Prevalence in Retired National Football League Players With a History of
Concussion and Lower Extremity Injury
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.
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?
Nicole Cattano
by: Jeffrey Driban