As sports medicine healthcare professionals, we have preached the importance of removal of every athlete from play after a concussion. Not returning to play until the athlete has fully healed is critical. Resolution of symptoms and return of neurocognitive performance to normal are believed to decrease the athlete’s risk of a prolonged recovery, suffering recurrent concussions and even second impact syndrome.
Could concussions, though, affect the athlete’s risk of other common sports injuries, like ankle sprains or ACL tears?
Concussions and the relationship to ankle sprains, knee injuries and more
Researchers recently surveyed 335 NCAA athletes who play basketball, baseball, football, cheerleading, soccer, softball and other sports. They weren’t just male athletes. In fact, about 62% of the athletes surveyed were female.
The researchers asked the athletes about their histories of concussions during their college careers. They also collected information on concussions known by the athlete but not reported to athletic trainers or doctors, as well as concussive events not recognized as concussions by the athletes. This last category included athletes with symptoms like memory loss, loss of consciousness and more but no diagnosis of concussion.
The researchers then correlated that data with the athletes’ history of musculoskeletal injuries.
• There was a significant association between a history of concussion and lower extremity injury, especially lateral ankle sprain, knee injuries and muscle strains.
• Athletes with a history of concussion during their college careers had between a 1.6 to 2.9 times increased risk of lower extremity musculoskeletal injury.
• When looking only at acknowledged concussions, athletes only had an increased risk for knee injuries.
• When unreported and unrecognized concussions were added, the risk for all three lower extremity injuries proved to have a significant association.
Take home message about concussions and lower extremity injuries
Accurate concussion identification is critical. Athletes need to tell athletic trainers, coaches and/or team physicians about every concussive event. They need to report symptoms, even if they are unsure they actually suffered a concussion. Then medical providers can evaluate the athlete and start proper treatment and rehab as well as determine appropriate return to play.
It’s unclear why previously concussed athletes have a higher rate of ankle sprains, muscle strains and injuries. Maybe these athletes have impaired motor or postural control. Maybe they have affected cognitive processing speeds that increase the risk for these injuries. Maybe these impairments persist for months or years after a concussion despite being medically cleared to play.
Regardless, this elevated risk for lower body injury is one more reason athletes need to report concussions and fully return to normal before playing again.
Does the risk of knee, ankle, and muscle injuries after concussions surprise you? Share your thoughts below!
Gilbert FC, Burdette GT, Joyner AB, Llewellyn TA, Buckley TA. Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes. Sports Health. 2016 Sep 1.