Sports Medicine Research: In the Lab & In the Field: Gridiron Graduation More Painful Based on Injury History (Sports Med Res)
Wednesday, August 2, 2017

Gridiron Graduation More Painful Based on Injury History

Osteoarthritis Prevalence in Retired National Football League Players With a History of Concussion and Lower Extremity Injury

Lynall RC, Pietrosimone B, Kerr ZY, Mauntel TC, Mihalik JC, & Guskiewicz KM. J Athlet Train. 2017; 52(6):518-525.  

Take Home Message: Retired professional football players with a history of multiple concussions and lower extremity injury are more likely to have osteoarthritis compared with players without such history.  Concussion history (without lower extremity injury) is also related to osteoarthritis.

An athlete after a concussion is at high risk for a lower extremity injury, which could then lead to an early-onset of osteoarthritis (OA). No one has investigated whether there is a relationship between concussion and OA.  Hence, the authors of this study investigated health surveys completed by 2,696 retired players from the National Football League (NFL) to examine the associations between physician/diagnosed OA, self-reported concussion history, and self-reported lower extremity injury history.  Approximately 36% of the retired NFL players reported having OA.  A retired athlete with more lower extremity injuries and concussions was more likely to have osteoarthritis than someone without either type of injury.  The presence of OA was ~70% higher among athletes with a history of multiple lower extremity injuries than someone with no history of injury. Similarly, the presence of OA was roughly 40 to 70% higher among athletes with a history of at least one concussion and no history of lower extremity injury. Players that suffered multiple lower extremity injuries and greater than 2 concussions were ~250% more likely to have OA compared with a former player with neither injury.  These relationships were best seen when looking at retired players who were younger than 55 years. 

A retired NFL player with either a history of a concussion or lower extremity injury was more likely to report having OA, especially in their earlier years (<55 years old).  Originally, one would think that the concussions may increase the risk of an injury, which increases the risk of OA. The findings of this study are very interesting because people with concussions but no history of lower extremity injury also had more OA than someone who never had a concussion.  It would have been interesting to see the estimated timing of the injuries (e.g., whether the concussion occurred before the lower extremity injuries) to try to establish risk and opportunities for targeted interventions.  A continuation of this study will also be interesting to see if this trend is still seen with players retiring today because sports cultures have changed.  Athletes seem to be more educated and comfortable reporting injuries (e.g., concussion) to medical personnel rather than the older mindset of “sucking it up.”  I wonder if this is part of the reason the older group (>55) is not seeing as strong of associations.  Professional football is a very unique cohort, with a high prevalence of injuries. It would be interesting to see if these associations were seen in retired players of other sports and from different levels of competition (e.g., college or high school). Regardless, this study is another reminder that clinicians need to be thinking about athlete’s long-term health and wellness after they are done competing. It is important for clinicians to educate athletes about strategies to promote healthy living and help reduce the risk of osteoarthritis as they transition from a competitive athlete to a “regular” physically active non-athlete.

Questions for Discussion:  Why do you think a concussion history would be associated with higher osteoarthritis rates?  What do you think that we should do with these athletes?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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