Association between concussion and lower extremity injuries in collegiate athletes.

Gilbert FC, Burdette GT, Joyner AB, Llewellyn TA, and Buckley TA. Sports Health. 2016. [Epub Ahead of Print].

Take Home Message: Athletes who reported sustaining a concussion were 1.6 to 2.9 times more likely to have also sustained a lower extremity musculoskeletal injury at the end of their intercollegiate athletic careers.

Despite significant educational and procedural efforts, reporting of concussions and concussive symptoms remains a challenge for clinicians. Underreporting, or delayed reporting of the symptoms may result in a patient prematurely returning to activity or participating in an activity before proper medical attention can be administered. This could result in patients participating with neurological deficits exposing them to further potential injury. To better understand this phenomenon, Gilbert and colleagues, completed a cross-sectional study to examine the relationship between concussion and lower extremity musculoskeletal injury rates. A total of 335 athletes who completed their athletic participation were recruited for the current study. All participants completed a 21-item questionnaire, which assessed the athletes’ concussion injuries (reported and/or unreported) and lower extremity injuries over the course of their career. Overall, a history of concussions was significantly associated with elevated risk of sustaining lower extremity musculoskeletal injuries. Analysis revealed that athletes who had a concussion were 1.6 to 2.9 times more likely to sustain a musculoskeletal injury. The specific injuries significantly associated with a history of concussions were lateral ankle sprains, knee injury, lower extremity muscle strain, and knee injury. These data also differed slightly with regards to if the concussion was reported, unreported or unrecognized.

The data presented in the current study should be of interest to current clinicians. The data presented suggests that concussions may have an impact on the risk of lower extremity musculoskeletal injuries. It should be noted that the current study did not seek to identify causation, as this was not the objective of the researchers. Also interesting was that the current study did not identify the order the injuries occurred. Future researchers should look at this limitation more critically. The data’s significance difference based on whether the concussion was reported, unreported or unrecognized. Perhaps if the order of injuries and the amount of time between injuries could be reported and analyzed more clinical questions could be explored. Until more is reported, the data presented in this study may not be immediately applicable. Understanding how these two injuries are related would be extremely helpful in the development of return to play decision-making tools for patients with concussions. Until this relationship can be better explained, clinicians should continue to implement the most current return to play criteria for any athletes with, or believed to have, a concussion.

Questions for Discussion: Have you anecdotally seen a correlation between concussions and lower extremity musculoskeletal injuries in the same patient? If so, do you feel one injury occurs before the other more often?

Written by: Kyle Harris
Reviewed by: Jane McDevitt

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Gilbert, F., Burdette, G., Joyner, A., Llewellyn, T., & Buckley, T. (2016). Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes Sports Health: A Multidisciplinary Approach, 8 (6), 561-567 DOI: 10.1177/1941738116666509