September 2016

Out on a limb: Brains, sprains, & the NFL

1Limb-JordanaBy Jordana Bieze Foster, Editor

National Football League (NFL) players say they worry more about lower extremity injuries than concussions. But a growing body of evidence suggests the latter injury actually increases the likelihood of the former.

In a 2014 USA Today survey, 293 NFL players were asked which body part they were most concerned about injuring in a game. Nearly half (46%) specified the knee or other aspects of the legs, while just 24% picked head and neck injuries.

Given the relatively brief careers of professional football players and the fact that their contracts are not guaranteed, it makes sense they would worry most about the injuries they think will result in the most time away from competition.

“Why would I want to sit there for eight months and not do anything, when with a concussion I’ll just wake up and I’ll be ready to go again,” New England Patriots tight end Rob Gronkowski, who tore his anterior cruciate ligament in 2014, said in an April 2015 Bleacher Report interview.

It’s true that—even with the league’s new concussion management protocol in place—players rarely miss more than a game or two after a concussion, whereas an anterior cruciate ligament (ACL) or Achilles injury can wipe out a player’s entire season. But Gronk and other players might be more concerned about head injuries if they knew that sustaining a concussion significantly increases the risk of one of those lower extremity injuries they fear more.

Players might take concussion prevention more seriously if they knew it could also help prevent season-ending leg injuries.

In mid-August, researchers from the University of Florida in Gainesville published a study in Sports Medicine that followed 73 Division I college athletes who returned from a concussion with at least 30 days remaining in their season. Compared with matched control athletes who had not had a concussion in a year, the concussed athletes were 3.39 times more likely to sustain a lower extremity injury during the same season.

Two weeks later, researchers from the University of Delaware in Newark reported significant associations between a history of concussion and a history of lower extremity injury, based on a survey of 335 student athletes. In that study, athletes with a history of concussion were 1.69 times more likely to report a history of lower extremity injury.

These are only the most recent studies to suggest such brain-sprain associations (see “Risk of lower extremity injury increases after athletes return from concussion,” February 2016, page 13). It’s still unclear which specific aspects of concussion contribute to the increased risk of lower extremity injuries, or the extent to which the timing of an athlete’s return to sports after a concussion might affect that risk. But the body of evidence is becoming difficult to ignore.

It’s understandable that ACL tears and other lower extremity injuries are what NFL players fear most. It’s even somewhat understandable that they are more concerned with the short-term implications of a concussion than the long-term consequences. But, knowing that preventing a head injury can help prevent season-ending leg injuries as well as long-term neurological complications, even Gronk might take concussions a little more seriously.

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