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

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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