Lauren Fournier, PT, DPT
Concussions can have detrimental effects in many ways. There is the more obvious trauma to the brain tissue, the skull and the neck musculature from sustaining a blow to the head or whiplash injury. The other, less thought of effects from the trauma can include effects on the person’s cognition, memory, balance, and vision among many others. After the physical and emotional wounds heal, people often think they are in the clear, but research has shown that, after experiencing a concussion, athletes are at a higher risk for lower extremity injuries severe enough to require missing game time.
Here is what some of the research over the last 3 years has shown:
- The University of Wisconsin in 2016 showed concussed collegiate athletes were at a higher risk of lower extremity injury for at least 90 days after their concussion.
- In a 2016 study, professional rugby players in Great Britain had a 60 percent higher risk of a leg injury for the remainder of the season in which a concussion was suffered.
- In the Journal of Athletic Training, a three-year study of over 18,000 previously concussed high school athletes across 27 sports in 26 states found a 34% increase in lower extremity injuries.
- In the Journal of Orthopaedic and Sports Physical Therapy, 11,522 active-duty soldiers were followed for two years after their concussion. They were closely matched for age, gender, rank and type of duty with 11,522 soldiers who had never suffered a concussion. This revealed a 45% higher risk of leg injury during the first 15 months post-concussion and a 38% higher risk over the course of two years vs. those that had not suffered a concussion.
The exact mechanism for this increased risk is unclear, but recent evidence has suggested that neuromuscular function, specifically lower extremity muscle stiffness, may play a role in the musculoskeletal injury risk. It’s also been hypothesized that small changes in subjects’ dynamic balance may be exacerbated in the highly dynamic sport atmosphere. These higher-level activities typically entail significant motor and cognitive demands, which are known areas adversely affected by concussions. Understanding the potential consequences of concussion will help develop the most effective post-concussion management strategies across the athletic and even non-athletic age spectrum, leading to safer return-to-activity protocols and reduce the risk of subsequent musculoskeletal injuries.
Traditional concussion management involves assessments of the patient’s symptoms and static/dynamic balance along with a gradual return-to-activity protocol. This allows therapists to better understand the various deficits after concussion and to allow for a more complete and safe return to activity. Even still, dynamic (i.e., while moving) balance deficits during gait have been found to remain even after improvements of reported symptoms and improvements in their static (i.e., while stationary) balance have taken place. These findings are interesting, but the clinical consequences of lingering dynamic balance deficits and altered gait mechanics are still unknown—they may be playing a role in the higher risk of musculoskeletal injury or not.
Here at Family Physical Therapy some patients need to transition from their original concussion program to a more “personal training” approach in order to return to vigorous activities, such as competitive sports. Some of the assessment tools used fall under the category of functional screening. These are used to assess how well the patient moves and then identifies, as well as corrects, faulty movement patterns as needed for each patient.
One of these screens is the Y Balance Test. This is a comprehensive test of your ability to balance, coordinate and control movement with your lower and upper body. Whether you are a competitive athlete, stay-at-home parent or grandparent, single leg balance as well as shoulder strength are crucial not only for safety but for improved performance. Another screen we use is the Motor Control Screen, which was adapted from the Y Balance Test, allowing an efficient and effective screen of how you stabilize, balance and control your movement.
While we employ the most recent and comprehensive techniques to rehabilitate our patients, get them performing at their best, and remaining on the field, there is much research that still needs to be done to determine the mechanisms at work and the best ways to improve them. Rest assured, we will continue to stay up to date on these developments to further improve patients’ outcomes and will share them as the field changes. Stay tuned!