The interaction between neck pain and known determinates of delayed return to play among NCAA student-athletes: a CARE consortium study

Background: Acute neck pain following a concussion has been identified as a symptom associated with a delay in symptom resolution and persistent post-concussion symptoms (PPCS), but little is known about the relationship between the presence of acute neck pain and other known risk factors of delayed return to play (RTP) such as sex, sport contact level, and race. Methods: This study reports the findings of a secondary data analysis of a prospective cohort study sample from the Concussion Assessment, Research, and Education (CARE) Consortium. We examined the possible mediating effects of neck pain severity on known factors of delayed RTP (sex, sport contact level, and race) following a suspected concussion. Results: While neck pain was identified as significant predictor of delayed RTP (b =.046, S.E. =.021, Wald χ²(1) = 4.745, p = 0.029), no interaction effect was observed between neck pain and the explored mediating factors of sex, sport contact level, and race. Conclusions: These results suggest that independent of an individual’s sex, sport contact level, and/or race, the presence of neck pain following a suspected concussion should be further evaluated and differentially diagnosed to rule out comorbid pathologies that may be contributing to PPCS following a suspected concussion.