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Erschienen in: Sports Medicine 5/2017

20.08.2016 | Original Research Article

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

verfasst von: Daniel C. Herman, Debi Jones, Ashley Harrison, Michael Moser, Susan Tillman, Kevin Farmer, Anthony Pass, James R. Clugston, Jorge Hernandez, Terese L. Chmielewski

Erschienen in: Sports Medicine | Ausgabe 5/2017

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Abstract

Background

Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury.

Objective

The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion.

Methods

Injury data were collected from 2006 to 2013 for men’s football and for women’s basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position.

Results

Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90–6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41).

Conclusions

The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.
Literatur
2.
Zurück zum Zitat Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.CrossRefPubMed
4.
Zurück zum Zitat Chiu SL, Osternig L, Chou LS. Concussion induces gait inter-joint coordination variability under conditions of divided attention and obstacle crossing. Gait Posture. 2013;38(4):717–22.CrossRefPubMed Chiu SL, Osternig L, Chou LS. Concussion induces gait inter-joint coordination variability under conditions of divided attention and obstacle crossing. Gait Posture. 2013;38(4):717–22.CrossRefPubMed
5.
Zurück zum Zitat Fait P, et al. Alterations to locomotor navigation in a complex environment at 7 and 30 days following a concussion in an elite athlete. Brain Inj. 2009;23(4):362–9.CrossRefPubMed Fait P, et al. Alterations to locomotor navigation in a complex environment at 7 and 30 days following a concussion in an elite athlete. Brain Inj. 2009;23(4):362–9.CrossRefPubMed
6.
Zurück zum Zitat Fait P, et al. Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. J Head Trauma Rehabil. 2013;28(4):293–301.CrossRefPubMed Fait P, et al. Altered integrated locomotor and cognitive function in elite athletes 30 days postconcussion: a preliminary study. J Head Trauma Rehabil. 2013;28(4):293–301.CrossRefPubMed
7.
Zurück zum Zitat Catena RD, van Donkelaar P, Chou LS. Cognitive task effects on gait stability following concussion. Exp Brain Res. 2007;176(1):23–31.CrossRefPubMed Catena RD, van Donkelaar P, Chou LS. Cognitive task effects on gait stability following concussion. Exp Brain Res. 2007;176(1):23–31.CrossRefPubMed
8.
Zurück zum Zitat Catena RD, van Donkelaar P, Chou LS. Altered balance control following concussion is better detected with an attention test during gait. Gait Posture. 2007;25(3):406–11.CrossRefPubMed Catena RD, van Donkelaar P, Chou LS. Altered balance control following concussion is better detected with an attention test during gait. Gait Posture. 2007;25(3):406–11.CrossRefPubMed
9.
Zurück zum Zitat Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009;6:25.CrossRefPubMedPubMedCentral Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009;6:25.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Martini DN, et al. The chronic effects of concussion on gait. Arch Phys Med Rehabil. 2011;92(4):585–9.CrossRefPubMed Martini DN, et al. The chronic effects of concussion on gait. Arch Phys Med Rehabil. 2011;92(4):585–9.CrossRefPubMed
11.
Zurück zum Zitat Hewett TE, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.CrossRefPubMed Hewett TE, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501.CrossRefPubMed
12.
Zurück zum Zitat Zazulak BT, et al. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical–epidemiologic study. Am J Sports Med. 2007;35(7):1123–30.CrossRefPubMed Zazulak BT, et al. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical–epidemiologic study. Am J Sports Med. 2007;35(7):1123–30.CrossRefPubMed
13.
