Preseason Reports of Neck Pain, Dizziness, and Headache as Risk Factors for Concussion in Male Youth Ice Hockey Players
https://www.ncbi.nlm.nih.gov/pubmed/23391986
Take Home Message: Preseason neck pain and headache may be predictors for in season concussion among male youth hockey players.
Over the last few years, concussion has become one of the most common injuries among youth hockey players. Athletes have reported preseason neck pain, headache, and dizziness in recent concussion research, but it remains unclear if these symptoms predict who may be at risk for concussion. Consequently, in this prospective cohort study, Schneider et al. sought to determine the risk of concussion among youth male hockey players with and without preseason complaints of neck pain, headaches, or dizziness. The authors stratified 3832 Canadian male youth hockey players into 2 groups based on skill level (body checking versus no body checking) and age (11 to 12 year olds and 13 to 14 years olds) and then observed the players over the course of 2 years using an injury surveillance system. Athletes were excluded from the analysis if they were female, did not complete their initial baseline questionnaire or Sport Concussion Assessment Tool (SCAT), had a history of concussion, or a history of injury/chronic illness that prevented full participation in ice hockey. Preseason measurements of dizziness, neck pain, and headache on the preseason SCAT were then analyzed against diagnosis of an in-season concussion. A total of 175 concussions occurred during the observation period. Preseason headache and neck pain were found to be risk factors for a concussion among all subsets of athletes. Dizziness was a risk factor only among the 11 to 12 year-old group when body checking was not allowed.
The results of this study are noteworthy because the results appear to be the first to find that pre-season complaints of neck pain, dizziness, or headaches may be risk factors for concussion in youth athletes. Further research is required to establish the potential link between concussions and the numerous causes of pre-season neck pain and headache (e.g., strength deficits, history of undiagnosed concussions, exposure to repetitive subconcussive head impacts) given that correlation does not equal causation. Additional exploration of dizziness as a preseason risk factor is also required given that the increased risk of concussion was only seen in the younger age group where there was no contact. Furthermore, studies exploring similar complaints in female athletes, other age groups, and other sports would be useful to validate these results. Ultimately, preseason screening for neck pain, dizziness, and headaches may be important indicators of patients at risk for concussion, at least among young male hockey players. If future studies can validate these findings, then coupling the screening with strategies aimed at addressing underlying causes of these complaints may become an effective approach in reducing the incidence of concussion in sports. Have you had any experience with pre-season complaints as predictors for concussion? Do you think similar results would be seen in females, athletes from other sports, or other age groups?
Written by: Stephen Stache, MD
Reviewed by: Marc Harwood, MD and Jeffrey Driban
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Schneider KJ, Meeuwisse WH, Kang J, Schneider GM, & Emery CA (2013). Preseason Reports of Neck Pain, Dizziness, and Headache as Risk Factors for Concussion in Male Youth Ice Hockey Players. Clinical Journal of Sport Medicine PMID: 23391986
I found this study to be incredibly interesting. I worked with both middle school and high school hockey teams and never once though about screening for baseline risk factors of concussion. I knew which athletes had sustained them in the past and especially kept my eye on those athletes, but really did not think much more about any other kind of risk factor. As it has been documented that neck strength may help to prevent concussion, it makes sense that neck pain and potentially weakness can be a risk factor for sustaining a concussion. It is easy enough to include questions about daily dizziness, headache, or neck pain on a pre-participation exam; however, more research must be done to confirm that it was indeed the baseline symptoms that played a role in concussion, not just coincidence. This model is also very easy to distribute to all sports, not just ice hockey. This is definitely something I may consider doing in my practice, if not as a definitive concussion risk factor, just to keep track and note my own findings and maybe keep an eye on those who did report these symptoms during PPE. Great idea for research, really got me thinking!