When should an athlete retire or discontinue participating in contact or collision sports following sport-related concussion? A systematic review

The Co-Occurrence of Vestibular/Ocular Motor Provocation and State Anxiety in Adolescents and Young Adults with Concussion

Vestibular/ocular motor provocation and state anxiety are both independently linked to poor recovery outcomes following concussion. However, the relationship between these two clinical presentations and their co-occurring effects on concussion recovery outcomes is understudied. The purpose was to examine the co-occurring effects of vestibular/ocular motor provocation and state anxiety following concussion. There were 532 participants (15-25 years) with concussions who completed the vestibular/ocular motor screening (VOMS), State-Trait Anxiety Inventory, and the Post-Concussion Symptom Scale within 30 days of injury. Participants were classified into provocation (PROV) and no provocation (NO PROV) groups based on exceeding/not exceeding VOMS cutoffs. An analysis of covariance was used to examine between-group comparisons on state anxiety scores; and logistic regressions, with adjusted odds ratios (Adj OR), were used to evaluate predictors of clinical levels of state anxiety and protracted recovery. A total of 418 participants (78.6%; age = 17.2 ± 2.6; 65% female) exceeding VOMS cutoffs were in the PROV, and 114 (21.4%; age = 16.6 ± 2.2; 53% female) participants were in the NO PROV group. The PROV group (mean [M] = 39.50, standard deviation [SD] = 12.05) exhibited significantly higher state anxiety scores than the NO PROV group (M = 32.45, SD = 10.43) (F[1, 532] = 15.36, p < 0.001, η2= 0.03). Vestibular/ocular motor provocation (Adj OR =3.35, p < 0.001, 95% confidence interval [CI]: 1.42-3.88) was the most robust predictor of clinical state anxiety following concussion (χ2 [4, 532] = 86.78, p < 0.001). Participants exhibiting vestibular/ocular motor provocation with clinical levels of state anxiety were at 2.47 times (p < 0.001, 95% CI: 1.53-3.99) greater odds of experiencing a protracted concussion recovery than participants with vestibular/ocular motor provocation without clinical state anxiety. Vestibular/ocular motor provocation is associated with increased state anxiety following concussion, and the addition of clinical state anxiety to vestibular/ocular motor provocation increases the odds for protracted recovery. Clinicians should assess vestibular/ocular motor function and anxiety following concussion.

Smirl J, Emery CA. Consequences of adolescent sport-related concussion: exploring long-term cardiorespiratory fitness and adiposity

BACKGROUND

Little is known regarding long-term consequences (≥5 years) of sport-related concussion (SRC) sustained during adolescence. Adolescent SRC has been linked to athlete considerations of sport participation and subsequent retirement from sport during this critical developmental period. Prolonged SRC symptoms can reduce ability to perform physical activity, and research suggests inactivity can extend years post-injury. Therefore, SRC may affect long-term physical activity, which may result in decreased cardiorespiratory fitness and increased adiposity.

OBJECTIVES

(1) To examine cardiorespiratory fitness, adiposity and associations with physical activity between three groups: adolescent SRC 5-15 years prior; adolescent musculoskeletal injury (MSK) 5-15 years prior; and individuals who played adolescent sport but were uninjured. (2) To explore whether biological sex-modified relationships assessed by the primary objective.

METHODS

Young adults (16-33 years old) who sustained SRC (n = 54) or MSK (n = 52) during adolescent sport and uninjured individuals (n = 50) were recruited (n = 156) from previous Sport Injury Prevention Research Centre studies and word-of-mouth. Participants completed a cycle-ergometer maximal exertion test, dual-energy X-ray absorptiometry scanning, and wore actigraphs for 1-week post-testing. Outcome measures of cardiorespiratory fitness [peak oxygen consumption (VO2peak[ml/min])] and adiposity [fat mass index (FMI)] were examined in relation to cohort, sex, time since injury, lean mass index and moderate-to-vigorous physical activity [daily MVPA (min)] via multiple linear regression.

