Integrated Diagnosis and Management of Spine Pain and Concussion in Trauma Patients: A Comprehensive Approach
By William Owens, DC, DAAMLP
Spine pain and concussion often occur simultaneously in trauma patients, especially among military personnel, veterans, and individuals involved in vehicular accidents. The relationship between these conditions is intricate, necessitating a detailed and nuanced approach to diagnosis and management.
Concussions, or mild traumatic brain injuries (TBI), often arise concurrently with spinal injuries because of the intense forces exerted on the body during traumatic incidents. These forces may cause brain movement within the skull, leading to concussions while simultaneously affecting the spinal structure and function, thereby complicating the clinical scenario and requiring an integrated diagnostic and therapeutic strategy.
The diagnostic journey begins with patient surveys like the Rivermead Post-Concussion Symptoms Questionnaire, a critical tool for gauging the subjective symptoms the patient experiences, such as cognitive difficulties, headaches, and dizziness. These symptoms are prevalent after a concussion but can also overlap with or be exacerbated by spinal injuries, highlighting the need for a comprehensive evaluation to discern their origins and impacts on patient well-being.
A detailed physical examination follows the survey, focusing on the neurological and musculoskeletal systems. This step is essential for identifying concussion indicators, including coordination and balance issues, and for assessing spinal health, looking for tenderness, movement restriction, and alignment discrepancies. This examination helps localize the specific body regions affected by the trauma.
Bloodwork is another cornerstone of the diagnostic process, leveraging biomarkers such as UCH-L1, GFAP, and MTHFR to shed light on brain injury severity and potential genetic factors affecting recovery. Elevated UCH-L1 and GFAP levels suggest neuronal damage indicative of a concussion, while MTHFR gene variations can influence the body’s folate metabolism and have been associated with various health conditions, including increased susceptibility to brain and spinal injuries.
Advanced neuroimaging, through MRI and CT scans, provides a detailed view of the brain and spine, revealing structural changes and abnormalities. These imaging modalities are indispensable for accurately diagnosing and developing a focused treatment strategy, as they allow clinicians to visualize internal changes, including soft tissue, bone, and nerve pathologies.
In spine management, the emphasis is on the integrated structural and functional health of the spine, which is vital for accurately diagnosing and managing spine pain and concussion. This specialty acknowledges the spine’s connection to the nervous system, understanding that damage to either can affect the other.
For instance, spinal misalignment can impair nerve function, potentially intensifying neurological symptoms linked to a concussion. Spine management experts utilize a holistic approach, combining information from surveys, physical exams, blood tests, and neuroimaging to form a complete view of the patient’s health. This comprehensive analysis ensures that the direct symptoms and underlying causes of spine pain and concussion are thoroughly addressed.
The management of patients with concurrent spine pain and concussion is inherently multidisciplinary, requiring personalized treatment plans that may include physical therapy, chiropractic interventions, medications, and cognitive rehabilitation. These plans aim to reduce pain, improve functional capacity, and enhance life quality.
In conclusion, the intricate link between spine pain and concussion in trauma patients requires an extensive, methodical approach to ensure accurate diagnosis and effective treatment. Beginning with patient surveys and progressing through physical exams, blood tests, and advanced imaging, medical professionals can gain a deep understanding of the conditions. A focus on spine management, emphasizing the structural and functional integrity of the spine, is crucial when diagnosing and treating these interconnected health issues, facilitating a comprehensive-care approach that targets symptom relief and underlying causes.
About the Author
Dr. William Owens Jr. is currently CE of National Spine Management Group, an evidence-based clinical education company with locations in Buffalo, New York, and Lehi, Utah. Dr. Owens is the clinical director of a fellowship in spinal biomechanics and trauma, as well as a residency program in spine management. He is in private practice in Buffalo, New York, and his practice employs four doctors of chiropractic and three doctors of physical therapy. Additionally, Dr. Owens holds faculty positions in the Department of Family Medicine at the University of Buffalo Jacobs School of Medicine and Cleveland University Kansas City College of Chiropractic.
