neck (cervical spine).
Sport Concussion Assessment Tool – 5th Edition (SCAT5)
The SCAT5 was developed by the Concussion in Sport Group and included in the international Consensus Statement on Concussion in Sport. The SCAT5 is a standardized tool for assessing concussions designed for use by physicians and licensed healthcare practitioners.
Essentially, the SCAT5 is primarily a sideline tool; however, some healthcare practitioners try to use it as a type of baseline test. Of note, preseason SCAT5 baseline testing can be useful for interpreting post-injury test scores; however, is not required for that purpose. During the episode, Dr. Marshall discusses a number of recent studies that call into question the usefulness of the SCAT5 as a preseason baseline test. He also explains that symptom score is a valuable metric for healthcare practitioners to have due to the significant changes pre- and post-injury.
Dr. Marshall also discusses the value of baseline testing. Although it’s not always a requirement for concussion diagnosis, Complete Concussion Management practitioners generally use these preseason baseline assessments and individual benchmarks for making safer return to play decisions.
CCMI utilizes a comprehensive, multimodal series of cognitive and physicals tests as part of our approach to baseline testing. Using a single test or a small group of tests tend to have issues with test-retest reliability. Using a variety of tests – such as medical history, symptom score, concentration, memory, visual tracking and reaction time, among others – offers more data, objective insights and improved accuracy and reliability versus a single test. This information can help to inform safer return to play decisions. Of note, baseline testing is not recommended for all athletes. Watch the video to determine if baseline testing is right for you.
Exercise Therapy and Concussion Recovery
Dr. Marshall discusses a recent study from the University of Toronto that investigated whether or not early intervention and activation of aerobic exercise following acute concussion can contribute to faster return to play or return to work.
Complete or absolute rest – or rest until symptom resolution – has been shown by numerous studies “to be ineffective and potentially hazardous following concussion and is no longer recommended.” The goal of this particular study was to determine how early a patient could begin active exercise after a concussion.
The study concluded that early aerobic exercise – guided by a licensed healthcare practitioner with training in concussion – was shown to be “safe and protective in improving recovery time following acute concussion.”
How soon a concussion patient should begin exercise following injury should be determined by a trained healthcare practitioner. Also, it’s important that a graded exercise program does not exacerbate or make concussion symptoms worse.
If you are suffering from a concussion, visit a clinic near you for a thorough assessment to determine the most appropriate approach to your recovery.
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 , et al Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016.
 Sport Concussion Assessment Tool – 5th Edition. Br J Sports Med: first published as 10.1136/bjsports-2017-097506SCAT5 on 26 April 2017. Available at: http://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf
 Lawrence DW, Richards D, Comper P, Hutchison MG (2018) Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. PLOS ONE 13(4): e0196062. https://doi.org/10.1371/journal.pone.0196062