{"id":10622,"date":"2023-06-19T06:00:13","date_gmt":"2023-06-19T05:00:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=10622"},"modified":"2023-06-14T09:53:02","modified_gmt":"2023-06-14T08:53:02","slug":"are-we-as-clinicians-playing-our-part-to-address-the-increased-injury-risk-following-a-sports-related-concussion","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2023\/06\/19\/are-we-as-clinicians-playing-our-part-to-address-the-increased-injury-risk-following-a-sports-related-concussion\/","title":{"rendered":"Are we as clinicians playing our part to address the increased injury risk following a Sports-Related Concussion?"},"content":{"rendered":"<p><span style=\"text-decoration: underline\"><strong><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-10624 aligncenter\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/physios-in-sport-logo.jpeg\" alt=\"\" width=\"135\" height=\"151\" \/><\/strong><\/span><\/p>\n<p><span style=\"text-decoration: underline\"><strong>Active rehabilitation and graded exercise rather than physical rest may help reduce the increased injury risk reported in many recent studies.\u00a0<\/strong><\/span><\/p>\n<p><b>Keywords:<\/b><span style=\"font-weight: 400\"> Sports-Related Concussion, Rehabilitation, Injury risk<\/span><\/p>\n<p><span style=\"font-weight: 400\">Sports-Related Concussion (SRC) may increase subsequent injury risk (1\u20133), with disturbances to the neuromuscular control system often theorised as a contributing factor (4).\u00a0 Outside elite sport, protocols advise 14-days physical rest and 5-days graded Return To Play (RTP). Despite a link between high acute-on-chronic workload ratios and increased injury risk (5), little attention has been given to the effect of no physical exercise for 14 days and RTP shortly after this.\u00a0 This blog will go on to explore this further.<\/span><\/p>\n<p><b>What may be causing the increased injury risk?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Neuromuscular control whilst performing complex tasks (often under fatigue) are qualities required for sporting activities. Impaired ability to perform these may increase injury risk (4),In particular, impaired neuromuscular control (6,7) has been associated with risk of cruciate ligament injury and deficient balance has been linked to ankle injury (8,9). Injury risk after SRC may be due to a variety of reasons:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Altered balance:<\/b><span style=\"font-weight: 400\"> slow or inappropriate response to perturbations from impaired proprioception, motor control, Vestibular-Ocular-Motor (VOM) function and reduced strength (10\u201315).<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Poor movement patterns:<\/b><span style=\"font-weight: 400\"> altered processing of sensory feedback and feedforward mechanisms alter motor control, coordination, postural stability and agility (16,17).\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Slower reactions:<\/b><span style=\"font-weight: 400\"> altered integration and processing of stimuli and VOM dysfunction may alter anticipatory muscle activation and speed to react to others (18,19).\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Reduced strength:<\/b><span style=\"font-weight: 400\"> altered neural activity may reduce max strength and rate of force development, impairing movement efficiency (20,21).<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Neurocognitive function:<\/b><span style=\"font-weight: 400\"> reaction time and motor processing speed deficits may impair decision-making, affecting neuromotor (22\u201328) and sensorimotor control (1).\u00a0\u00a0\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Dual task activities:<\/b><span style=\"font-weight: 400\"> reduced physical and\/or cognitive performance (29,30) may negatively affect physical performance whilst making strategic decisions.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Physical loading tolerance:<\/b><span style=\"font-weight: 400\"> returning to too much load too quickly has been linked to increased injury risk (5).\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Deficits have been reported up to 90 days post injury (11,31) and long after athletes have RTP (32,33).\u00a0 Despite these factors, many graded RTP protocols do not suggest focusing on any of the above aspects during or after RTP, this could leave athletes unable to cope with the demands of their sport.\u00a0\u00a0<\/span><\/p>\n<p><b>How does this inform my practice?<\/b><\/p>\n<p><span style=\"font-weight: 400\">Extending SRC rehabilitation beyond the standardised protocols may reduce subsequent injury risk.