The conversation about concussion in sport has justifiably increased over the last few years here in Australia, particularly in the AFL and NRL spheres. The association of multiple concussions with Chronic Traumatic Encephalopathy (CTE) and mental health disorders has been highlighted in the media. Concussion has also been associated with the increased risk of sustaining a musculoskeletal injury in the weeks immediately following return to sport. Concussions are a common occurrence in sports, and they require proper management to minimize the risk of secondary injuries. Understanding the odds ratio and timeframes associated with secondary injuries after a concussion is crucial for healthcare professionals, athletes, and coaches alike. A successful return to sport with a reduced chance of further time-loss due to injury associated with concussion is the topic of this blog.
The Odds Ratio for Secondary Injury
The odds ratio is a statistical measure that quantifies the likelihood of an event occurring in one group compared to another. In the context of concussion and secondary injuries, the odds ratio provides insight into the increased risk of sustaining subsequent injuries following a concussion.
Several studies have examined the odds ratio for secondary injury after a concussion in athletes. While the specific values may vary across studies, they consistently indicate an elevated risk compared to athletes without a history of concussion.
Concussed athletes were between 2.35 - 3.79 times more likely to have a subsequent musculoskeletal injury relative to non-injured controls.
While those who sustained multiple sports related concussions were three times more likely to sustain lower extremity injuries compared to those who sustained a single concussion and healthy controls.
Factors Influencing Timeframes for Secondary Injury
The timeframe for an athlete to sustain a secondary musculoskeletal injury after a concussion can vary depending on several factors. These factors include the severity of the initial concussion, the sport or activity being performed, the athlete's readiness to return to play, and the effectiveness of rehabilitation and injury prevention programs.
While the immediate aftermath of a concussion is marked by neurological symptoms and impairment, the vulnerability to secondary musculoskeletal injuries may persist beyond this acute phase. Neurological deficits, altered balance, decreased coordination, and diminished muscle control resulting from a concussion can increase the risk of subsequent musculoskeletal injuries.
The return-to-play process and the athlete's adherence to appropriate rehabilitation protocols play a crucial role in mitigating the risk of secondary musculoskeletal injuries. Rushing the return to sport without addressing underlying issues or fully restoring physical capabilities can significantly increase the likelihood of subsequent injuries.
Research suggests that the highest risk of secondary injury occurs within the initial weeks following a concussion. Specifically findings have found an increased odds of injury in the 90 days following return to sport.
Preventive Measures and Management Strategies
To reduce the odds of sustaining a secondary injury after a concussion, athletes, coaches, and healthcare professionals must implement preventive measures and appropriate management strategies. These may include:
Comprehensive Evaluation: Thoroughly assess the athlete's concussion history, symptoms, and recovery progress before considering a return to play.
Education and Awareness: Provide education on concussion signs, symptoms, and the importance of reporting head injuries promptly. Promote a culture of safety and encourage athletes to prioritize their long-term well-being.
Rest and Recovery: Allow adequate time for complete recovery before gradually reintroducing physical activity.
Protective Equipment: Encourage the use of appropriate protective equipment, mouthguards, and other sport-specific gear. The use of headgear in AFL and NRL has been found to have no impact on reducing the severity of sports related concussion.
Supervision and Monitoring: Ensure proper medical supervision during the recovery process and closely monitor athletes for any signs of symptom exacerbation or cognitive decline.
The vulnerability to secondary injury is highest within the initial weeks, but caution should be exercised throughout the recovery process. By implementing preventive measures, adhering to proper management strategies, and prioritising athlete safety, the risk of secondary injuries can be mitigated, facilitating a safer return to sport.
If you have suffered a sports related concussion and would like advice and guidance on return to sport, contact the TMJ and Headache Clinic.