Influence of Cognitive Performance on Musculoskeletal Injury Risk: A Systematic Review

Abstract

Background: While a large number of studies have investigated the anatomic, hormonal, and biomechanical risk factors related to musculoskeletal (MSK) injury risk, there is growing evidence to suggest that cognition is an important injury contributor in the athletic population. A systematic review of the available evidence regarding the influence of cognitive performance on MSK injury risk has yet to be published in the sports medicine literature. Purpose/Hypothesis: The purpose was to determine the effects of cognition on (1) MSK biomechanics during sports-specific tasks and (2) MSK injury occurrence in the athletic population. It was hypothesized that athletes with lower cognitive performance would demonstrate biomechanical patterns suggestive of MSK injury risk and that injured athletes would perform worse on baseline measures of cognition as compared with their noninjured counterparts. Study Design: Systematic review. Methods: PubMed and SPORTDiscus were searched from January 2000 to January 2020. Manual searches were performed on the reference lists of the included studies. A search of the literature was performed for studies published in English that reported MSK biomechanics as a function of cognitive performance and MSK injury occurrence after baseline measures of cognition. Two independent reviewers extracted pertinent study data in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines and assessed study quality using the Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health. A meta-analysis was not performed, owing to the heterogeneous nature of the study designs. Results: Ten studies met inclusion criteria: 4 cognition–MSK biomechanics studies and 6 cognition–MSK injury studies. All 4 cognition–MSK biomechanics studies demonstrated that worse performance on measures of cognition was associated with lower extremity MSK biomechanical patterns suggestive of greater risk for MSK injury. The majority of the cognition–MSK injury studies demonstrated that injured athletes significantly differed on baseline cognition measures versus matched controls or that cognitive performance was a significant predictor for subsequent MSK injury. Conclusion: Although the literature exploring cognitive contributions to MSK injury risk is still in its infancy, it is suggested that sports medicine personnel conduct baseline assessments of cognition—in particular, reaction time and working memory—to identify which athletes may be at elevated risk for future MSK injury.

No Association Between Processing Speed and Risk of Sport-Related Concussion in Youth Soccer

“…Despite evidence suggesting that slower processing speed is associated with lower extremity musculoskeletal injury, [16][17][18] our findings suggest that slow processing speed is not a risk factor for sport-related concussion among junior high school soccer players. Our findings are similar to prior work in older athletes, demonstrating that baseline concussion test scores are not useful for predicting a future sport-related concussion.…”

Sex Moderates the Relationship between Perceptual-Motor Function and Single-Leg Squatting Mechanics

“…The speed-accuracy tradeoff (i.e., Fitts' Law) is a well-established motor learning principle (Fitts, 1954) and an important distinction to make with regards to biomechanics and musculoskeletal injury risk. Simple reaction time has repeatedly been associated with lower extremity biomechanics, (Herman and Barth, 2016;Almonroeder et al, 2018;Monfort et al, 2019;Avedesian et al, 2021) but evidence addressing the role of accuracy during complex reaction time tasks is limited. Choice reaction time has discriminated between participants displaying high and low knee abduction angles (Herman and Barth, 2016); additionally, healthy participants have demonstrated slower discriminative reaction times, while injured patients exhibit quicker choice responses (Etemadi et al, 2016), further suggesting meaningful interplay between speed, accuracy, and neuromuscular function (Burcal et al, 2019).…”

“…When performing dynamic tasks such as sport-specific maneuvers, perceptual-motor attributes such as reaction time, processing speed, working memory, and muscular coordination allow adaptation to changing environmental conditions and protect musculoskeletal structures during high load scenarios (Swanik, 2015). Slower reaction time and working memory performance have been associated with unstable neuromuscular control patterns (i.e., increased ground reaction forces and greater knee abduction angles/moments) that contribute to musculoskeletal injury occurrence (Avedesian et al, 2021). Although deficits in perceptual-motor function have been demonstrated as risk factors for musculoskeletal injury, (Covassin et al, 2007;Mcdonald et al, 2019) evidence pertaining to sex-specific effects of perceptual-motor function and its relationship to neuromuscular control is sparse (Avedesian et al, 2021).…”

“…Slower reaction time and working memory performance have been associated with unstable neuromuscular control patterns (i.e., increased ground reaction forces and greater knee abduction angles/moments) that contribute to musculoskeletal injury occurrence (Avedesian et al, 2021). Although deficits in perceptual-motor function have been demonstrated as risk factors for musculoskeletal injury, (Covassin et al, 2007;Mcdonald et al, 2019) evidence pertaining to sex-specific effects of perceptual-motor function and its relationship to neuromuscular control is sparse (Avedesian et al, 2021). There is compelling evidence arguing that males and females perceive stimuli differently, particularly visual stimuli.…”

Visual–Spatial Attentional Performance Identifies Lower Extremity Injury Risk in Adolescent Athletes

“…6 In male and female collegiate athletes, visuomotor RT and working memory contribute to LEMSK biomechanical patterns associated with injury (ie, dynamic knee valgus) and predict in-season LEMSK injury incidence. 14…”