\u00a0 Several assessments have been researched\/studied, many detecting more than one dysfunction, and dysfunction of one system interacting and impairing function of another.\u00a0 For example, dysfunction of the cervical spine may produce, or contribute to, VOM dysfunction, consequently altering balance and coordination (34).\u00a0 Hence, clinicians should be aware treatment of a singular dysfunction may not resolve symptoms, and a multi-faceted approach to assessment and treatment is warranted (35\u201337).\u00a0 The Post-Concussion Symptom Scale may help clinicians to select which assessments are higher priority, depending on what type of symptoms are reported (Figure 1).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10627\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.14.03-300x163.png\" alt=\"\" width=\"426\" height=\"231\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.14.03-300x163.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.14.03-768x418.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.14.03-640x348.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.14.03.png 1298w\" sizes=\"auto, (max-width: 426px) 100vw, 426px\" \/><\/p>\n<p><span style=\"font-weight: 400\">Using a symptom-based approach to assessment, clinicians can start a targeted approach to rehabilitation and monitoring after RTP, depending on what dysfunctions are present.\u00a0 For example;<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Vestibular and cervical rehabilitation has been shown to improve VOM dysfunction (34).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Exercise intolerance can be treated with a graded increment of aerobic exercise (38).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Dual task exercises may restore motor control, postural stability and ability to complete dual task activities (4).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Strengthening neck and global muscle groups may reduce injury risk when returning to sport (39).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Returning athletes to adequate loading prior to RTP will ensure the load is adequate to meet the demands of their sport.<\/span><\/li>\n<\/ul>\n<p><b>Conclusion\u00a0<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">SRC increases subsequent injury risk through a variety of mechanisms.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Motor control, spatial awareness, dual task activities, and reaction times may be affected long after athletes have RTP.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A multi-faceted approach to assessment and rehabilitation during and following RTP may reduce injury risk.<\/span><\/li>\n<\/ul>\n<p><strong>Take home messages:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-10623\" src=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08-300x214.png\" alt=\"\" width=\"518\" height=\"369\" srcset=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08-300x214.png 300w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08-768x547.png 768w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08-640x456.png 640w, https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08.png 1514w\" sizes=\"auto, (max-width: 518px) 100vw, 518px\" \/><\/p>\n<p><b>Authors and Affiliations<\/b><\/p>\n<p><span style=\"font-weight: 400\">Kerry Glendon<\/span><span style=\"font-weight: 400\">a*<\/span><span style=\"font-weight: 400\">, Glen Blenkinsop<\/span><span style=\"font-weight: 400\">a<\/span><span style=\"font-weight: 400\">, Antonio Belli<\/span><span style=\"font-weight: 400\">b<\/span><span style=\"font-weight: 400\">, and Matthew Pain<\/span><span style=\"font-weight: 400\">a<\/span><\/p>\n<p><i><span style=\"font-weight: 400\">a<\/span><\/i><i><span style=\"font-weight: 400\">School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK;\u00a0<\/span><\/i><\/p>\n<p><i><span style=\"font-weight: 400\">b<\/span><\/i><i><span style=\"font-weight: 400\"> Institute of Inflammation and Ageing, University of Birmingham, UK<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">*Physios in Sport Association: <\/span>supports<span style=\"font-weight: 400\"> Chartered Physiotherapists who are interested in and or work in Sports &amp; Exercise Medicine.\u00a0 Please follow this <\/span><a href=\"https:\/\/www.physiosinsport.org\/courses\/acpsem-golden-jubilee-conference2023.html\"><span style=\"font-weight: 400\">link<\/span><\/a><span style=\"font-weight: 400\"> to find out more information about their upcoming Golden Jubilee event on 1st July, which is open to all professions.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Authors have no competing interests.\u00a0<\/span><\/p>\n<p><b>References<\/b><\/p>\n<ol>\n<li><span style=\"font-weight: 400\">McPherson AL, Nagai T, Webster KE, Hewett TE. 