Zurück zum Zitat Nordstrom A, Nordstrom P, Ekstrand J. Sports-related concussion increases the risk of subsequent injury by about 50 % in elite male football players. Br J Sports Med. 2014;48(19):1447–50.CrossRefPubMed Nordstrom A, Nordstrom P, Ekstrand J. Sports-related concussion increases the risk of subsequent injury by about 50 % in elite male football players. Br J Sports Med. 2014;48(19):1447–50.CrossRefPubMed
14.
Zurück zum Zitat Cross M, et al. Professional Rugby Union players have a 60 % greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes. Br J Sports Med. Epub. 2015;. doi:10.1136/bjsports-2015-094982. Cross M, et al. Professional Rugby Union players have a 60 % greater risk of time loss injury after concussion: a 2-season prospective study of clinical outcomes. Br J Sports Med. Epub. 2015;. doi:10.​1136/​bjsports-2015-094982.
15.
Zurück zum Zitat Pietrosimone B, et al. Concussion frequency associates with musculoskeletal injury in retired NFL players. Med Sci Sports Exerc. 2015;47(11):2366–72.CrossRefPubMed Pietrosimone B, et al. Concussion frequency associates with musculoskeletal injury in retired NFL players. Med Sci Sports Exerc. 2015;47(11):2366–72.CrossRefPubMed
16.
Zurück zum Zitat Lynall RC, et al. Acute lower extremity injury rates increase following concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487–92.CrossRefPubMed Lynall RC, et al. Acute lower extremity injury rates increase following concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487–92.CrossRefPubMed
17.
Zurück zum Zitat Brooks MA, et al. Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes. Am J Sports Med. 2016;44(3):742–7.CrossRefPubMed Brooks MA, et al. Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes. Am J Sports Med. 2016;44(3):742–7.CrossRefPubMed
19.
Zurück zum Zitat Livingston SC, et al. A preliminary investigation of motor evoked potential abnormalities following sport-related concussion. Brain Inj. 2010;24(6):904–13.CrossRefPubMed Livingston SC, et al. A preliminary investigation of motor evoked potential abnormalities following sport-related concussion. Brain Inj. 2010;24(6):904–13.CrossRefPubMed
20.
Zurück zum Zitat Powers KC, Cinelli ME, Kalmar JM. Cortical hypoexcitability persists beyond the symptomatic phase of a concussion. Brain Inj. 2014;28(4):465–71.CrossRefPubMed Powers KC, Cinelli ME, Kalmar JM. Cortical hypoexcitability persists beyond the symptomatic phase of a concussion. Brain Inj. 2014;28(4):465–71.CrossRefPubMed
21.
Zurück zum Zitat De Beaumont L, et al. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain. 2009;132(Pt 3):695–708.CrossRefPubMed De Beaumont L, et al. Brain function decline in healthy retired athletes who sustained their last sports concussion in early adulthood. Brain. 2009;132(Pt 3):695–708.CrossRefPubMed
22.
Zurück zum Zitat Pearce AJ, et al. The long-term effects of sports concussion on retired Australian football players: a study using transcranial magnetic stimulation. J Neurotrauma. 2014;31(13):1139–45.CrossRefPubMed Pearce AJ, et al. The long-term effects of sports concussion on retired Australian football players: a study using transcranial magnetic stimulation. J Neurotrauma. 2014;31(13):1139–45.CrossRefPubMed
23.
Zurück zum Zitat Tallus J, et al. Long-lasting TMS motor threshold elevation in mild traumatic brain injury. Acta Neurol Scand. 2012;126(3):178–82.CrossRefPubMed Tallus J, et al. Long-lasting TMS motor threshold elevation in mild traumatic brain injury. Acta Neurol Scand. 2012;126(3):178–82.CrossRefPubMed
24.
Zurück zum Zitat Kuenze CM, et al. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train. 2015;50(3):303–12.CrossRefPubMedPubMedCentral Kuenze CM, et al. Persistent neuromuscular and corticomotor quadriceps asymmetry after anterior cruciate ligament reconstruction. J Athl Train. 2015;50(3):303–12.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Pietrosimone BG, Gribble PA. Chronic ankle instability and corticomotor excitability of the fibularis longus muscle. J Athl Train. 2012;47(6):621–6.CrossRefPubMedPubMedCentral Pietrosimone BG, Gribble PA. Chronic ankle instability and corticomotor excitability of the fibularis longus muscle. J Athl Train. 2012;47(6):621–6.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Pietrosimone BG, et al. Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil. 2013;22(1):1–6.CrossRefPubMed Pietrosimone BG, et al. Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil. 2013;22(1):1–6.CrossRefPubMed
