Concussion Management using a Structural Nasal Release Technique
Product Details
Live Zoom session
17th July 2020
6 pm London time
Who can attend . Physiotherapists, chiropractors, Osteopath, Medical Doctors.
Tutor : Dr Cynthia Stien
In this 90 minutes interactive session Dr Cynthia Stein will introduce her clinical experience in concussion management using a structural nasal release technique. Dr Cynthia has been active in teaching this successful technique in the US and internationally to Physiotherapists, chiropractors, osteopath and medical doctors. visit conquer concussion website
Upon the attendance of this session Dr Cynthia will deliver a 5 hours session for limited number of clinicians where one to one training will be provided on using the technique to qualify as a practitioner in managing concussion using nasal release technique. Date of this course to be confirmed soon.
What is Nasal release technique :
Statistics have shown that 15-20 % of all concussed patients continued to suffer chronic symptoms following concussion despite having treatment. The evidence based standard of care for physical therapy management of concussion involves evaluation, eye exercises, balance training and exertion training. This lecture will talk about the rationale behind structural techniques which help to release force from the skull and assist the heads fluid movement. The techniques discussed will be craniosacral therapy, lymphatic drainage therapy, myofascial release and nasal release technique. This talk will be a prelude to training in Nasal Release Technique with how it releases the deep sutures of the skull thereby assisting in better eye tracking, and reduction of symptoms.
When a concussive force goes into the head, structural changes occur in the brain. Dr Bennett Omalu was the first pathologist to discover that concussion leads to metabolic changes in the brain. It makes sense that when an impaction force goes into the head it affects the sutural movement in the bones of the skull. This trauma then affects the fluid movement to the brain. It was always believed in osteopathic thought that the cerebrospinal fluid was the clearing mechanism in the brain. In June of 2015, lymphatic vessels were discovered by high resolution imagery. When the brain is traumatized by a concussion, the brain has difficulty clearing the metabolic response to the injury. This why the protein lays down in the brain.
There are structural techniques that can address this problem. and restore this fluid movement. This class will introduce Nasal Release Technique. This is a structural procedure that uses a blood pressure bulb with a finger cot attached to it. It is inserted between the spaces of the turbinates and inflated. This releases the sutures of the skull mechanically through the pressure of the inflation. Following this, patients who have not responded to standard vestibular care see reduction or elimination of symptoms.
CASE REPORT
A 21year old male presented to Conquer Concussion complaining of post-concussion symptoms dating back to July of 2009. The patient was a catcher on the high school baseball team. He was hit in the head by a baseball suffering a Grade III concussion with loss of consciousness. He wore braces at the time, and previously sustained other blows to the head without loss of consciousness. Following the baseball injury, his symptoms were so severe that he was unable to return to school for two months. At six months, he was cleared to resume full activity. Around this time, his braces were removed. Consequently, significant symptoms returned including disabling migraines, fatigue, irritability, fogginess, nausea, significant weight loss, neck, shoulder, and TMJ pain, trigeminal neuralgia, syncope, inability to chew, burning behind the eyes, sensitivity to light, and cognitive difficulties, including inability to focus, comprehension, memory,and recall. As a result of these symptoms, he was unable to return to school for the rest of the year. Prior to the concussion, this patient’s past medical history was unremarkable. At the time of initial trauma, the treatment included bed rest, avoidance of activity, and a prescription of amitriptyline for pain. The patient reported that the symptoms did not change with this course of treatment.
In 2010, he saw a neuromuscular dentist who began splint therapy to realign his jaw. This continued over the next six years with multiple splint adjustments and braces. While the treatment decreased the shoulder and neck pain, his headaches, lethargy, and cognitive problems continued. At this time the recommendation of dental surgery was made. During this timeframe he fell and hit his head. Additional therapies were tried including vestibular therapy, chiropractic, craniosacral therapy, lymph drainage therapy, vision therapy, trigger point therapy, hyperbaric oxygen therapy, and acupuncture. Unfortunately the patient reported that none of these treatments eliminated his symptoms. On exam, he had trigger point tenderness in his suboccipital, levator scapula, rhomboid, trapezius, temporalis, masseter,
sternocleidomastoid, pterygoid, and scalene muscles. His neck and shoulder range of motion was within normal limits.
