Professional Rugby Union players have a 60% greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes

Abstract

AimTo investigate incidence of concussion, clinical outcomes and subsequent injury risk following concussion.MethodsIn a two-season (2012/2013, 2013/2014) prospective cohort study, incidence of diagnosed match concussions (injuries/1000 h), median time interval to subsequent injury of any type (survival time) and time spent at each stage of the graduated return to play pathway were determined in 810 professional Rugby Union players (1176 player seasons).ResultsMatch concussion incidence was 8.9/1000 h with over 50% occurring in the tackle. Subsequent incidence of any injury for players who returned to play in the same season following a diagnosed concussion (122/1000 h, 95% CI 106 to 141) was 60% higher (IRR 1.6, 95% CI 1.4 to 1.8) than for those who did not sustain a concussion (76/1000 h, 95% CI 72 to 80). Median time to next injury following return to play was shorter following concussion (53 days, 95% CI 41 to 64) than following non-concussive injuries (114 days, 95% CI 85 to 143). 38% of players reported recurrence of symptoms or failed to match their baseline neurocognitive test during the graduated return to play protocol.Summary and conclusionsPlayers who returned to play in the same season after a diagnosed concussion had a 60% greater risk of time-loss injury than players without concussion. A substantial proportion of players reported recurrence of symptoms or failed to match baseline neurocognitive test scores during graduated return to play. These data pave the way for trials of more conservative and comprehensive graduated return to play protocols, with a greater focus on active rehabilitation.

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

“…al. noted similar findings among professional rugby players, with the incidence of any injury for players who returned to play in the same season following a diagnosed concussion being 60% higher compared to non-concussed players [14]. Finally, Pietrosimone et.…”

Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes

“…39 However, the results and odds ratios are highly consistent with the limited previous findings relating concussion and subsequent musculoskeletal injury. 9,11,28,36,39 Concussion self-report is inherently limited by the honesty and accuracy of the respondents but has previously demonstrated moderate to high reliability. 24,32 The instrument herein has been previously utilized and demonstrated high test-retest reliability (0.92), but the study is limited by the presumption of accurate responses and interpretation of the questions.…”

“…Interestingly, soccer players also had an elevated injury risk in the year prior to concussion. 11,36 Similarly, a Swedish hospital database also identified an elevated injury risk in the 2 years prior (1.98× elevated risk) or after (1.72× elevated risk) a diagnosed concussion. 9 Most recently, 2 tightly controlled prospective studies of collegiate student-athletes identified a 1.6 to 2.5 times elevated risk of subsequent lower extremity injury postconcussion.…”

Is the content and duration of the graduated return to play protocol after concussion demanding enough? A challenge for Berlin 2016

“…Typically, the time to RTP after concussion is shorter than for the majority of other injuries. The average time taken for professional rugby players to return after concussion in the Cross study3 is 11 days compared to an average of 21 days for musculoskeletal injury in the same cohort 5…”

“…Three recently published studies on professional soccer players,1 American college athletes2 and professional rugby players,3 have all identified an increased risk of injury following RTP after concussion. In addition, although not statistically significant, a further study highlighted a trend for concussed Australian rules footballers to have twice the rate of injuries of matched non-concussed players on RTP 4.…”