BACKGROUND: Rehabilitation after sport-related mild traumatic brain injury/concussion requires complex treatment where a contribution of musculoskeletal, in particular cervicogenic, and vestibular systems has to be taken into account. The recommended rehabilitation concept of complete rest until symptom-free has been re-evaluated. Recent reports suggest positive effects of early mobilization and multimodal physiotherapy. Several clinical studies also investigated medical benefits of selected physiotherapeutic hands-on manual techniques. However, recommendations for manual therapeutic techniques as a mandatory part of the post-concussion rehabilitation program have not been made so far. OBJECTIVE: To summarize existing RCTs and to analyse the effectiveness of manualtherapeutic techniques in combination with vestibular rehabilitation on symptom clearance and regaining sporting resilience after sport-related concussion. METHOD: Systematic research in the databases ClinicalTrials.gov, WHO-ICTRP, EBSCO, PubMed and PEDro. Search terms included concussion, physiotherapy, manual therapy and mild traumatic brain injury. RCTs that investigate manual therapeutic techniques after sports-related concussions or mild forms of traumatic brain injury were included. The methodological quality was assessed using PEDro scale. RESULTS: Published results of two RCTs with good and moderate methodological quality (PEDro scale 7 to 8/10 points) and a follow-up study were included. The primary outcome parameter was the time until return to play release. Secondary outcome parameters comprised the time until symptom-free condition, post concussion scale, numeric pain rating scale, balance confidence Scale, Dizziness Handicap Index, Sport Concussion Assessment Tool 2 and Joint Position Error Test. The results of RCTs showed significant differences in favour of the intervention groups. However, included clinical trials have been rather heterogeneous regarding designs, methodology and selected manual techniques, which made their direct comparison difficult. CONCLUSION: Completed clinical trials suggest that manual therapeutic techniques can be beneficial as a part of a multimodal post-concussion rehabilitation program. Due to the small number of RCTs and their heterogeneous study design, it is currently not possible to evaluate the effectiveness or benefit of specific manual therapeutic techniques. Further high-quality studies are required.

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