Lower Extremity Injury Rates Increase following Concussion in College Athletes

Lynall RC, Mauntel TC, Padua DA, Mihalik JP.
Med Sci Sport Exerc. 2015; ahead of print

Take Home Message: College
athletes are nearly 2 times more likely to sustain an acute lower extremity
injury for up to 1-year post concussion compared with a year before the

control deficits change functional movement patterns during simple gait
activities (for example, increase sway area) following a concussion. These
changes continue well beyond the athlete’s full return-to-play, which is worrisome
because these lingering changes may put the athlete at risk for a lower
extremity injury. However, there is limited research addressing the risk of
lower extremity injury following a concussion. Therefore, the authors
investigated the risk of lower extremity musculoskeletal injury pre and post
concussion in a cohort of 44 Division I athletes within 3 time periods around a
concussion injury (± 90, ± 180, and ± 360 days). The authors also compared
concussed athletes with 58 healthy matched controls. The concussion group had
no previous history of concussion before the concussion that was evaluated in
this study. The control group was matched for sex, sport, competition playing
time, age, height, and weight. Musculoskeletal injury and concussion data were
collected from the institution’s electronic medical record system. Information
about all injuries and illnesses were recorded for 365 days prior to the
concussion of interest and 365 days after return-to-play. Lower extremity musculoskeletal
data (for example, type of injury, location of injury, mechanism of injury,
days out of sport activity due to injury, and days of limited athletic
participation due to injury) were collected for the matched controls for the
same time periods as their matched concussed participant. Athletic-exposure
rates for each athlete were calculated based on the number of days of physical
activity while on a team. There were no differences between groups in regards
to age, height, or weight. An athlete in the concussion group was almost twice
as likely to experience an acute lower musculoskeletal injury following a concussion
than during a similar time interval before the concussion. In contrast, there
were no differences over time in lower extremity musculoskeletal injury rates
within control group. There were also no differences in injury rates between
the concussed and control groups prior to concussion; however, the concussed
group was 65% more likely to have an acute lower extremity injury compared with
the control group for a year after a concussion.

authors demonstrated that college athletes are almost twice as likely to suffer
acute lower extremity injury following a concussion. Additionally, it is
alarming to see that these athletes were at risk for an injury up to 180 and
365-days post injury, which brings up more questions such as “Are we doing
enough to rehabilitate a concussed athlete before returning them to play?” It
is important to note that the concussed athletes only had a greater risk of
injury after the concussion and not when compared with the control group prior
to a concussion. Therefore, it is unlikely that the greater risk of injury is
related to an athlete’s aggressiveness or risk taking on the field. Instead this
increased risk could be attributed to neuromuscular control deficits, which
could change functional movement patterns, and increase an athlete’s risk of
lower extremity injury. However, this study did not directly investigate
possible mechanisms for the increased musculoskeletal rates so more research
needs to be done to validate of these findings. Still, the concussed group may
be susceptible to an injury. Therefore, medical professionals should be aware
of possible neuromuscular deficits that could impair athletic abilities, which
can put their athletes at risk for lower extremity musculoskeletal injuries. Additionally,
we may want to consider implementing functional movement pattern assessments
and rehabilitation before returning an athlete to play even though this may
warrant more research.

Questions for Discussion:
 Do you include any functional movement
pattern in your concussion assessment protocol to determine readiness to return
to play after injury? Should there be a functional movement rehabilitation
following a concussion to potentially decrease risk of lower extremity
injuries? Do you think acute upper extremity injury rates post concussion would
also be affected?

by: Jane McDevitt, PhD
by: Jeff Driban


Lynall RC, Mauntel TC, Padua DA, & Mihalik JP (2015). Acute Lower Extremity Injury Rates Increase following Concussion in College Athletes. Medicine and Science in Sports and Exercise PMID: 26057941