Sports Medicine Research: In the Lab & In the Field: Concussed Athletes Face Tough Odds Against Lower Extremity Injuries After Return to Play (Sports Med Res)
Monday, February 15, 2016

Concussed Athletes Face Tough Odds Against Lower Extremity Injuries After Return to Play

Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes

Brooks MA, Peterson K, Biese K, Sanflilippo J, Heiderscheit BC, Bell DR. Am J Sports Med. 2016; ahead of print

Take Home Message: Athletes with a recent concussion are ~2.5 times more likely to sustain a lower extremity injury within 90 days after return to play compared with athletes without a concussion.

Athletes suffering from a concussion may demonstrate cognitive and neuromuscular deficiencies even after an athlete has been cleared to play. However, it is still unclear to what extent these impairments increase the risk for lower extremity injuries. Therefore, the authors reviewed injury data to determine if collegiate athletes are more likely to sustain an acute lower extremity musculoskeletal injury within 90 days after return to play from a concussion. The authors included men and women participating in NCAA Division I football, soccer, hockey, basketball, wrestling, and volleyball from 2011-2012 through 2013-2014. Injury records from the university’s Sports Injury Monitoring System (SIMS) database identified 87eligible concussion cases among 75 athletes (58 men and 17 women, average return-to-play time = 21 days). One hundred and eighty-two control participants (136 males and 46 females) without a history of concussion within the previous year were randomly matched to concussed athletes by sex, sport, position, and game/practice athletic exposure. Athletes within 90 days after a concussion sustained more acute lower extremity injuries (17%) compared with the control group (9%). Recently concussed athletes were 2.5 times more likely to sustain a lower extremity injury compared with controls during the same 90-day period.

The authors determined that concussed athletes are nearly 2.5 times more likely to suffer a lower extremity injury within 90 days after return to play. These findings complement a previous study that indicated that an athlete with a concussion was twice as likely to sustain a lower extremity injury during the first year after a concussion as the year before the concussion. Hence, concussions are not just a transient injury, but result in both acute and chronic consequences. While there are numerous assessments to test the acute changes after a concussion injury, there is no test or set of tests sensitive to the subtle changes that linger in the subacute or chronic stage of a concussion injury. This limits our ability to determine whether it is safe for an athlete to play. Currently, medical professionals lack concussion rehabilitation tools to treat these neuromuscular deficits and the strategies we have are typically instituted when an athlete is still suffering from a protracted concussion recovery and may still be symptomatic. Perhaps, all concussion athletes would benefit from some form of rehabilitation. Until more research explores new strategies to determine concussion return to play, medical professionals should be aware and educate athletes on the possible subclinical problems that may be still occurring, and their risk for lower extremity injuries due to their previous concussive injury.

Questions for Discussion: Are athletes possibly being released too soon? Is the 5-step progression sensitive or functional enough to test if the athlete is ready to return to play? Do you see more lower extremity injuries in athlete’s with a history of concussion?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:

Brooks, M., Peterson, K., Biese, K., Sanfilippo, J., Heiderscheit, B., & Bell, D. (2016). Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes The American Journal of Sports Medicine DOI: 10.1177/0363546515622387


KellyMartinUVA said...

This is an interesting article as it recognizes the potential risks for comorbidity in those affected with concussions. Although the participants may have potentially been predisposed to injury even before being diagnosed with a concussion in the concussion group, the significant difference between the two groups should be taken into account. This just comes to show how much the brain may actually be affected by concussion in terms of efficiently being able to network along the efferent pathway to the lower extremities. I would be interested to see the long term outcomes of concussions (past the 90 days mark), and if that population is still at an increased risk as well. Overall, this was a good read on a compelling hot topic within sports medicine.

ATC_16 said...

There appeared to be fewer differences between the concussed group and the control group than similarities. For instance, the average time from return to play to lower extremity injury was equal between the concussed group and the control group, the histogram of the injuries per week during the follow-up period showed no remarkable patterns, and Table 1 reflected very few differences between the two groups in terms of injury location and type. Additionally, it was acknowledged that one of the limitations of this study was possible discrepancies in exposure to risk between the concussed and control group. I think athlete monitoring through the use of wearable devices could provide more information on the external loads each group faced and how those loads could have contributed to lower extremity injury. The incorporation of wearable devices into a longitudinal study may paint a broader picture of the relationship between concussions and lower extremity injury after return to play.

Jeffrey Driban said...

Kelly, that's a great question. I hope someone is working on that study question.
ATC_16 thanks for the great ideas. Those would help further advances this research. It will be important to see if these findings can be replicated. I think this is an interesting issue that warrants more research so I hope the investigators and others are continuing this line of work.

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