I always have my eye out for the latest research in the
world of concussions and some very interesting studies have been emerging
lately. The question being asked is do athletes have an increased risk of
sustaining a lower extremity injury following a concussion?
One study by Lynall et al in 2015 retrospectively looked at
injury data in Division I collegiate athletes.
They found these athletes were almost twice as likely to experience
lower extremity musculoskeletal injury after concussion when compared with
controls.
Another more recent study in May 2017 found similar findings
with collegiate athletes. Herman et al
reported that the odds of sustaining a musculoskeletal injury were 3.39 times
higher in the concussion athletes.
Yet another recent study by Lynall et all published in
November 2017 looked at high school athletes. This study found that for every
previous concussion, the odds of sustaining a subsequent time-loss lower
extremity injury increased 34%.
So, what gives with all this increased injury risk? It is suspected that lingering deficits in
gait and dynamic balance may have something to do with it. Lynall et al has proposed there may be
reduced cortical excitability impairing the brain’s ability to effectively
control and coordinate movement after concussion. Further, this may have something to do with
delayed reaction and movement time. If
we think about this in relation to the high physical and cognitive demands of
athletics it is easy to see where the potential for injury may occur.
With this information how do we make a change to help lower
the risk? Currently many concussion
protocols primarily utilize neurocognitive testing, static balance tests, and symptom
reporting. It is proposed that utilizing
more functional balance assessments would be beneficial (especially using sport
specific tasks such as cutting and jumping).
This sounds a lot like what I do at Next Level in my exertion
assessments. During an exertion
evaluation the athlete completes multiple dynamic tasks testing the vestibular
system at high levels and elevating the athlete’s heart rate. We consider the specific nature of each
sport and look to progress all aspects before return to play including cutting,
changing direction, accelerating/decelerating, jumping, running, throwing,
coordination, reaction time, and cognition.
The goal of future research will be to take a deeper look at
functional movement after concussion and come up with a dynamic assessment that
is easy to implement in our concussion protocols across all levels of
athletics.
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| Exertion Physical Therapy-where we jump, cut, change direction, and get sport specific :) |
My take home message from this research is that concussions
are something that should be taken seriously for many reasons. If you have a concussion it is important to get evaluated to make sure everything clears (including those
dynamic balance and sport specific tasks) before returning to sport to avoid the
risk of musculoskeletal injury. Hopefully
soon everyone in athletics will have more detailed assessment tools and we can
see the incidence of these injuries go down.
References
Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute lower extremity
injury rates increase after concussion in college athletes. Med Sci Sports Exerc. 2015;47(12):2487-2492.
Herman DC, Jones D, Harrison A, et al. Concussion may
increase the risk of subsequent lower extremity musculoskeletal injury in
collegiate athletes. Sports Med. 2017;47(5):1003-1010.
Lynall RC, Mauntel TC, Pohlig RT, et al. Lower extremity
musculoskeletal injury risk after concussion recovery in high school athletes. J Athl Train. 2017;52(11):1028-1034.
