The effect of concussion on subsequent musculoskeletal injury risk in high school athletes

Background Studies have demonstrated an increased risk of musculoskeletal (MSK) injury after concussion in collegiate and professional athletes, but there has been relatively little study of this relationship in younger athletes. Objective To determine the odds of experiencing a subsequent MSK injury after concussion in high school athletes. It was hypothesized that concussion would increase the risk of MSK injury within 365 days of the concussion event. Design Retrospective observational study. Setting Twelve high school sports programs. Participants Athletes (n = 14,461) from athletic training room records queried between 2010 and 2017. Independent Variables History of concussion and history of concussion and MSK injury in the year preceding MSK injury. Main Outcome Measures General estimating equation analyses were conducted to examine the odds of MSK injury related to (1) concussion within the preceding 365 days of injury; and (2) concussion and MSK injury within the preceding 365 days of concussion. Results Respectively, 8% and 8.3% of athletes were identified with a concussion and MSK injury. After controlling for gender and sport, athletes with a concussion and prior MSK injury (odds ratio = 2.19, 95% confidence interval: 1.02–4.67) and athletes with a concussion alone (odds ratio = 1.67, 95% confidence interval: 1.15–2.44) both had higher odds of experiencing a subsequent MSK injury compared to athletes without prior concussion. Conclusions High school athletes who sustain a concussion have elevated odds of MSK injury at rates comparable to those for collegiate athletes. These findings support the use of neuromuscular–based rehabilitation and injury prevention protocols in the post‐concussion period. These findings may also suggest exploring methods to modify concussion return‐to‐play criteria with the goal to reduce the risk of future MSK injury.