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Neurological Rehabilitation

Osteopathic Manipulative Treatment for Post-Concussive Symptoms: A Systematic Review of Interventions and Outcomes in Neurological Rehabilitation

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 10

    Primary Author(s)

  • Rachel Yim, Other

    Medical Student
    AT Still University School of Osteopathic Medicine in Arizona
    Lake Orion, Michigan

    • Co-Author(s)

  • PR

    Pedram Razavi, Other

    Medical Student
    AT Still University School of Osteopathic Medicine in Arizona
    Corona, California

  • ZM

    Zaid Mateen, Other

    Medical Student
    AT Still University School of Osteopathic Medicine in Arizona
    Canton, Michigan

  • Tamara Valovich McLeod, PhD, Other (she/her/hers)

    Chair, Department of Athletic Training; Research Professor, School of Osteopathic Medicine in Arizon
    A.T. Still University
    Mesa, Arizona

Disclosure(s):
Rachel Yim, Other: No financial relationships to disclose
Tamara Valovich McLeod, PhD, Other: No financial relationships to disclose
Background and/or Objectives: Despite growing interest in holistic approaches to recovery, the role of osteopathic manipulative treatment (OMT) in concussion management remains underexplored. This systematic review aimed to evaluate the clinical impact of OMT on PPCS, synthesizing evidence from interventional studies to determine its effectiveness in neurological symptom resolution and functional recovery.

Design: Systematic review of prospective cohort studies, RCTs, pilot trials, and retrospective studies evaluating OMT for patients with concussion or PPCS.

Setting : Online search of PubMed, Ovid, EBSCO, Sport Rxiv, Med Rxiv using search terms (“Brain Concussion”, “Osteopathic Manipulative Treatment”, “Post-Concussion Syndrome”, “Pain Management”, “Cognitive Dysfunction”).

Participants : Included studies focused on adult participants aged 18–65 with post-concussive symptoms following concussion or traumatic brain injury in both athletic and non-athletic populations.

Interventions: NA

Main Outcome Measures: Outcomes included changes in symptom severity (via PCSS, HIT-6, VAS), cognitive function (e.g., visual memory, reaction time), sleep quality, headache burden, autonomic measures (e.g., rMSSD), and physiologic parameters (e.g., intracranial pressure [ICP], optic nerve sheath diameter [ONSD]).

Results: Across 9 interventional studies and 4 case series, OMT was consistently associated with symptom improvement. RCTs showed significant reductions in symptom severity following even a single OMT session. Cognitive performance improved in college athletes after 1–2 sessions. In chronic PPCS, cranial and cervical-directed OMT reduced headache scores and improved autonomic markers. A retrospective study demonstrated OMT significantly reduced ICP and CSF output in severe TBI patients. Although some studies were underpowered or lacked between-group significance, outcomes were largely positive and clinically meaningful.

Conclusions: OMT appears to be a promising adjunctive therapy for both acute concussion and persistent post-concussive symptoms, with benefits on headache, cognition, sleep quality, and autonomic regulation. Although these findings support the integration of neurologically focused OMT into multidisciplinary concussion rehabilitation, larger-scale RCTs with standardized outcome measures are needed to define optimal treatment protocols and identify subpopulations most likely to benefit.