Neuromuscular training after concussion clearance reduced further injury risk among athletes

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The findings indicate the risk of sports-related injuries for the year after a concussion among the control group was 3.6 times higher than the risk of injury in the group of athletes who completed the training.
The findings indicate the risk of sports-related injuries for the year after a concussion among the control group was 3.6 times higher than the risk of injury in the group of athletes who completed the training. File image © Mike Bain

An American study that explored ways to help reduce injury after a successful return to sport following concussion may lead to new treatment approaches and programs for individualized care.

The study by researchers at Children’s Hospital Colorado, published in the American Journal of Sports Medicine, looked at whether a neuromuscular training program reduced the risk of further injury.

While preliminary, the findings indicate the risk of sports-related injuries for the year after a concussion among the control group (athletes who did not participate in the neuromuscular training intervention) was 3.6 times higher than the risk of injury in the group of athletes who completed the training.

David Howell, lead researcher at the Sports Medicine Center at the hospital, and assistant professor in the Department of Orthopedics at the University of Colorado School of Medicine, conducted the single-site prospective randomized clinical trial along with a team of other investigators from the hospital’s Sports Medicine Center.

“It is important to understand that a concussion is a brain injury, but it is one that athletes can recover from,” he says. “However, prior research indicates athletes who are cleared after a concussion have a greater risk of subsequent sports-related injuries such as ACL tears or sprained ankles than those without a concussion.

“We want to understand the risks and potential ways to mitigate risks so kids can get back to safely doing the things they love.”

Persistent neuromuscular control deficits – trouble with balance, posture, reaction time, or other functions necessary for sports performance – have been documented after athletes are cleared to return to sports.

In previous studies, the research team found that athletes demonstrated post-concussion deficits that were detected when combining motor and cognitive measures. They also found that those deficits may take longer to resolve than symptoms and may contribute to a higher injury risk after a concussion.

In the study, 27 youth athletes were put through a progressive intervention including core strength training, multi-tasking performance and motor factors (balance, posture, attention, orienting, awareness and functional adaptability) over an eight-week period after clearance to return to playing sports.

For a year after returning from an injury, athletes kept a monthly log of sports-related injuries and organized sports competitions.

Preliminary data found that during the year after returning to sports following a concussion, time-loss sports-related injuries were more common among control group participants relative to neuromuscular training intervention group participants, despite similar levels of sports competition between the two groups over the year (75% of the control athletes sustained an injury versus 36% of the neuromuscular training intervention group).

“An injury to the brain impacts many different parts of the body and the severity is hard to judge,” Howell says.

“The brain is the core of who you are – it touches all facets of your life and has many different effects on individuals. Each athlete is on a recovery spectrum post-concussion, so we need to understand what interventions or treatments might work best for each individual.

“The clinical takeaway from this study was that a relatively simple and progressive intervention performed twice per week under the guidance of an athletic trainer can help keep athletes safe during a time after concussion where they may be potentially vulnerable to further injuries.”

After athletes were cleared to return to sports following a concussion, the group that undertook the intervention program enjoyed a significant protective effect in reducing time-loss, sports-related injury over the subsequent year.

Despite the study limitations, the findings provide initial promising evidence for clinicians to consider when developing return-to-play and rehabilitation programs for athletes who sustain a concussion.

It is the first phase of a two-part study. The next steps involve understanding if the same effects can be observed using a more accessible approach where the researchers ask athletes to perform a guided intervention using telehealth or smartphone technology.

“The hope is that under proper guidance of a sports medicine clinician or concussion specialist, this approach can be accessed by athletes who do not have everyday access to in-person rehabilitation,” Howell says.

The study was funded by the Children’s Colorado Research Institute Pilot Award Program.

An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial
David R. Howell, Corrine N. Seehusen, Patrick M. Carry, Gregory A. Walker, Sarah E. Reinking, Julie C. Wilson
The American Journal of Sports Medicine, January 21, 2022, DOI https://doi.org/10.1177/03635465211069372

 

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