title: Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes.
abstract: BACKGROUND
  Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury.
  
  
  OBJECTIVE
  The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion.
  
  
  METHODS
  Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position.
  
  
  RESULTS
  Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90-6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41).
  
  
  CONCLUSIONS
  The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA. hermadc@ortho.ufl.edu.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Herman
authors.affiliation: UF Health Rehab Center, Orthopaedics and Sports Medicine Institute, Gainesville, FL, USA.
authors.forename: Debi
authors.initials: D
authors.lastname: Jones
authors.affiliation: ProFormPT, Maitland, FL, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Harrison
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA.|University of Florida Athletic Association, University of Florida, Gainesville, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Moser
authors.affiliation: UF Health Rehab Center, Orthopaedics and Sports Medicine Institute, Gainesville, FL, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Tillman
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, PO Box 112727, Gainesville, FL, 32611, USA.|University of Florida Athletic Association, University of Florida, Gainesville, FL, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Farmer
authors.affiliation: University of Texas Athletics, Austin, TX, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Pass
authors.affiliation: University of Florida Athletic Association, University of Florida, Gainesville, FL, USA.|Department of Community Health and Family Medicine, Student Health Care Center, University of Florida, Gainesville, FL, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Clugston
authors.affiliation: College of Veterinary Sciences, University of Florida, Gainesville, FL, USA.
authors.forename: Jorge
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: TRIA Orthopedic Center, Bloomington, MN, USA.|Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
authors.forename: Terese L
authors.initials: TL
authors.lastname: Chmielewski
mesh_terms: D000328:Adult; D056352:Athletes / Q000706:statistics & numerical data*; D001265:Athletic Injuries / Q000453:epidemiology*; D001490:Basketball / Q000293:injuries; D001924:Brain Concussion / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005538:Football / Q000293:injuries; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D012916:Soccer / Q000293:injuries; D013334:Students / Q000706:statistics & numerical data; D014495:Universities; D055815:Young Adult