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By Dr. Eduardo Enriquez

Concussion Increase the Risk of Subsequent Musculoskeletal Injuries
A systematic review of 12 research papers, from Tennessee State University Department of Physical Therapy, revels that athletes that suffered a concussion, in a variety of sports increase the risk of further subsequent injuries.
A concussion is a “complex pathological process induced for traumatic forces secondary to direct or indirect forces to the head that disrupt the function of the brain” It is classified as a mild traumatic brain injury where lineal an rotational acceleration of the brain occur in relation to the skull, producing shear forces that damage the cellular components of the brain and the cortical and subcortical pathways.
Symptoms include altered mental status, headaches, nausea, vomiting, dizziness, diminished balance, fatigue, difficulty sleeping, drowsiness, sensitivity to light and noise, blurred vision, memory deficit, and difficulty concentrating.
An estimated 1.6 to 3.8 million sport related concussions result in 250,000 visits to the emergency room, every year
Twenty to 30% of high school football players will sustain at least one concussion, however this represents diagnosed concussions, not including the ones unreported due to difficulty recognizing the signs and symptoms.
Short term complications include second impact syndrome, as the athlete is 3 or 4 times more likely to sustain another concussion within 7 to 10 days, especially if they return to sports too soon.
Long term complications include chronic traumatic encephalopathy and Alzheimer’s disease.
There’s variability in the recovery statistics, 80% of individuals demonstrated a significant reduction of neurologic symptoms within 3 weeks, although children and adolescents make take longer to recover. The average length to return to sports ranges from 9 to 18 days.
Motor changes also occur post-concussion, with gait, balance, and dynamic stability. These motor changes may increase the risk of musculoskeletal injuries if the athlete is not screened properly, rehabilitated sufficiently or premature return to competition.
The definition of Motor Control is a complex process that involves the brain, muscles, limbs, and often external objects. It underlies motion, balance, stability, coordination, and our interaction with others and technology. Motor control may be affected by a compromise neural function after a concussion and these decrease the responsiveness of the neurological system. Example of it is joint kinematics, balance, dynamic stability, gait deviation, navigating obstacles and dual task performance.
Kinematics changes, is characterized for lower extremity stiffness during a single leg jump or single leg stance activities were noted post-concussion. Using a force plate 3D motion is possible to capture an analyzed hip, knee and ankle kinematics during a single leg jump from a 25cm step. Concussion athletes had decrease overall leg stiffness and a delay quadriceps activation that potentially suggest an increased risk for knee and ankle ligamentous sprains or meniscal tear due altered landing mechanics.
Impaired balance, dizziness and postural instability are all acute symptoms following a concussion due to somatosensory, visual, and vestibular impairment. Intra cortical inhibition of the motor cortex (area of the brain that controls mobility) has been documented one-year post concussion. Diminished joint proprioception (deep feeling information) has also been reported producing changes in balance and stability.
Gait deviation and the capacity to navigate obstacles is another of the symptoms of post traumatic concussion. The most common gait deficit was decrease of speed and increase of sway, resulting in decreased anticipatory postural adjustment, increasing risk of new injury. During obstacle concussed athletes demonstrated a more conservative of center of gravity even 14 to 28 day post injury, possible for an increase of contraction of the spinal stabilizer as compensator measure. Consider that statistically 80% to 90% of the athletes return to competition 7 to 10 post-concussion, this finding suggests that the ability to navigate obstacles still impaired, leading to increased risk for new injuries. Moreover, cortical resources of the brain to react quickly are affected post-concussion. That includes the difficulty with visual field processing, reduction of visual field, and difficulty to react to changes in the external environment. Dual performing is often measured by introducing auditory interference question and answer task, cognitive and obstacles task and changing directions. Noticeable changes during dual task gait include, increase sway and decrease gait speed and decrease of dynamic stability. A deficit during sport related activities (Cutting, jumping, running etc.) was observed up to one-year post concussion, even when single task gait was normal and the patient was cleared to play sports. Athletes need high processing to meet the demand of the sport, but a concussion decreases the ability to perform complex dual movements thereby increasing the risk for injury. Be sure that the athlete does not have a deficit in motor control, this is an important element to reintegrate him or her to the sport. Field rehabilitation must be encouraged as final process in the recuperation.

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