Higher rates of concussion following COVID-19 infection in high school athletes.

Bullock GS, Emery CA, Nelson VR, et. al, Br J Sports Med, 2023; [epub ahead of print]. doi: 10.1136/brjsports-2022-106436.

Full Text Freely Available

Take-Home Message

Athletes who tested positive for a COVID-19 infection were more likely to sustain a concussion within 60 days of recovering from the infection than athletes who did not contract COVID-19.


COVID-19 impacts the respiratory, cardiovascular, and nervous systems. In some cases, COVID-19 could lead to long-term consequences (e.g., impaired cognition). It is currently unknown if COVID-19 infection influences the risk of sports-related concussions.

Study Goal

Bullock and colleagues completed a prospective cohort study to compare the concussion rates between high school athletes who recently tested positive for COVID-19 and those who did not.


The authors recruited athletes from high schools in 6 states. A certified athletic trainer recorded all instances of COVID-19 infection or concussion. If an athlete reported COVID-like symptoms or had an elevated temperature during a daily screening, the athletic trainer administered a COVID test. The study team also recorded when an athlete participated in a practice or competition. The authors focused on the rate of concussions within 60 days of an athlete returning to play after a COVID-19 infection. All data were recorded in the Players Health Rehab system, including demographic information, sport, and illness dates for all athletes.


A total of 72,522 athletes participated in high school sports at the included school during the 2020-2021 school year. Among these athletes, 430 had COVID-19 infections. Of the athletes with a COVID-19 infection, 32 had a concussion, and 1,241 athletes without COVID-19 had a concussion. An athlete with a history of COVID-19 was about 3 times more likely to have a concussion within 60 days of returning to play than an athlete without COVID-19.


Overall, the authors found that a previous COVID-19 infection increased the risk of a concussion during the first 60 days after COVID-19 recovery. Hence, the effects of COVID-19 infection may linger after being returned to play. Knowing if this is true for other sports-related injuries would be interesting. Furthermore, if we learn why these athletes are at greater risk for concussion (e.g., deconditioning, lingering symptoms), we could develop prevention strategies and make informed decisions about when and how to clear an athlete to play after a COVID-19 infection.

Clinical Implications

Clinicians should explain to patients with COVID-19 that they may experience lingering effects that make them susceptible to a concussion. We need to help the patient make an informed decision about when to return to play after a COVID-19 infection. Once an athlete does return, clinicians should monitor these patients for concussions.

Questions for Discussion

What other measures have you implemented to monitor athletes following COVID-19 infection in your clinical practice? Is a COVID-19 infection something you currently document?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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