Concussion as a Risk Factor for Lower Extremity Musculoskeletal Injury in Collegiate Athletes

Determining when it is safe for an athlete to return-to-play (RTP) after sustaining a concussion is a primary concern for healthcare professionals. The purpose of this study was to investigate the relationship between sport-related concussion and subsequent occurrence of lower extremity musculoskeletal injury in collegiate athletes. This study also aimed to establish if a relationship exists between the length of recovery-time needed by an athlete prior to returning to play after a concussion and risk of lower extremity musculoskeletal injury. We also examined the contribution that sex may have on recovery time and lower extremity musculoskeletal risk after a concussion. A retrospective, matched-cohort study design utilizing a review of medical records of collegiate athletes from the past ten years was conducted.

A total of 164, athletes across 10 different sports were included in this study. Eighty-two concussed athletes (58 male, 24 female) were each randomly matched with one non-concussed athlete by sex, sport, position, calendar year, and body mass index (BMI). Data pertaining to any lower extremity musculoskeletal injury that had occurred, in the 90-day period prior to the concussed subjects’ concussion and in the subsequent 180-day period after the concussed athlete RTP, was collected and analyzed for each concussed athlete and their matched control.

The results of this study revealed that concussed athletes were at increased risk of future lower extremity musculoskeletal injury after RTP following a concussion. Sixty-two percent of concussed athletes selected for this study sustained a lower extremity musculoskeletal injury within 180 days after RTP following their concussion as compared to 26% of matched control athletes. These results indicate that the odds for an athlete with history of concussion, sustaining a lowering extremity musculoskeletal injury after RTP following a concussion is 7.37 greater than an athlete with no history of concussion. The number of days it took for athletes to RTP after a concussion was not statistically different in athletes who sustained a subsequent lower extremity musculoskeletal injury and those who did not. Although not statistically significant, female athletes demonstrated longer concussion recovery times and a greater incidence of lower extremity musculoskeletal injury following a concussion.

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Year

Entry

1999

Powell JW, Barber-Foss KD. Injury patterns in selected high school sports: a review of the 1995–1997 seasons. J Athl Train. September 1999;34(3):277-284.

1999

Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA. September 8, 1999;282(10):958-963.

2004

McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med. January 2004;14(1):13-17.

1970

Williams RD. Discussion. In: Gurdjian ES, Lange WA, Patrick LM, Thomas LM, eds. Impact Injury and Crash Protection. Springfield, IL: Charles C. Thomas; 1970:124.

1998

Cantu RC. Second-impact syndrome. Clin Sports Med. January 1998;17(1):37-44.