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