Sports Medicine Research: In the Lab & In the Field: Multiple Concussions may Lead to Multiple Problems (Sports Med Res)

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Wednesday, May 9, 2018

Multiple Concussions may Lead to Multiple Problems

Association between history of multiple concussion and health outcomes among former college football players: A 15-year follow-up from the NCAA concussion study (1999-2001)

Kerr Z, Thomas LC, Simon JE, McCrea M, and Guskiewicz KM. Am J Sports Med 2018. [Epub Ahead of Print].

Take Home Message: Former collegiate football players reporting 3 concussions were more likely to have worse physical and mental health than individuals reporting fewer concussions.


While many people raise concerns about the long-term consequences of concussions, we know little about the long-term effects of concussions among college football players. Understanding the impact of concussions on long-term health will help clinicians educate patients and develop return-to-play protocols, which can better protect athletes’ long-term health. Therefore, Kerr and colleagues completed a cross-sectional study to examine the relationship between concussions and adverse health outcomes in 204 former NCAA football athletes, 15 years after playing their final collegiate game. The authors identified potential participants from the original NCAA Concussion Study (2905 athletes). They selected former athletes who played at least 1 season of NCAA football between 1999 to 2001 but never played professional football. A total of 204 participants responded to the researcher’s invitation and completed demographic, medical history, injury history, and health history questionnaires. Concussion exposure was self-reported. Participants recorded the number of concussions they believed they sustained before and during their collegiate football career. Participants also completed The Veterans RAND 36 Item Health Survey, Patient Health Questionnaire, and CAGE to assess physical and mental health, depression, and alcohol dependence, respectively. Overall, 44 participants (22%) reported worse physical health than the US average. Former football players who reported 3 or more concussions may be more than twice as likely to have worse physical or mental health compared to those who report one or two concussions. Furthermore, former players reporting ≥ 3 concussions were 4.2 times more likely to report moderate to severe depression. A history of repeated concussion history was unrelated to alcohol dependence.

Overall, the authors demonstrated worse physical and mental health in former football players who reported multiple concussions. These findings should be important to clinicians as it adds to the growing body of evidence that multiple concussions can have a long-term impact on an athlete’s health. This evidence further supports the need for more long-term follow ups and more research to better understand how these concussions were treated and when return to play occurred. Although not the purpose of this study, more detail regarding how these concussions were treated and when participants returned to play was not recorded for this study. This makes it difficult to understand how current treatments and return-to-play protocols impact these long-term outcomes; but, it is a logical next question to ask. Until the research can bridge this gap, clinicians should continue to use best practices with regards to determining return to play and seek the most objective assessment practices possible. Furthermore, clinicians should educate athletes on the potential long-term implications of multiple concussions.

Questions for Discussion: Do you educate your athletes on the potential long-term implications regarding their concussion?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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