Lower Extremity Injury Risk Following Concussion

Concussion awareness continues to grow and many parents, coaches and medical staffs are now taking more cautious measures before allowing athletes to return to sport following a concussion, for the fear of sustaining a second one.  Something we may need to also consider is the risk for non-contact musculoskeletal injury due to lingering effects of the concussion.  Many of the lower extremity injuries that require medical attention and treatment occur during sporting events without contact from another participant, the most notable being ACL tears.  A recent study from the American Journal of Sports Medicine found that concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal injury after return to sport than their non-concussed teammates. The study was inspired by recent work suggesting subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk for lower extremity musculoskeletal injury. The authors looked at 87 NCAA Division I athletes participating in football, soccer, hockey, softball, basketball, wrestling and volleyball at the University of Wisconsin between 2011-2014. Concussed athletes were observed over a 90 day post-concussion period for acute lower extremity injury. They found that concussed athletes were more likely to experience an acute non-contact lower extremity injury than their matched controls. 

The clinical relevance of this study is that there may be a period of time during post concussion recovery that should be focused on neuromuscular and proprioceptive training to help sharpen balance, coordination, spacial awareness and visual reactive timing. In other words, the type of training prescribed to athletes recovering from a musculoskeletal injury just prior to returning to sport.