Objective: The purpose of this case series is to present the clinical assessment and diagnosis of postural orthostatic tachycardia syndrome (POTS) in three elite, professional athletes with persistent post-concussive symptoms (PPCS), and to describe and discuss the outcomes of an individualised and targeted, multi-system management approach provided by a chiropractor. Clinical Features: Three male elite, professional athletes, aged from 26 to 29 years old (mean age, 27.7 years), presented with PPCS which remained refractory to typical interventions. A clinical diagnosis of POTS, exertional intolerance, vestibulo-oculomotor dysfunction, motor coordination impairments, as well as cervical spine musculoskeletal impairments was made through synthesis of the patient history and detailed multi-system clinical assessment. Intervention and Outcome: Treatment addressed the specific dysfunctions and impairments identified on assessment in a hierarchical manner. The multi-system treatment and management approach for each patient was individualised, and first targeted and addressed the POTS and autonomic nervous system (ANS) dysfunction identified on clinical assessment. All three patients demonstrated significant decreases in PPCS symptoms and changes in mental health, as measured by the Post-Concussion Symptom Scale (PCSS), Rivermead Post-concussion Symptoms Questionnaire (RPQ) and 9-Item Patient Health Questionnaire (PHQ-9). All three patients had improvements in orthostatic vital signs, Infrared Video Goggle assessment, vestibulo-oculomotor assessment (including quantitative eye tracking technology), and motor coordination assessments (including balance via quantitative force plate technology). Conclusion: Three elite, professional athletes with PPCS which remained refractory to typical treatment, had quantitative subjective and objective improvements in symptoms and function following individualised, multi-system management that first targeted and addressed the POTS and ANS dysfunction identified on clinical assessment. Further research involving larger randomized controlled and clinical trials with long-term follow up are both required and warranted to clarify the effectiveness of a POTS and ANS hierarchically targeted, multi-system treatment approach in the management of PPCS.
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