Friday, March 9, 2018

Is there a higher risk of lower extremity injury after a concussion?

By Kirsten Carmichael DPT, CSCS, SFG I, MFDc

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.
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.

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