Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Thomas A Buckley; Avinash Chandran; Timothy C Mauntel; Zachary Yukio Kerr; Derek W Brown; Adrian J Boltz; Daniel C Herman; Eric E Hall; Robert C Lynall

doi:10.1177/03635465221125155

Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Am J Sports Med. 2023 Feb;51(2):511-519. doi: 10.1177/03635465221125155. Epub 2023 Jan 6.

Authors

Thomas A Buckley^{1

2}, Avinash Chandran³, Timothy C Mauntel⁴, Zachary Yukio Kerr⁵, Derek W Brown⁶, Adrian J Boltz⁷, Daniel C Herman⁸, Eric E Hall⁹, Robert C Lynall¹⁰

Affiliations

¹ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA.
² Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, Delaware, USA.
³ Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA.
⁴ DoD-VA Extremity Trauma & Amputation Center of Excellence, Womack Army Medical Center, Fort Bragg, North Carolina, USA.
⁵ Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.
⁶ Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
⁷ Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA.
⁸ Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA.
⁹ Department of Exercise Science, Elon University, Elon, North Carolina, USA.
¹⁰ Department of Kinesiology, University of Georgia, Athens, Georgia, USA.

PMID: 36255302
DOI: 10.1177/03635465221125155

Abstract

Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability.

Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP).

Study design: Descriptive epidemiology study.

Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non-time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports.

Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [OR_Adj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (OR_Adj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports.

Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.

Keywords: injury prevention; mild traumatic brain injury; postural control.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Athletes
Athletic Injuries* / epidemiology
Brain Concussion* / epidemiology
Football* / injuries
Humans
Incidence
Leg Injuries* / epidemiology
Lower Extremity / injuries
Students
United States
Universities