Lower Extremity Stiffness Changes after Concussion in Collegiate Football Players

Dubose, Dominique; Herman, Daniel C.; Jones, Deborah L.; Tillman, Susan M.; Clugston, James R.; Pass, Anthony; Hernández, Jorge A.; Vasilopoulos, Terrie; Horodyski, MaryBeth; Chmielewski, Terese L.

doi:10.1249/mss.0000000000001067

Cited by 64 publications

(53 citation statements)

References 39 publications

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“…28 Cognitive control refers to the subset of brain processes underlying perception, memory, and action, 8 and neuromechanical coupling refers to modulations in muscle tone that can optimize joint stiffness. 4 A subtle cognitive-control deficit could adversely affect the ability to rapidly generate muscle stiffness, which may be due to either a previous concussion 11,24 or musculoskeletal injury. 20,29 Even football players exposed to repetitive head blows that did not result in a concussion diagnosis exhibited significant reductions in ImPACT verbal memory or visual memory scores.…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Initial and Subsequent Core or Lower Extremity Sprain or Strain Among Collegiate Football Players

McDonald¹,

Wilkerson

McDermott

et al. 2019

Journal of Athletic Training

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Context Exposure to game conditions and previous injury are known to increase the risk of injury, but little available evidence pertains to modifiable factors that may mediate dynamic control of body segments, such as core muscle endurance and neurocognitive capabilities. Objective To identify potentially modifiable factors associated with the occurrence of a core or lower extremity sprain or strain during participation in football. Design Prospective cohort study. Setting National Collegiate Athletic Association Division I Football Bowl Subdivision football program. Patients or Other Participants All team members who participated for the duration of 1 season or both of 2 consecutive seasons (n = 142). Main Outcome Measure(s) Predictors of injury occurrence were derived from analysis of preparticipation data that included the results of front plank hold (FPH) and neurocognitive tests. Receiver operating characteristic analysis was used to establish binary classifications of injury risk. Logistic regression analyses were conducted to build multivariable injury-prediction models for optimal discriminatory power. Results Exceptionally good discrimination between injured and noninjured participants was provided by models that included the results of the FPH and ImPACT neurocognitive tests. A high level of exposure to game conditions and injury during the preceding year magnified the effects of other risk factors. A model for identifying players with an elevated risk for injury occurrence during both of 2 consecutive seasons included FPH ≤120 seconds, verbal memory score ≤87, composite reaction time ≥560 milliseconds, and starter status. Having ≥2 of the 4 risk factors demonstrated 44% sensitivity and 91% specificity, with an odds ratio = 8.40. Conclusions Core muscle endurance and neurocognitive processes may both play important roles in generating anticipatory muscle stiffness during participation in collegiate football. These factors may be particularly important for players who sustained an injury during the previous year and those who have a high level of game exposure.

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Section: Resultsmentioning

confidence: 99%

Risk Factors for Initial and Subsequent Core or Lower Extremity Sprain or Strain Among Collegiate Football Players

McDonald¹,

Wilkerson

McDermott

et al. 2019

Journal of Athletic Training

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show abstract

“…Assessing athletes during more challenging neuromuscular tasks that better reflect athletic demands may help identify those athletes who may continue to have deficits after concussion symptom resolution. One recent study by Dubose et al [88] investigated the effect of concussion on neuromuscular performance during a jump-landing task. Compared with baseline pre-concussion jump-landing performance, concussed subjects demonstrated increased hip stiffness and reduced knee and leg stiffness.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review

et al. 2018

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An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.

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“…The exact mechanism for this increased risk of musculoskeletal injury after concussion is unclear. Recent evidence 11 suggested that neuromuscular function, specifically altered lower extremity muscle stiffness, may play a role in the musculoskeletal injury risk after concussion. Previous authors 5 also hypothesized that relatively smallmagnitude dynamic balance deficits may be exacerbated in the highly dynamic sport environment with significant motor and cognitive demands.…”

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confidence: 99%

Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes

Lynall

Mauntel

Pohlig

et al. 2017

Journal of Athletic Training

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Among high school athletes, concussion increased the odds of sustaining subsequent time-loss lower extremity injuries but not non-time-loss injuries. By definition, time-loss injuries may be considered more severe than non-time-loss injuries. The exact mechanism underlying the increased risk of lower extremity injury after concussion remains elusive and should be further explored in future research.

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Lower Extremity Stiffness Changes after Concussion in Collegiate Football Players

Cited by 64 publications

References 39 publications

Risk Factors for Initial and Subsequent Core or Lower Extremity Sprain or Strain Among Collegiate Football Players

Risk Factors for Initial and Subsequent Core or Lower Extremity Sprain or Strain Among Collegiate Football Players

Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A Scoping Review

Lower Extremity Musculoskeletal Injury Risk After Concussion Recovery in High School Athletes

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