A Review of Combined Cervical Manual Therapy and Vestibulo-Oculomotor Exercises for Athletes with Post-Concussive Cervicogenic Symptoms
Hussnain Shakeel
Co-Presenters: Sam Mauri Mallari, Kyle Tufaro
College: College of Health Professions and Human Services
Major: DPT.PHYSTHERAPY
Faculty Research Mentor: Tucker, Jenna Lee, John
Abstract:
Persistent post-concussive symptoms (PPCS) are common among athletes and can significantly delay recovery after sports-related concussion. Cervicogenic dysfunction can be an overlooked contributor to PPCS and may present as neck pain, dizziness and headaches. Because cervical musculoskeletal impairments can negatively impact vestibular and visual systems, an integrated treatment approach may be necessary to optimize recovery. This study aims to synthesize existing evidence on the combined use of cervical manual therapy and vestibulo-oculomotor exercises to improve symptom resolution and accelerate return to sport in athletes with PPCS.We searched PubMed and CINAHL for Level I-II evidence published between 2014 and 2025. Search terms included: “sport-related concussion,” “cervical manual therapy,” and “vestibulo-oculomotor.” Studies were excluded if they involved non-athlete participants, patients in the acute phase of concussion, or investigated a single modality.Of 2,454 articles screened, four met inclusion criteria, including two systematic reviews, one randomized controlled trial, and one international consensus statement. The collective evidence demonstrated that multimodal cervico-vestibular rehabilitation resulted in reduced symptom duration, improved cervical and vestibular function, and a shorter time to medical clearance for return to sport compared to standard care or rest alone.Findings support active, multimodal rehabilitation should be prioritized over passive intervention, reinforcing the critical role of physical therapists in expediting recovery, reducing symptom burden and facilitating safe return to sport. Future research is indicated to refine multimodal concussion treatment protocols, including optimal dosing, to maximize outcomes for athletes with post-concussive cervicogenic symptoms.Keywords: Post-Concussion Syndrome, Cervicogenic Pain, Vestibular Rehabilitation, Manual Therapy, Sport-Related Concussion