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

Herman, Daniel C.; Jones, Debi; Harrison, Ashley J.; Moser, Michael W.; Tillman, Susan M.; Farmer, Kevin W.; Pass, Anthony; Clugston, James R.; Hernández, Jorge A.; Chmielewski, Terese L.

doi:10.1007/s40279-016-0607-9

Cited by 132 publications

(147 citation statements)

References 38 publications

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“…This may result in insufficient sensorimotor responses and increased susceptibility to musculoskeletal injuries secondary to concussion . Significant elevations in musculoskeletal injury risk are reported for up to a year following a concussion, and subtle lingering neuromuscular control deficits despite clinical recovery post‐concussion are speculated to be behind the injury . Ensuring the safety of athletes is therefore of utmost importance.…”

Section: Discussionmentioning

confidence: 99%

Balance Testing Following Concussion: Postural Sway versus Complexity Index

Purkayastha

Adair

Woodruff

et al. 2019

PM&R

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Background Although postural control deficits are common following a concussion, the current clinical assessments for postural control tend to resolve within 3 to 10 days after injury. There is a lack of sensitive tools to examine subtle changes in postural control during the recovery phase following sports‐related concussion. Only a limited number of studies have examined nonlinear dynamics of postural control; no study has examined this metric longitudinally during the recovery phase following a sports‐related concussion. Objective To examine sway and complexity index of postural control in collegiate athletes during day 3, day 21, and day 90 following a concussion and compare them with noninjured controls. Design Prospective longitudinal case‐control study. Setting University cerebrovascular research laboratory. Participants Thirty‐one male and female collegiate athletes on day 3 following a concussion. Twenty‐eight athletes returned on day 21, and 21 completed assessments on day 90. Twenty‐nine sports‐matched noninjured controls. Methods Center of pressure (COP) measurements obtained during 60‐second quiet standing on a force plate system with either eyes opened or closed. Postural sway was estimated as range and variability of COP in the anteroposterior (AP) and mediolateral planes. Main Outcome Measurements Complexity index of AP COP utilizing multiscale entropy analysis. Results Postural sway measured as AP range (P = .03) and variability (P = .04) during quiet standing with eyes closed were higher on day 3 compared to the controls. Postural sway in the concussed group was comparable to the noninjured controls by day 21 postinjury. However, postural control dynamics utilizing complexity index was lower on day 3 (P < .001) and persisted on day 21 (P < .006) and day 90 (P < .02), despite resolution of abnormal postural sway 21 days postinjury. Conclusion Complexity index utilizing nonlinear dynamics might be a more sensitive objective biomarker for examining postural control following a concussion, with implications for return‐to‐play and interventions. Future studies with a larger sample size are needed to validate this finding. Clinical Trial Number NCT02754206. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

Balance Testing Following Concussion: Postural Sway versus Complexity Index

Purkayastha

Adair

Woodruff

et al. 2019

PM&R

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“…For example, altered landing mechanics and dynamic alignment are risk factors common to both ACL injury and BSI and are also treatment targets [2‐4]. History of concussion has been associated with increased risk of lower limb injuries including ACL injury [5]. A practical framework for a sex‐specific approach to the rehabilitation of these injuries is also described.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Common Sports Injuries

Lin

Casey

Herman

et al. 2018

PM&R

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Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. LEVEL OF EVIDENCE: IV.

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“…11,28 This finding has since been supported by a small number of studies demonstrating a higher risk of lower extremity injury with poorer performance on a reaction time test 30 and after temporary alteration of normal neurocognitive performance, such as with a concussion. 8,19,22 The mechanisms by which neurocognition affects injury risk are not known but may exert an effect on neuromuscular performance. For example, athletes who have experienced a recent concussion demonstrated altered gait patterns during a dual-attention task, even after the point of return to play.…”

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confidence: 99%

Drop-Jump Landing Varies With Baseline Neurocognition

Herman

Barth

2016

Am J Sports Med

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Background Neurocognitive status may be a risk factor for anterior cruciate ligament (ACL) injury. Neurocognitive domains such as visual attention, processing speed/reaction time, and dual-tasking may influence ACL injury risk via alterations to neuromuscular performance during athletic tasks. However, the relationship between neurocognition and performance during athletic tasks is not yet established. Hypothesis Athletes with low baseline neurocognitive scores will demonstrate poorer jump landing performance compared with athletes with high baseline neurocognitive score. Study Design Controlled laboratory study. Methods Neurocognitive performance was measured using the Concussion Resolution Index (CRI). Three-dimensional kinematic and kinetic data of the dominant limb were collected for 37 recreational athletes while performing an unanticipated jump-landing task. Healthy, nonconcussed subjects were screened using a computer-based neurocognitive test into a high performers (HP; n = 20; average CRI percentile, 78th) and a low performers (LP; n = 17; average CRI percentile, 41st) group. The task consisted of a forward jump onto a force plate with an immediate rebound to a second target that was assigned 250 milliseconds before landing on the force plate. Kinematic and kinetic data were obtained during the first jump landing. Results The LP group demonstrated significantly altered neuromuscular performance during the landing phase while completing the jump-landing task, including significantly increased peak vertical ground-reaction force (mean ± SD of LP vs HP: 1.81 ± 0.53 vs 1.38 ± 0.37 body weight [BW]; P <.01), peak anterior tibial shear force (0.91 ± 0.17 vs 0.72 ± 0.22 BW; P <.01), knee abduction moment (0.47 ± 0.56 vs 0.03 ± 0.64 BW × body height; P = .03), and knee abduction angle (6.1° ± 4.7° vs 1.3° ± 5.6°; P = .03), as well as decreased trunk flexion angle (9.6° ± 9.6° vs 16.4° ± 11.2°; P <.01). Conclusion Healthy athletes with lower baseline neurocognitive performance generate knee kinematic and kinetic patterns that are linked to ACL injury. Clinical Relevance Neurocognitive testing using the CRI may be useful for identification of athletes at elevated risk for future ACL injury.

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

Cited by 132 publications

References 38 publications

Balance Testing Following Concussion: Postural Sway versus Complexity Index

Balance Testing Following Concussion: Postural Sway versus Complexity Index

Sex Differences in Common Sports Injuries

Drop-Jump Landing Varies With Baseline Neurocognition

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