RESULTS

In relation to the uninjured cohort, MSK (mean difference = 297.14 ml/min; β = 2.88; 95%CI: 0.99-4.76, p = 0.003) and SRC (mean difference = 268.01 ml/min; β = 2.61; 95%CI: 0.77-4.44, p = 0.006) cohorts demonstrated higher VO2peak and this did not differ based on biological sex. FMI did not differ for MSK (mean difference= -0.10 kg/m2; β= -0.02; 95%CI: -0.22-0.18, p = 0.847) or SRC (mean difference=-0.22 kg/m2; β= -0.05; 95%CI: -0.24-0.15, p = 0.642) cohorts relative to the uninjured cohort for both males and females.

CONCLUSIONS

It is possible to maintain adequate long-term cardiorespiratory fitness and adiposity following adolescent SRC relative to those who only sustained sport related MSK injuries or did not sustain significant injuries as adolescents/adults.

Case Characterization and Perceptions of Athletic Trainers Regarding Medical Disqualification Following Concussion

CONTEXT

Medical disqualification (MDQ) following concussion is a challenging decision clinicians may encounter with little evidence-based guidance.

OBJECTIVE

To (1) describe the MDQ following concussion cases athletic trainers (ATs) have been involved in, (2) describe beliefs about MDQ following concussion, and (3) explore factors that ATs believed should be involved in the MDQ following concussion process.

DESIGN

Mixed methods.

SETTING

Online cross-sectional survey with follow-up semistructured interviews.

PATIENTS OR OTHER PARTICIPANTS

Athletic trainers (n = 502) employed at the collegiate setting completed a survey (completion rate = 82.3%, n = 413/502; men = 175, 34.9%; women = 235, 46.8%, prefer not to answer = 4, 0.8%; no response = 88, 17.5%; age = 35.3 ± 10.8 years). Twenty participants were also interviewed (men = 13, 65.0%; women = 7, 35.0%; average age = 40.7 ± 11.0 years).

DATA COLLECTION AND ANALYSIS

Participants completed a cross-sectional survey comprised of 3 sections of MDQ experience and specific case information, MDQ beliefs, and demographic items. We also interviewed participants who completed the survey and indicated involvement in at least 1 MDQ following a concussion case. We addressed aims 1 and 2 using descriptive statistics and aim 3 with a 5-cycle content analysis.

RESULTS

Nearly half of respondents had been involved in an MDQ case following concussion (49.0%, n = 246; not involved = 51.0%, n = 256). Athletic trainers who had been involved in at least 1 MDQ case were involved in an average of 2.3 ± 1.9 cases (n = 241). Participants often described many factors that they believed should influence the MDQ decision, including sport type, concussion history and recovery, health-related quality of life, and academic performance.

CONCLUSIONS

Our findings highlight that nearly half of participants were involved in an MDQ case following concussion and navigated this process without guidelines. Given this, multiple factors were considered to evaluate the patient's well-being holistically. The number of ATs involved in MDQ cases following concussion and factors that guided this process warrant further research to develop evidence-based recommendations that assist clinicians in these difficult decisions.

Optimizing sports performance in China: Investigating the influence of training, recovery, motivation, and environmental support within a moderation-mediation framework

The expansion of sports in China is astounding. Given the country's focus on athletic achievement, it is crucial to comprehend the different facets of sports. This research examines China's athletic success in training, recuperation, motivation, and environment. The moderation-mediation strategy is used to understand how these variables affect athletic performance. This study fills a gap in understanding Chinese players' on-field performance. The study examined 355 Chinese athletes from various regions and sports. The sample has a balanced gender distribution, diverse age distribution, and representation from various regions. Furthermore, training programs, recovery strategies, motivation, psychological well-being, support systems, and experience levels influence athletes' sports performance. The study reveals that the coefficients indicate that training, recuperation tactics, motivation, and support systems affect athletic performance. Psychological health emerges as a critical mediator in explaining the effects of these factors on performance outcomes. Additionally, athlete experience moderates the influence of these variables, highlighting nuanced differences. These findings offer crucial insights for enhancing the performance of Chinese athletes. By adopting a moderation-mediation approach, this research illuminates the interconnected dynamics among key components, enriching our understanding of avenues for athlete improvement. Specifically, the results underscore the interconnectedness of athletes' psychological well-being, on-field experience, and competitive performance, emphasizing the importance of tailored interventions. This study could help Chinese politicians, sports psychologists, and coaches enhance athletes' performance.