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Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29127267<\/span><\/li>\n<li><span style=\"font-weight: 400\">Schneider KJ. Concussion &#8211; Part I: The need for a multifaceted assessment. Musculoskelet Sci Pract. 2019 Jul 1;42:140\u201350.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Brown L, Camarinos J. The Role of Physical Therapy in Concussion Rehabilitation. Semin Pediatr Neurol. 2019 Jul 1;30:68\u201378.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Schneider KJ. Concussion part II: Rehabilitation \u2013 The need for a multifaceted approach. Musculoskelet Sci Pract [Internet]. 2019 Jul 1 [cited 2020 Feb 4];42:151\u201361. Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2468781219300177<\/span><\/li>\n<li><span style=\"font-weight: 400\">Leddy JJ, Hinds A, Sirica D, Willer B. The Role of Controlled Exercise in Concussion Management. Am Acad Phys Med Rehabil [Internet]. 2016 Mar [cited 2020 Feb 4];8(3):S91\u2013100. Available from: http:\/\/dx.doi.org\/10.1016\/j.pmrj.2015.10.017<\/span><\/li>\n<li><span style=\"font-weight: 400\">Eckersley CP, Nightingale RW, Luck JF, Bass CR. The role of cervical muscles in mitigating concussion. J Sci Med Sport [Internet]. 2019 Jan 18 [cited 2019 Mar 19]; Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1440244018309915<\/span><\/li>\n<\/ol>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Active rehabilitation and graded exercise rather than physical rest may help reduce the increased injury risk reported in many recent studies.\u00a0 Keywords: Sports-Related Concussion, Rehabilitation, Injury risk Sports-Related Concussion (SRC) may increase subsequent injury risk (1\u20133), with disturbances to the neuromuscular control system often theorised as a contributing factor (4).\u00a0 Outside elite sport, protocols advise [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bjsm\/2023\/06\/19\/are-we-as-clinicians-playing-our-part-to-address-the-increased-injury-risk-following-a-sports-related-concussion\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":463,"featured_media":10623,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[8271,16068],"class_list":["post-10622","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-concussion","tag-featured"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Are we as clinicians playing our part to address the increased injury risk following a Sports-Related Concussion? - BJSM blog - social media&#039;s leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=10622\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Are we as clinicians playing our part to address the increased injury risk following a Sports-Related Concussion? - BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Active rehabilitation and graded exercise rather than physical rest may help reduce the increased injury risk reported in many recent studies.\u00a0 Keywords: Sports-Related Concussion, Rehabilitation, Injury risk Sports-Related Concussion (SRC) may increase subsequent injury risk (1\u20133), with disturbances to the neuromuscular control system often theorised as a contributing factor (4).\u00a0 Outside elite sport, protocols advise [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bjsm\/?p=10622\" \/>\n<meta property=\"og:site_name\" content=\"BJSM blog - social media&#039;s leading SEM voice\" \/>\n<meta property=\"article:published_time\" content=\"2023-06-19T05:00:13+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bjsm\/files\/2023\/06\/Screenshot-2023-06-14-at-20.10.08.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1514\" \/>\n\t<meta property=\"og:image:height\" content=\"1078\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"bjsm\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"bjsm\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622\"},\"author\":{\"name\":\"bjsm\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#\\\/schema\\\/person\\\/02b7ae2dae6231c8629aa4da74bb9e6b\"},\"headline\":\"Are we as clinicians playing our part to address the increased injury risk following a Sports-Related Concussion?\",\"datePublished\":\"2023-06-19T05:00:13+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622\"},\"wordCount\":2081,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/files\\\/2023\\\/06\\\/Screenshot-2023-06-14-at-20.10.08.png\",\"keywords\":[\"Concussion\",\"featured\"],\"articleSection\":[\"General\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bjsm\\\/?p=10622\",\"name\":\"Are we as clinicians playing our part to address the increased injury risk following a Sports-Related Concussion? 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