In treating him, it was decided that he might benefit from the use of NRT. The first treatment was performed using a one finger cot and one inflation. The patient reported that the procedure was temporarily painful, stating he experienced multiple pops and cracks. He did report following the treatment that he could breathe more easily. The patient was seen once a week for 8 weeks for 8 total visits. Since the treatment was no longer painful, the therapist was able to progress the treatment to four cots and five inflations. During the treatment, the patient stated that he continued to feel movement in his head. In conjunction with the NRT, the treatment was followed by craniosacral therapy and lymph drainage therapy.
After eight treatments over a two-month period, the patient reported that his headaches and head pressure disappeared, he had a noticeable elevation in his mood, and an improvement in his ability to handle life stresses. He is still experiencing some cognitive difficulties, but is able to attend college with a lessened academic workload. He reports he has remained headache and pain free for two years.
DISCUSSION
The American Physical Therapy Association’s position on concussion management is that physical therapists are among the health care professionals qualified to be a part of a multidisciplinary team(9). Presently vestibular physical therapy includes testing, eye and balance exercises and exertion training. This case demonstrates a relatively new manual/structural technique, NRT, for treatment of post-concussion symptoms. To date, no research or clinical studies have been done by physical therapists to validate this technique.
The radiological study done by Oleski, Smith, and Crow demonstrated evidence that there is movement in the bones of the skull following a concussion(10). One might conclude from this that concussive forces can indeed alter the cranial bones. In this particular case report, previous conventional and alternative treatments had only provided short-term beneficial effects. The question is then, why did this technique eliminate the symptoms? Perhaps wearing braces at the time of the concussion locked the force in his head. Was it that NRT releasedt this force from the cranial bones? This author tried craniosacral and lymphatic drainage therapy in previous treatment sessions with minimal symptom relief. The patient stated he felt the immediate release of pressure from his head with the NRT. Because of this statement, one might theorize that it was the NRT that led to this pressure and symptom relief. It could be deduced that craniosacral and lymphatic drainage therapy assisted in the maintenance of the loss of symptoms. Another theory based on cranial osteopathy is that restoring “normal” cranial motion enhances the function of the brain. Berman, Frymann, and Sutherland have stated that abnormal cranial motion and function are related to brain pathophysiology. There is radiographic evidence that the cranial bones move subtly so with the cessation of symptoms after NRT, one might theorize that the procedure restores motion to the cranium(11,12,13).
Osteopaths suggest that the noises and clicking patients report during the procedure are due to the movement of the cranial bones. If cranial bones are affected by a blow to the head, it stands to reason the cessation of symptoms from the procedure are due to the restoration of the movement of these bones. With movement restored, the cerebrospinal, arterial, venous and lymphatic fluid movements can adequately nourish the brain, reversing the metabolic effects of the concussion and thus eliminating the symptoms.
CONCLUSION
While this case study demonstrated relief of long term concussion symptoms with NRT which had not happened with just craniosacral or lymphatic drainage therapy, one might conclude that it was the NRT that cleared the symptoms. No objective data was gathered and no outcomes data reporting system was used. This author has treated numerous long-term concussion clients with a variety of techniques. Since initiating the use of NRT more clients have reported the lessening/elimination of symptoms. Further study is needed to determine the efficacy of Nasal Release Technique for Post-Concussion Syndrome. Presently there are eye-tracking devices that can assist in this research.
ACKNOWLEGEMENTS:
The author of this case study wishes to thank Dr. Rod Jackson for introducing this work to her and Dr. Rik Cedarstrom for teaching her the technique. The author would also like to thank
Annamarie LaCava for her help in researching this topic and Gail Freidhoff-Bohman, PT, MA.T,
Board Certified Sports Clinical Specialist, AT- Ret. for her editorial comments
REFERENCES
1. US Dept of Health and Human Service centers for Disease Control and Prevention.