The Postconcussion Syndrome and Posttraumatic Headaches in Civilians, Soldiers, and Athletes

Posttraumatic headaches are one of the most common and controversial secondary headache types. After a mild traumatic brain, an estimated 11% to 82% of people develop a postconcussion syndrome, which has been controversial for more than 160 years. Headache is estimated as present in 30% to 90% of patients after a mild head injury. Most headaches are tension-type-like or migraine-like. Headaches in civilians, soldiers, athletes, and postcraniotomy are reviewed. The treatments are the same as for the primary headaches. Persistent posttraumatic headaches can continue for many years.

The Effect of Primary ACL Reconstruction on Career Longevity in English Premier League and Championship Soccer Players Compared With Uninjured Controls: A Matched Cohort Analysis

BACKGROUND

Because of the multitude of variables that affect the retirement decisions of professional soccer players, it has proven difficult to isolate the effect of undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) on career longevity.

PURPOSE

To compare the career longevity of professional soccer players after a primary ACLR with that of an uninjured matched control cohort.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A retrospective review of a consecutive series of primary ACLR was performed between 2008 and 2018 in professional male soccer players from the senior author's practice. Each athlete with ACLR was matched to 3 control athletes who had not undergone ACLR according to age, league, playing position, and preinjury game appearances/minutes played. Player career statistics-including league, game appearances, and game minutes-were compiled for each year until retirement or July 1, 2022.

RESULTS

A total of 82 soccer players in the English Premier League or Championship at the time of their primary ACLR were matched to 246 control athletes. The mean career length after ACLR was 6 ± 2.6 years, while that of the matched control athletes was 7.6 ± 2.8 years (P < .001). After primary ACLR, an athlete had a 2 times greater chance of retirement compared with the matched control athlete (hazard ratio, 2.19; P < .001). At 5 years after ACLR, 16% of athletes had retired from professional soccer, while 8.5% of the matched cohort were retired (P = .060). By 10 years, 72% of the ACLR cohort had retired compared with 43% of the matched cohort (P < .001). Forwards were more likely to have shortened careers compared with goalkeepers (P = .021); however, no significant differences were observed between midfielders, defenders, and forwards. Within the ACLR cohort, a contralateral ACL tear during the athlete's career caused a 2.30 times (P = .022) increased chance of retirement compared with athletes with only 1 ACL tear during their career. Mechanism of injury, meniscal pathology, graft rerupture, and chondral lesions did not affect career length.

CONCLUSION

Professional male soccer players who underwent ACLR had decreased career length by approximately 1.6 years compared with a matched player cohort.

Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023

The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.

Improving outcome after paediatric concussion: challenges and possibilities

The term concussion has permeated mainstream media and household vocabulary mainly due to awareness regarding the risks of concussion in professional contact sports, yet it occurs across a variety of settings and ages. Concussion is prevalent in infants, preschoolers, children, and adolescents, and is a common presentation or reason for referral to primary care providers, emergency departments, and specialised trauma clinics. Its broad range of symptoms and sequelae vary according to multiple individual, environmental, and clinical factors and can lead to health and economic burden. More than 20 years of research into risk factors and consequences of paediatric concussion has revealed as many questions as answers, and scientific work and clinical cases continue to expose its complexity and heterogeneity. In this Review, we present empirical evidence for improving outcome after paediatric concussion. We consider work pertaining to both sports and other injury mechanisms to provide a perspective that should be viewed as complementary to publications focused specifically on sports concussion. Contemporary challenges in prevention, diagnosis, prognosis, and intervention are discussed alongside pathways and future directions for improving outcome.

The National Football League and traumatic brain injury: blood-based evaluation at the game

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