27.
Zurück zum Zitat Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(Pt 8):2161–71.CrossRefPubMed Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008;131(Pt 8):2161–71.CrossRefPubMed
28.
Zurück zum Zitat Herman DC, et al. Effect of neurocognition and concussion on musculoskeletal injury risk. Curr Sports Med Rep. 2015;14(3):194–9.CrossRefPubMedCentral Herman DC, et al. Effect of neurocognition and concussion on musculoskeletal injury risk. Curr Sports Med Rep. 2015;14(3):194–9.CrossRefPubMedCentral
29.
Zurück zum Zitat Swanik CB, et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943–8.CrossRefPubMed Swanik CB, et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35(6):943–8.CrossRefPubMed
30.
Zurück zum Zitat Wilkerson G. Neurocognitive reaction time predicts lower extremity sprains and strains. Int J Athl Ther Train. 2012;17(6):4–9.CrossRef Wilkerson G. Neurocognitive reaction time predicts lower extremity sprains and strains. Int J Athl Ther Train. 2012;17(6):4–9.CrossRef
31.
Zurück zum Zitat Moore RD, Hillman CH, Broglio SP. The persistent influence of concussive injuries on cognitive control and neuroelectric function. J Athl Train. 2014;49(1):24–35.CrossRefPubMedPubMedCentral Moore RD, Hillman CH, Broglio SP. The persistent influence of concussive injuries on cognitive control and neuroelectric function. J Athl Train. 2014;49(1):24–35.CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Moore RD, et al. The persistent influence of pediatric concussion on attention and cognitive control during flanker performance. Biol Psychol. 2015;109:93–102.CrossRefPubMed Moore RD, et al. The persistent influence of pediatric concussion on attention and cognitive control during flanker performance. Biol Psychol. 2015;109:93–102.CrossRefPubMed
33.
Zurück zum Zitat McGrath N, et al. Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Inj. 2013;27(1):103–13.CrossRefPubMed McGrath N, et al. Post-exertion neurocognitive test failure among student-athletes following concussion. Brain Inj. 2013;27(1):103–13.CrossRefPubMed
34.
Zurück zum Zitat Tsushima WT, et al. Effects of two concussions on the neuropsychological functioning and symptom reporting of high school athletes. Appl Neuropsychol Child. 2016;5(1):9–13.CrossRefPubMed Tsushima WT, et al. Effects of two concussions on the neuropsychological functioning and symptom reporting of high school athletes. Appl Neuropsychol Child. 2016;5(1):9–13.CrossRefPubMed
35.
Zurück zum Zitat Dai B, et al. Prevention of ACL injury, part II: effects of ACL injury prevention programs on neuromuscular risk factors and injury rate. Res Sports Med. 2012;20(3–4):198–222.PubMed Dai B, et al. Prevention of ACL injury, part II: effects of ACL injury prevention programs on neuromuscular risk factors and injury rate. Res Sports Med. 2012;20(3–4):198–222.PubMed
36.
Zurück zum Zitat Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769–76.CrossRefPubMed Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769–76.CrossRefPubMed
37.
Zurück zum Zitat Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44(15):1082–8.CrossRefPubMed Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44(15):1082–8.CrossRefPubMed
Metadaten
Titel
Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes
verfasst von
Daniel C. Herman
Debi Jones
Ashley Harrison
Michael Moser
Susan Tillman
Kevin Farmer
Anthony Pass
James R. Clugston
Jorge Hernandez
Terese L. Chmielewski
Publikationsdatum
20.08.2016
Verlag
Springer International Publishing
Erschienen in
Sports Medicine / Ausgabe 5/2017
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-016-0607-9

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