Concussion & Cranio-Vertebral Angle
Concussion
It’s estimated that up to 1.8 million kids from the age 0-18 will suffer from a concussion each year.
Up to 400,000 of them will be sports related. 1
A concussion can occur from a direct hit (coup injury) to the head or through a whiplash type motion that causes the brain to bounce off the inside of the skull, called a coup-contrecoup injury.
Concussions are unique for everyone. Some individuals recover quickly with no side effects or long term issues; while other individuals can have one concussion and have their life changed forever.
Cranio-Vertebral Angle Cranio-Vertebral Angle (CVA) is a measure of how far the head has gone forward from the base of the rest of the spine. As the head moves forward the CVA decreases.
How Are Concussion & Cranio-Vertebral Angle Connected
When it comes to concussion establishing a baseline is extremely important for recovery and helping the individual get back to their baseline. With a wider range of baseline tests occurring, associations are coming to light connecting different symptoms with an increased risk of concussion.
To date research has shown individuals with one or more of: neck pain, headache, dizziness, or altered proprioception during the pre-season were at a higher risk for concussion during the season.
How is this related to CVA?
A decreased CVA (forward head posture) is associated with: neck pain, disability, decreased range of motion, change in proprioception, change in balance and headaches.
Many of the symptoms associated with forward head posture are also associated with an increased risk of concussion.
Measuring CVA in the offseason and working with players to help decrease their symptoms and improve their CVA could help decrease the risk of concussion. While no studies have been done yet to see if their is a connection between concussion risk and CVA the research points in that direction.
Next week I’m going to do a detailed look at how forward head posture changes the afferent communication from the body to the brain and how that could explain the associations between concussion and FHP. If you’re wondering what afferent communication is check out our blog post from last week by clicking here.
Concussion Research Snippets
“Male youth athletes reporting neck pain or headache at baseline assessment were at an increased risk of concussion during the season… Dizziness increased the risk of concussive injury 3 fold in Pee Wee athletes…. players reporting any 2 of dizziness, neck pain, and headache had a 3.65 and 2.40 times increased risk of concussion, respectively, during the season.” 2
“ Individuals reporting a headache or neck pain at the start of the season were 1.48 and 1.69 times more likely to suffer a concussion during the season… Individuals reporting any two of dizziness, headache and neck pain were 1.99 times more likely to sustain a concussion.” 3
”…altered proprioception was an independent predictor of in-season head/neck injuries regardless of the history of sports related concussion.” 4
CVA Research Snippets
“A decreased CVA and ROM (range of motion) of cervical flexion, can be predictors of pain.” 5
”…subjects with neck pain had a more forward head posture.” 6
”Patients with small CV angle have a greater forward head posture, and the greater the forward head posture, the greater the disability.” 7
“Subjects with mechanical neck pain exhibited a decreased cervical range of motion, a harder neck tissue status and
greater neck joint position errors than the healthy controls.
…head forward and neck flexion posture reproduced the neck pain severity and reduced the balance control ability of the mechanical neck pain subjects.” 8
“Our study showed that CVA and CMA (cranio-medullary angle) narrowing affects the occurrence of CH (Cervicogenic Headaches). The average CMA and CVA values in CH patients were significantly narrower than those in controls, and there was an inverse relationship between the pain scores and CVA and CMA values.” 9
References
1. Mersine A. Bryan, Ali Rowhani-Rahbar, R. Dawn Comstock, Frederick Rivara and on behalf of the Seattle Sports Concussion Research Collaborative Pediatrics July 2016, 138 (1) e20154635; DOI: https://doi.org/10.1542/peds.2015-4635
2. Schneider, K. J., Meeuwisse, W. H., Kang, J., Schneider, G. M., & Emery, C. A. (2013). Preseason Reports of Neck Pain, Dizziness, and Headache as Risk Factors for Concussion in Male Youth Ice Hockey Players. Clinical Journal of Sport Medicine, 23(4), 267-272. doi:10.1097/jsm.0b013e318281f09f
3. Schneider K, Emery C, Kang J, et al Are pre-season reports of neck pain, dizziness and/or headaches risk factors for concussion in male youth ice hockey players?British Journal of Sports Medicine 2011;45:319-320.
4. Hides, J. A., Smith, M. M., Mendis, M. D., Treleaven, J., Rotstein, A. H., Sexton, C. T., . . . Mccrory, P. (2017). Self-reported Concussion History and Sensorimotor Tests Predict Head/Neck Injuries. Medicine & Science in Sports & Exercise, 49(12), 2385-2393. doi:10.1249/mss.0000000000001372
5. Kim, D., Kim, C., & Son, S. (2018). Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong Public Health and Research Perspectives, 9(6), 309-313. doi:10.24171/j.phrp.2018.9.6.04
6. Lau, K. T., Cheung, K. Y., Chan, K. B., Chan, M. H., Lo, K. Y., & Chiu, T. T. (2010). Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Manual Therapy, 15(5), 457-462. doi:10.1016/j.math.2010.03.009
7. Yip CH, Chiu TT, Poon AT. The relationship between head posture and severity and disability of patients with neck pain. Manual Therapy 2008;13:148e54.
8. Lin, C., Hua, S., Lin, C., Cheng, C., Liao, J., & Lin, C. (2020). Impact of Prolonged Tablet Computer Usage with Head Forward and Neck Flexion Posture on Pain Intensity, Cervical Joint Position Sense and Balance Control in Mechanical Neck Pain Subjects. Journal of Medical and Biological Engineering, 40(3), 372-382. doi:10.1007/s40846-020-00525-8
9. Coban, G., Coven, I., Ciftci, B. E., Yildirim, E., Yazici, A. C., & Horasanli, B. (2013). The importance of craniovertebral and cervicomedullary angles in cervicogenic headache. Diagnostic and Interventional Radiology. doi:10.5152/dir.2013.