Musculoskeletal Injury Risk After Sport-Related Concussion: A Systematic Review and Meta-analysis

Abstract

Based on the evidence of higher risk of MSK injuries after concussion, standard clinical assessments for athletes with concussion should include not only physical symptoms and cognitive function before return to sport but also neuromuscular risk factors associated with increased risk for MSK injuries.

Athletes with a concussion history in the last two years have impairments in dynamic balance performance

“…The presence of these sensorimotor deficits in individuals whose injury occurred <2 years ago (despite "clinical recovery") may help explain the growing body of evidence demonstrating that athletes with a recent history of concussion are at a greater risk of sustaining further concussive 3 and lower-limb musculoskeletal injuries. 4 Furthermore, the use of inertial sensor technology may help address some of the limitations of the traditional clinical assessments which have shown no utility in identifying those at an increased risk of musculoskeletal injury post-concussion. 34 For example, recent prospective research by Johnston et al 15 reported that Rugby Union players with poorer dynamic balance performance measured using inertial sensor technology during the YBT were at a three times greater relative-risk of concussion than individuals with optimal performance.…”

“…Specifically, athletes with a history of a concussive injury have an increased risk of sustaining future concussive 3 and/or lower-limb musculoskeletal injuries. 4 While the underlying mechanism behind this relationship has yet to be fully uncovered, it has been suggested that the association may be related to the presence of subtle sub-clinical sensorimotor and neurocognitive deficits which persist beyond the resolution of the traditional signs and symptoms of concussion. 5 These concerns are beginning to be substantiated, with research demonstrating that sensorimotor control deficits post-clinical recovery from concussion may be more pronounced during dynamic balance 6 and dual-task situations.…”

“…As sports-related concussion has previously been shown to result in the adoption of a more constrained and predictable movement control strategy, 6,16,17 in the present study, it is hypothesized that the concussive injury would result in the adoption of a more constrained and predictable movement strategy during the YBT reach excursions. Additionally, while research has demonstrated that athletes may be at risk of sustaining future musculoskeletal injury for up to 2 years following a sports-related concussion, 4 little attention has been paid to the effect of time since injury on these persistent sub-clinical deficits. As such, the secondary aim was to investigate if athletes with no history of concussion, those who sustained an injury within the last 2 years, and those who sustained an injury greater than 2 years ago possess differences in dynamic balance performance.…”

Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice

“…The female athlete triad (bone density abnormalities, menstrual dysfunction, and abnormal nutrition status) is present in 40% of high school female athletes, 69% of female endurance athletes, and 77% of female ballet dancers . Women also carry a 56% to 265% increased risk of concussion compared to their male counterparts . These diagnoses can all be managed by musculoskeletal physiatrists.…”

“…18 Women also carry a 56% to 265% increased risk of concussion compared to their male counterparts. 6,19 These diagnoses can all be managed by musculoskeletal physiatrists. Furthermore, many, if not all can be well managed with first-line conservative treatment including medications and physical therapy, which are routinely prescribed by physiatrists.…”