CHICAGO — While the American Medical Association made headlines here last week during its annual meeting with statements regarding government health policies, the American Physical Therapy Association also held its annual conference in this city, attracting far less attention.
The APTA meeting featured sessions for educators but also for clinicians who specialize in balance disorders, geriatrics, neurology, oncology, orthopedics, pain, pediatrics and sports, among others. However, one diagnosis was the subject of more lectures than any other, drawing the attention of balance, neurologic, orthopedic and sports specialists alike: concussion.
What the physical therapists learned about the latest research on concussion should be of just as much interest to athletes, coaches and parents.
In short, concussions — even those that are seemingly minor — should never be taken lightly.
According to multiple studies, 80 percent of adult concussion victims are well within two weeks, while a similar percentage of teenagers will be well within a month. Or so it seems.
Their symptoms may be gone. Their cognitive baseline testing may be back to normal. Still, a disturbing trend is emerging among concussion victims: In the days, months, even years after returning to sport or active duty in the military, they risk suffering serious injury to the lower extremity. Most commonly, they incur torn knee ligaments, strained thigh muscles, broken bones and sprained ankles.
Speaking Saturday morning, Tennessee State physical therapy professor Derek Charles and Elon University physical therapy professor Crystal Ramsey reported that athletes — regardless of level — are 2.5 times more likely to suffer a lower extremity injury for at least a year after a concussion. They cited numerous studies to illustrate.
A study out of the University of Wisconsin in 2016 showed 87 concussed collegiate athletes were at that higher risk for at least 90 days.
That same year, a study of 810 professional rugby players in Great Britain revealed a 60 percent higher risk of a leg injury for the remainder of the season in which a concussion was suffered.
A year later, a three-year study of over 18,000 high school athletes across 27 sports in 26 states was published in the Journal of Athletic Training. That investigation found a 34 percent increase in lower extremity injuries severe enough to result in time lost from competition.
Finally last year, a study was published in the Journal of Orthopaedic and Sports Physical Therapy that followed 11,522 active duty soldiers for at least two year after they had experienced a concussion sometime between 2005 and 2011. They were then closely matched for age, gender, rank and type of duty with 11,522 soldiers who had never suffered a concussion. Ultimately, the study revealed a 45 percent higher risk of leg injury during the first 15 months post-concussion and a 38 percent higher risk over the course of two full years.
The apparent culprit for all these injuries? Impaired coordination that is subtle and difficult to measure.
As their lecture began, Charles and Ramsey asked if athletes were being returned to play too soon following concussion. The data they then cited seems to suggest that the answer is yes. However, they also acknowledged that it is not practical to sideline athletes and soldiers — who feel “fine” — for a year or two after a concussion.
Instead, they recommended, “Contact sport athletes should have cognitive and neuromuscular testing as a baseline for comparison.”
Cognitive baseline tests, such as ImPACT, are common among high school athletic programs. Neuromuscular baseline tests, those that purport to measure balance and coordination, are less widely in use. There are a great many of them; they are time-consuming; they offer varying reliability; and no single one has gained the acceptance that ImPACT has.
Until one such test gains widespread acceptance, this epidemic of post-concussion orthopedic injuries will continue.