No Clinical Predictors of Postconcussion Musculoskeletal Injury in College Athletes

Abstract

Purpose This study aimed to identify clinical predictors of postconcussion subsequent musculoskeletal (MSK) injuries. Methods We recruited 66 National Collegiate Athletic Association intercollegiate student-athletes with a diagnosed concussion as well as 36 National Collegiate Athletic Association student-athletes without a concussion. All participants completed a multifaceted concussion baseline consisting of 1) 22-item 0–6 self-reported symptom checklist with outcomes including both the number of symptoms endorsed (0–22) and 2) total symptom score (0–132), 3) Standard Assessment of Concussion, 4) Balance Error Scoring System, 5) Immediate Post-Concussion Assessment and Cognitive Testing, 6) clinical reaction time, and 7) the King-Devick as well as demographic and injury characteristics. The concussion participants completed the same examination acutely postconcussion, and binary logistic regression was used to identify predictors of subsequent MSK from the change scores (acute minus baseline). From the 66 concussed student-athletes, a subset 36, matched with the healthy athletes, compared the risk of subsequent MSK in the year before and year after their concussion. Results The concussion participants were 1.78 times (95% confidence interval, 1.12–2.84; P = 0.015) more likely to suffer a lower extremity MSK in the year after their concussion than the control participants. The participant demographics and injury characteristics (P = 0.318) and concussion clinical outcomes (P = 0.461) did not predict subsequent MSK. Conclusion The concussion participants were 1.78 times more likely to sustain a subsequent MSK; however, no demographic, injury characteristic, or concussion assessments predicted the MSK. Thus, clinicians are not able to utilize common neurological measures or participant demographics to identify those at risk for subsequent lower extremity MSK. Injury prevention strategies should be considered for collegiate student-athletes upon premature return to participation after a concussion to reduce the subsequent MSK.

Relationship Between Cognitive Performance and Lower Extremity Biomechanics: Implications for Sports-Related Concussion

“… 35 , 42 Overall, it appears the elevated risk for LE injury post-SRC is present in both short and long terms after an athlete returns to unrestricted participation. 4 , 5 , 12 , 14 , 29 Compared with previous decades, it appears that SRCs are increasing within the collegiate athlete population, 9 which may predispose more competitors to subsequent LE injuries.…”

Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players

“…10,17 However, the exact neuromuscular mechanism is still unknown. 6 This is an area of conflicting evidence, as some have postulated that injury risk after an SRC is an artifact of an athlete having an overall increased risk of injury regardless of the concussion event. 7,24,34 These authors hypothesized that the increased risk of injury before and after an SRC may be due to ''risk-taking behavior'' or play style.…”

Athletes with a concussion history in the last two years have impairments in dynamic balance performance

“…4 Furthermore, the use of inertial sensor technology may help address some of the limitations of the traditional clinical assessments which have shown no utility in identifying those at an increased risk of musculoskeletal injury post-concussion. 34 For example, recent prospective research by Johnston et al 15 reported that Rugby Union players with poorer dynamic balance performance measured using inertial sensor technology during the YBT were at a three times greater relative-risk of concussion than individuals with optimal performance. Additionally, individuals with impaired dynamic balance performance have been shown to possess an increased risk of sustaining lower limb injuries such as lateral ankle sprains 35 and anterior cruciate ligament ruptures.…”