Concussion Increases Odds of Sustaining a Lower Extremity
Musculoskeletal Injury After Return to Play Among Collegiate Athletes
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
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.
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.
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.
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?
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
by: Jane McDevitt, PhD
Reviewed
by: Jeff Driban
by: Jeff Driban
Related
Posts:
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
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.
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.
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.