Risk of recurrent injury in athletes with a history of sports-related concussion

BACKGROUND: Concussions are frequent injuries sustained by collegiate athletes. They are often underdiagnosed and may lack adequate treatment due to a lack of standardization in diagnosis and return to play guidelines. Current research suggests that there is an increased risk of subsequent injury after returning to play among previously concussed athletes. Recurrent injuries have a detrimental impact on athletic careers and often result in early retirement from competitive sports. The relationship between sports-related concussions (SRCs) and subsequent musculoskeletal injuries in the NCAA reveals a lack of consensus on return to play (RTP) guidelines and management. Clinical guidelines are evolving with the progressive understanding of SRC pathophysiology. LITERATURE REVIEW FINDINGS: Previous research has found an association between concussion and subsequent acute musculoskeletal injuries, specifically lower extremity injuries. In addition, sports-specific athlete cohorts, such as soccer and football players, have been shown to have a high incidence of SRC. The exact mechanism of action linking SRC and subsequent acute injury is currently unknown. There are numerous etiologic possibilities offered in the literature, including gait alterations, neuromuscular control deficits, and impaired reaction time. However, further research is required to elucidate this relationship—in our review of the current literature we were able to find no studies evaluating the risk of both upper and lower extremity injury following SRC after returning to play in the NCAA population. PROPOSED PROJECT: The goal of the proposed retrospective cohort study of BU athletes is to evaluate the impact of concussion history on recurrent injury after returning to sports. Study inclusion criteria will consist of BU athletes diagnosed with concussions at a single NCAA Division I institution. This cohort will be collected from NCAA injury database and electronic medical records will be matched with controls who have not sustained concussions over the same period. CONCLUSIONS: History of concussion is associated with increased risk of recurrent injury in athletes, specifically at the collegiate level. Further work must be done at all levels of athletics to standardize return to play guidelines to prevent this increased risk of subsequent injury. SIGNIFICANCE: This study will help determine whether a relationship exists between concussion and subsequent sports-related injuries. This information may allow for closer monitoring of return to play and treatment of concussions. Additionally, it may encourage further developments to diagnostic criteria, education, and injury prevention