Concussion Treatment Case Report
© Ting Lung LAc 2020
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Abstract
This case report describes a patient with a history of multiple concussions over several years, presenting to our outpatient clinic for acupuncture treatment following his most recent injury. Previously, the patient required 2-3 months to achieve full recovery. However, after two acupuncture sessions, he achieved normal cognitive function and was free of physical symptoms within two weeks. This case report suggests that acupuncture may be a potential alternative or adjunctive treatment option for concussions, warranting further research.
Introduction
The present study highlights the challenge of managing concussions in youth athletes, with an overall incidence rate of 12.1% reported by Tsushima et al. For students, the need to rest without further cognitive demands presents significant difficulties in completing school work.
“The overall incidence of concussion among youth athletes was 1,250 (12.1%). The relative risk for a concussion was almost two times greater in 18-year olds than in 13-year-old athletes. In comparable sports, girls had a 1.5 times higher concussion risk than boys. Athletes with a prior concussion had 3-5 times greater risk to sustain a concussion than those with no history of a concussion. Among varied sports, wrestling and martial arts had the highest relative risk of a concussion, followed by cheerleading, football, and track and field. No differences in concussion risks were found among the football players in different positions.” (Tsushima, et al)
Participants in high contact sports, older youth athletes, females, and those with a history of concussion are widely recognized as having an increased risk of sustaining a concussion. The patient described in this case report is a 14-year-old male wrestler with a history of multiple concussions.
Case
The patient and his father presented to the office two weeks after the patient's latest injury, resulting from landing on his head following a throw during wrestling. The patient had a history of previous concussions that typically resulted in physical symptoms, cognitive and emotional changes, and sleep disturbances lasting several months.
Following the SCAT2 assessment tool, the patient was diagnosed with a mild concussion, presenting with symptoms including headache, light sensitivity, foggy thoughts, difficulty with memory and concentration, irritability, and disrupted sleep. As each component of the SCAT assessment is independently scored, subsequent follow-up sessions were focused solely on the components where the patient presented with symptoms.
The acupuncture treatment plan for the patient aimed to increase blood flow to the brain and subtly adjust tension in the tentorium cerebelli and the falx cerebri. This approach was based on acupuncture channels and aimed to enhance blood and nutrient supply to the brain while promoting homeostasis of the fascia within the skull. Previous research by Ratmansky et al. has demonstrated the effects of acupuncture on cerebral blood flow.
The treatment outcome exceeded expectations, with the patient seeing the practitioner twice with a one-week interval between treatments. Following the treatment, the patient's father reported that his son was completely symptom-free and no further treatment was necessary. This was confirmed by reassessment using the SCAT2 test in the areas where the patient showed symptoms. The father expressed his appreciation by sharing his positive experience with anyone on his son's wrestling team who was willing to listen, highlighting the effectiveness of the treatment.
Discussion
Concussion is a significant challenge for youth athletes, as it can impede their ability to continue with sports and school. The conventional approach for concussion management involves rest and avoidance of physical and cognitive activity. While other therapies, such as hyperbaric oxygen therapy, have been employed, they are often impractical and yield minimal benefits. In contrast, acupuncture has demonstrated the capacity to increase cerebral blood flow and modulate intracranial fascial tension, thereby providing gentle stimulation to the brain. It is important to note that concussion syndrome is not primarily a condition of hypoxia, but rather a result of the mechanical forces causing a "shaken brain" syndrome. Therefore, increasing oxygen supply to the brain is not effective, as the brain is not oxygen-deprived to begin with. By altering the tension of fascia, which is comparable to healing any injury, there is an associated increase in blood flow and facilitated recovery.
The acupuncture channels known to reach the cerebrum include Bladder (BL), Gallbladder (GB), Triple Burner (SJ), Liver (LR), and Stomach (ST). Other channels that reach the brain include yin and yang qiao, yin and yang wei, and Ren and Du. Within the primary channels, it can be noted that all foot yang channels reach the brain, along with their complementary arm counterparts, by extension (such as Large Intestine - Stomach as part of Yang Ming), if viewed as paired channels.
Additionally, the complementary channels of yin-yang pairing, namely the Bladder and Kidney channels, are known to reach the brain via divergent channels. It should be noted that all divergent channels except for the Large Intestine channel lead to the head. Thus, applying stimulation to a Kidney point can have an impact on the Bladder channel which extends over the head from the base of the occiput to the inner canthus. Moreover, Kidney points are linked to the yin wei and yin qiao meridians, which both enter the brain.
To enhance blood flow to the brain, attention should be paid to the major arteries located in the neck, specifically the front (ST channel) and back (BL channel) regions that lead into the calvarium. These arteries are the carotid and basilar arteries (via the vertebral arteries), respectively. As long as there are no underlying conditions such as hemorrhage or infarction within the brain, augmenting blood flow into the brain through the neck is considered safe. Additionally, as the affected region of the brain cannot be precisely determined, a global approach to treating the brain is recommended.
Point selection
The cornerstone of treatment involves the primary channels that reach the brain. To target the BL channel, acupuncture points along the SI and K channels can be utilized. Similarly, points along SJ and LR are used to address the GB channel, while PC and GB points are effective for treating the LR channel.
GB37, a luo point, covers the GB and LR channels and extends to the SJ channel. This region spans from GB20 on the occipital bone to the parietal, temporal, sphenoid, and frontal bones through the GB channel. The SJ channel covers similar areas around the temporal bone, passing through the sphenoid bone to the lateral side of the orbit. The LR channel, on the other hand, extends to the vertex via the face.
LI4 is effective in targeting the LR channel and the Yang Ming region of the frontal bone.
K2 covers the BL channel, extending from the occipital to the frontal bones.
Conclusion
This case report suggests that acupuncture may be a potential alternative or adjunctive treatment option for concussions, warranting further research. The conventional approach for concussion management involves rest and avoidance of physical and cognitive activity. While other therapies, such as hyperbaric oxygen therapy, have been employed, they are often impractical and yield minimal benefits. In contrast, acupuncture has demonstrated the capacity to increase cerebral blood flow and modulate intracranial fascial tension, thereby providing an effective chance for the brain to heal itself.
Although the management of concussion with acupuncture in youth athletes has demonstrated encouraging outcomes, the presentation of traumatic brain injury in adult populations differs and necessitates additional investigation.