Sports Medicine

, Volume 47, Issue 5, pp 1003–1010 | Cite as

Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes

  • Daniel  C. Herman
  • Debi Jones
  • Ashley Harrison
  • Michael Moser
  • Susan Tillman
  • Kevin Farmer
  • Anthony Pass
  • James R. Clugston
  • Jorge Hernandez
  • Terese L. Chmielewski
Original Research Article

Abstract

Background

Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury.

Objective

The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion.

Methods

Injury data were collected from 2006 to 2013 for men’s football and for women’s basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position.

Results

Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90–6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41).

Conclusions

The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.

References

  1. 1.
    Daneshvar DH, et al. The epidemiology of sport-related concussion. Clin Sports Med. 2011;30(1):1–17.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Buckley TA, et al. Altered gait termination strategies following a concussion. Gait Posture. 2013;38(3):549–51.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Chiu SL, Osternig L, Chou LS. Concussion induces gait inter-joint coordination variability under conditions of divided attention and obstacle crossing. Gait Posture. 2013;38(4):717–22.CrossRefPubMedGoogle Scholar
  5. 5.
    Fait P, et al. Alterations to locomotor navigation in a complex environment at 7 and 30 days following a concussion in an elite athlete. Brain Inj. 2009;23(4):362–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Fait P, et al. Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. J Head Trauma Rehabil. 2013;28(4):293–301.CrossRefPubMedGoogle Scholar
  7. 7.
    Catena RD, van Donkelaar P, Chou LS. Cognitive task effects on gait stability following concussion. Exp Brain Res. 2007;176(1):23–31.CrossRefPubMedGoogle Scholar
  8. 8.
    Catena RD, van Donkelaar P, Chou LS. Altered balance control following concussion is better detected with an attention test during gait. Gait Posture. 2007;25(3):406–11.CrossRefPubMedGoogle Scholar
  9. 9.
    Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009;6:25.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Martini DN, et al. The chronic effects of concussion on gait. Arch Phys Med Rehabil. 2011;92(4):585–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Hewett TE, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.CrossRefPubMedGoogle Scholar
  12. 12.
    Zazulak BT, et al. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical–epidemiologic study. Am J Sports Med. 2007;35(7):1123–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Nordstrom A, Nordstrom P, Ekstrand J. Sports-related concussion increases the risk of subsequent injury by about 50 % in elite male football players. Br J Sports Med. 2014;48(19):1447–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Cross M, et al. Professional Rugby Union players have a 60 % greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes. Br J Sports Med. Epub. 2015;. doi:10.1136/bjsports-2015-094982.Google Scholar
  15. 15.
    Pietrosimone B, et al. Concussion frequency associates with musculoskeletal injury in retired NFL players. Med Sci Sports Exerc. 2015;47(11):2366–72.CrossRefPubMedGoogle Scholar
  16. 16.
    Lynall RC, et al. Acute lower extremity injury rates increase following concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Brooks MA, et al. Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes. Am J Sports Med. 2016;44(3):742–7.CrossRefPubMedGoogle Scholar
  18. 18.
    De Beaumont L, et al. Persistent motor system abnormalities in formerly concussed athletes. J Athl Train. 2011;46(3):234–40.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Livingston SC, et al. A preliminary investigation of motor evoked potential abnormalities following sport-related concussion. Brain Inj. 2010;24(6):904–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Powers KC, Cinelli ME, Kalmar JM. Cortical hypoexcitability persists beyond the symptomatic phase of a concussion. Brain Inj. 2014;28(4):465–71.CrossRefPubMedGoogle Scholar
  21. 21.
    De Beaumont L, et al. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain. 2009;132(Pt 3):695–708.CrossRefPubMedGoogle Scholar
  22. 22.
    Pearce AJ, et al. The long-term effects of sports concussion on retired Australian football players: a study using transcranial magnetic stimulation. J Neurotrauma. 2014;31(13):1139–45.CrossRefPubMedGoogle Scholar
  23. 23.
    Tallus J, et al. Long-lasting TMS motor threshold elevation in mild traumatic brain injury. Acta Neurol Scand. 2012;126(3):178–82.CrossRefPubMedGoogle Scholar
  24. 24.
    Kuenze CM, et al. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train. 2015;50(3):303–12.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Pietrosimone BG, Gribble PA. Chronic ankle instability and corticomotor excitability of the fibularis longus muscle. J Athl Train. 2012;47(6):621–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Pietrosimone BG, et al. Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil. 2013;22(1):1–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(Pt 8):2161–71.CrossRefPubMedGoogle Scholar
  28. 28.
    Herman DC, et al. Effect of neurocognition and concussion on musculoskeletal injury risk. Curr Sports Med Rep. 2015;14(3):194–9.CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Swanik CB, et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Wilkerson G. Neurocognitive reaction time predicts lower extremity sprains and strains. Int J Athl Ther Train. 2012;17(6):4–9.CrossRefGoogle Scholar
  31. 31.
    Moore RD, Hillman CH, Broglio SP. The persistent influence of concussive injuries on cognitive control and neuroelectric function. J Athl Train. 2014;49(1):24–35.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Moore RD, et al. The persistent influence of pediatric concussion on attention and cognitive control during flanker performance. Biol Psychol. 2015;109:93–102.CrossRefPubMedGoogle Scholar
  33. 33.
    McGrath N, et al. Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Inj. 2013;27(1):103–13.CrossRefPubMedGoogle Scholar
  34. 34.
    Tsushima WT, et al. Effects of two concussions on the neuropsychological functioning and symptom reporting of high school athletes. Appl Neuropsychol Child. 2016;5(1):9–13.CrossRefPubMedGoogle Scholar
  35. 35.
    Dai B, et al. Prevention of ACL injury, part II: effects of ACL injury prevention programs on neuromuscular risk factors and injury rate. Res Sports Med. 2012;20(3–4):198–222.PubMedGoogle Scholar
  36. 36.
    Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769–76.CrossRefPubMedGoogle Scholar
  37. 37.
    Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44(15):1082–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Daniel  C. Herman
    • 1
  • Debi Jones
    • 3
  • Ashley Harrison
    • 4
  • Michael Moser
    • 1
    • 2
  • Susan Tillman
    • 3
  • Kevin Farmer
    • 1
    • 2
  • Anthony Pass
    • 5
  • James R. Clugston
    • 2
    • 6
  • Jorge Hernandez
    • 7
  • Terese L. Chmielewski
    • 8
    • 9
  1. 1.Department of Orthopaedics and RehabilitationUniversity of FloridaGainesvilleUSA
  2. 2.University of Florida Athletic Association, University of FloridaGainesvilleUSA
  3. 3.UF Health Rehab CenterOrthopaedics and Sports Medicine InstituteGainesvilleUSA
  4. 4.ProFormPTMaitlandUSA
  5. 5.University of Texas AthleticsAustinUSA
  6. 6.Department of Community Health and Family Medicine, Student Health Care CenterUniversity of FloridaGainesvilleUSA
  7. 7.College of Veterinary SciencesUniversity of FloridaGainesvilleUSA
  8. 8.TRIA Orthopedic CenterBloomingtonUSA
  9. 9.Department of Physical TherapyUniversity of FloridaGainesvilleUSA

Personalised recommendations