Cervical Range of Motion and Pericranial Muscle Tenderness in Patients With Persistent Post-Concussion Symptoms: A Cross-Sectional Study

OBJECTIVES: To examine the active cervical range of motion (aCROM) in 15- to 30-year-old patients with high levels of persistent post-concussion symptoms (PCS) 2-6 months after a mild traumatic brain injury (mTBI) compared with healthy individuals. Additionally, we examined the association between aCROM, the severity of PCS (measured by the Rivermead Post-Concussion Symptom Questionnaire [RPQ]), and the pericranial tenderness score (pTTS). SETTING: A research outpatient clinic at a rehabilitation hospital in the Central Denmark Region. Patients were recruited by referral from general practitioners or emergency departments. PARTICIPANTS: Young individuals (aged 15-30 years) with high levels of PCS (n = 108) within 2-6 months after a direct head trauma. Reference data of aCROM was obtained from a published study conducted on healthy individuals (n = 100) (aged 20-29 years). DESIGN: Cross-sectional study using baseline data from a randomized controlled trial examining the effect of a non-pharmacological intervention for PCS. MAIN OUTCOME MEASURES: aCROM measured using a CROM 3 device, pTTS, and RPQ-score. RESULTS: Patients with PCS had a 5% lower mean total aCROM compared with a published reference mean on healthy individuals (mean group difference [95% confidence interval] = -19°[-31; -7.0], P = .002). The reduction in aCROM was primarily driven by a subset of individuals (n = 12). A significant negative correlation was found between total pTTS and total aCROM ( ρ = -.43, P < .001). There was no significant correlation between the RPQ score and the total aCROM (r = -0.12, P = .214). CONCLUSION: The findings indicate that concomitant cervical impairment may exist in a subset of patients with PCS. A clinical implication could be to include systematic neck examination in patients with mTBI to ensure accurate diagnosis. However, further research is necessary before implementing this information into regular clinical practice.