Lower Extremity Musculoskeletal Injuries After Concussion in Collegiate Student-Athletes

Thomas A. Buckley, Avinash Chandran*, Timothy C. Mauntel, Zachary Yukio Kerr, Derek W. Brown, Adrian J. Boltz, Daniel C. Herman, Eric E. Hall, Robert C. Lynall

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: An association has been identified between concussion and lower extremity musculoskeletal injury (LEMSKI) after return to sports participation. However, the collegiate student-athlete studies have relied on relatively small single-institution studies, which limits generalizability. Purpose: To assess odds of, and time to, LEMSKI after concussion in US collegiate athletes, using the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). Study Design: Descriptive epidemiology study. Methods: Data from the NCAA ISP during the 2010-2011 through 2019-2020 athletic seasons were considered for analysis. Frequency distributions were examined for details related to the initial and subsequent injuries (injuries to bone, bursa, joint, ligament, muscle, or tendon). Multivariable logistic regression models and random-effects Poisson regression models examined odds of time loss (TL) and non–time loss (NTL) LEMSKI after concussion, as well as the time interval between initial concussion and subsequent LEMSKI in a single athletic season, or initial musculoskeletal injury (MSKI) and subsequent LEMSKI in a single athletic season. Analyses were performed separately for football and other sports. Results: A total of 31,556 initial injuries were recorded (football: 11,900; other sports: 19,656), which were followed by 0 or 1 injury in the same season. Overall, first injury type was not a significant predictor of subsequent LEMSKI, although certain contrasts yielded significant estimates. In football, the odds of NTL LEMSKI were higher after concussion than after upper extremity MSKI (UEMSKI; adjusted odds ratio [ORAdj], 1.56; 95% CI, 1.06-2.31). In football, the odds of TL LEMSKI were lower after concussion than after UEMSKI (ORAdj, 0.71; 95% CI, 0.51-0.99). No other significant effect estimates were observed for football or other sports. Conclusion: First injury type, either concussion or upper extremity, was not associated with an elevated risk of LEMSKI. Specifically, the results of this study did not identify an elevated odds of LEMSKI after a concussion. However, the authors observed greater odds of NTL LEMSKI and lower odds of TL LEMSKI in football.

Original languageEnglish
Pages (from-to)511-519
Number of pages9
JournalAmerican Journal of Sports Medicine
Issue number2
StatePublished - Feb 2023
Externally publishedYes


  • injury prevention
  • mild traumatic brain injury
  • postural control


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