Getting Back in the Fight: A Systematic Review of Osteopathic Manipulative Treatment for Concussion and Mild Traumatic Brain Injury–Related Symptoms in Military Personnel and Athletes

Moultrie, GA

Background: Concussion and mild traumatic brain injury (mTBI) are common among athletes and military service members and may result in persistent post-concussive symptoms, including headache, dizziness, sleep disturbance, and cognitive impairment. Current management strategies are largely supportive, and effective non-pharmacologic adjunctive therapies remain limited. Osteopathic manipulative treatment (OMT) has been proposed as a potential intervention to address somatic dysfunction and altered neurologic and fluid dynamics following concussion and mTBI.

Objective: To systematically review the clinical literature evaluating the effects and safety of osteopathic manipulative treatment in patients with concussion, mTBI, or post-concussion syndrome.

Methods: A systematic literature search identified peer-reviewed human studies evaluating OMT as an intervention for concussion, mTBI, post-concussion syndrome, or traumatic brain injury–related sequelae. Studies reporting clinical or physiologic outcomes following OMT were included, while review articles and non-osteopathic manual therapies were excluded. Eleven studies met inclusion criteria and were qualitatively synthesized.

Results: Included studies comprised randomized controlled trials, randomized pilot studies, observational studies, and case reports involving athletic, civilian, and hospitalized trauma populations. Across concussion-specific studies, OMT was associated with reductions in overall symptom burden, headache severity, and neurocognitive impairments, including improvements in visual memory and reaction time. Pilot and observational studies demonstrated mixed but generally favorable effects on sleep quality and post-concussive symptoms. Studies involving patients with severe traumatic brain injury suggested that gentle OMT could be safely administered in acute inpatient settings and was associated with improvements in intracranial pressure–related physiologic measures. No serious adverse events related to OMT were reported.

Conclusion: Evidence suggests that OMT may be a safe and potentially beneficial adjunctive therapy in the management of concussion and TBI-related symptoms. Definitive conclusions are limited by heterogeneity in study design, outcome measures, and sample sizes. Further large-scale, controlled trials, particularly in military and athletic populations, are warranted to clarify the role of OMT in concussion recovery and return-to-duty or return-to-play outcomes. Such efforts align with the mission of the U.S. Army Medical Corps, “To Conserve Fighting Strength.”