By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
By now, most athletes understand that a concussion leads to changes in brain function. After a concussion an athlete may have symptoms such as headache and light sensitivity. Students may have difficulties with concentration in the classroom.
But what most athletes don’t know about is that a concussion also leads to changes in balance and peripheral vision. It turns out that those associated changes create an increased risk of injuries to the lower extremity, such as knee injuries or ankle sprains. In a recently published analysis, athletes with a concussion were 2x more likely to have a lower extremity injury in the weeks and months after a concussion.
Many of the associated changes after a concussion are very subtle and not easily observed by an outside examiner. Many studies have shown that there is a slower response in rapid eye movements after concussion, which can lead to poor peripheral awareness during sport. Other studies have shown alterations in balance and spatial awareness (“proprioception”) and some studies have even shown a loss of lower extremity strength.
It’s well known that poor landing mechanics are a risk factor for ACL injury, and it’s also well known that poor balance and spatial awareness are risk factors for ankle injury. So it’s reasonable to connect the dots between concussion and lower extremity injury risk. But the extent of the injury risk after concussion was surprising to me. I expected it to be smaller.
What should we do with this information?
The most important take away from my perspective is that proper return to play decisions should include an assessment of balance as well as some type of visual function testing.
Medical practitioners who have training in sports concussion management will definitely include these types of tests in their assessment and return to play planning. Unfortunately, many primary care doctors and pediatricians do not have specific training in sport concussion management. These well-meaning medical providers may not be aware of the benefits of balance and visual testing in making the return to play decision.
I’ve written previously about seeing the right doctor after a possible concussion. A sports concussion specialist will be aware of current best practices and put the concussed athlete in the best possible position for a safe return to sport.