EC Orthopaedics

Introduction: Athletes with a concussion history are at increased risk for lower extremity injury compared to healthy athletes. Limb asymmetry during landing may be a factor that contributes to this increased injury risk, however this is currently unknown. The purpose of this study was to determine the effect of concussion history on limb symmetry during a cutting task.

Methods: Athletes with a history of sports-related concussion and a healthy control group performed an unanticipated land and cut maneuver with both the dominant limb side as well as the non-dominant limb side. Kinematic analyses were captured using a 10 camera Vicon motion capture system. Two force platforms were used for kinetic analyses. Biomechanical analyses on the dominant and non-dominant limbs were conducted and a symmetry index value was obtained for each variable of interest. Symmetry index values were compared between groups. Additional analyses were conducted comparing symmetry index values between males and females.

Results: Females in the concussion history group exhibited greater asymmetry in vertical ground reaction force compared to females in the control group (p < .05).

Conclusion: Results suggest that female athletes with a concussion history may exhibit mechanics during cutting that can place them at increased risk of lower extremity injury.

 Keywords: Head Injury; Kinematics; Kinetics; Motion Analysis

1. Manley Geoff., et al. “A systematic review of potential long-term effects of sport-related concussion”. British Journal of Sports Medicine12 (2017): 969-977.
2. Broglio Steven P., et al. “National Athletic Trainers' Association position statement: management of sport concussion”. Journal of Athletic Training2 (2014): 245-265.
3. Howell David R., et al. “Neuromuscular control deficits and the risk of subsequent injury after a concussion: a scoping review”. Sports Medicine (Auckland, N.Z.)5 (2018): 1097-1115.
4. Patricios Jon S., et al. “Consensus statement on concussion in sport: the 6^th International Conference on Concussion in Sport-Amsterdam, October 2022”. British Journal of Sports Medicine11 (2023): 695-711.
5. Chmielewski Terese L., et al. “Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury: Implications for clinical management and rehabilitation”. Journal of Sport and Health Science 2 (2021): 154-161.
6. Covassin Tracey., et al. “Sex differences in sport-related concussion long-term outcomes”. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology A (2018): 9-13.
7. Covassin T., et al. “Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes”. British Journal of Sports Medicine11 (2006): 923-927.
8. Frommer Leah J., et al. “Sex differences in concussion symptoms of high school athletes”. Journal of Athletic Training1 (2011): 76-84.
9. Koerte Inga K., et al. “Sex-related differences in the effects of sports-related concussion: a review”. Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging 4 (2020): 387-409.
10. Lynall Robert C., et al. “Acute lower extremity injury rates increase after concussion in college athletes”. Medicine and Science in Sports and Exercise12 (2015): 2487-2492.
11. Dubose Dominique F., et al. “Lower extremity stiffness changes after concussion in collegiate football players”. Medicine and Science in Sports and Exercise1 (2017): 167-172.
12. Lapointe Andrew P., et al. “Kinematic differences during a jump cut maneuver between individuals with and without a concussion history”. International Journal of Psychophysiology: Official Journal of the International Organization of PsychophysiologyA (2018): 93-98.
13. Lynall Robert C., et al. “Single-legged hop and single-legged squat balance performance in recreational athletes with a history of concussion”. Journal of Athletic Training5 (2020): 488-493.
14. Lynall Robert C., et al. “Reaction time and joint kinematics during functional movement in recently concussed individuals”. Archives of Physical Medicine and Rehabilitation5 (2018): 880-886.
15. Feigenbaum Luis A., et al. “Post-concussive changes in balance and postural stability measured with CanesenseTM and the balance error scoring system (BESS) in division I collegiate football players: a case series”. International Journal of Sports Physical Therapy2 (2019): 296-307.
16. Bishop Chris., et al. “Asymmetries of the lower limb”. Strength and Conditioning Journal6 (2016): 33-43.
17. Sato Kimitake and Gary D Heise. “Influence of weight distribution asymmetry on the biomechanics of a barbell back squat”. Journal of Strength and Conditioning Research2 (2012): 342-349.
18. Shorter K Alex., et al. “A new approach to detecting asymmetries in gait”. Clinical Biomechanics (Bristol, Avon)4 (2008): 459-467.
19. Rohman Eric., et al. “Changes in involved and uninvolved limb function during rehabilitation after anterior cruciate ligament reconstruction: implications for Limb Symmetry Index measures”. The American Journal of Sports Medicine6 (2015): 1391-1398.
20. Zwolski Christin., et al. “The utility of limb symmetry indices in return-to-sport assessment in patients with bilateral anterior cruciate ligament reconstruction”. The American Journal of Sports Medicine8 (2016): 2030-2038.
21. Pfeiffer Steven J., et al. “Peak knee biomechanics and limb symmetry following unilateral anterior cruciate ligament reconstruction: Associations of walking gait and jump-landing outcomes”. Clinical Biomechanics (Bristol, Avon) 53 (2018): 79-85.
22. Kyritsis Polyvios., et al. “Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture”. British Journal of Sports Medicine15 (2016): 946-951.
23. Avedesian Jason M., et al. “Landing biomechanics in adolescent athletes with and without a history of sports-related concussion”. Journal of applied biomechanics5 (2020): 313-318.
24. Avedesian Jason M., et al. “The influence of sports-related concussion on cognition and landing biomechanics in collegiate athletes”. Scandinavian Journal of Medicine and Science in Sports7 (2024): e14698.
25. Lee Bobby Jean., et al. “Movement patterns during a jump-landing task in athletes after sport-related concussion and healthy control individuals”. Journal of Athletic Training12 (2021): 1306-1312.
26. Koga Hideyuki., et al. “Mechanisms for noncontact anterior cruciate ligament injuries: knee joint kinematics in 10 injury situations from female team handball and basketball”. The American Journal of Sports Medicine11 (2010): 2218-2225.
27. Hewett Timothy E., et al. “Understanding and preventing acl injuries: current biomechanical and epidemiologic considerations - update 2010”. North American Journal of Sports Physical Therapy: NAJSPT4 (2010): 234-251.
28. Leppänen Mari., et al. “Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players”. The American Journal of Sports Medicine2 (2017): 386-393.
29. Paterno Mark V., et al. “Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction”. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine4 (2007): 258-262.
30. Eagle Shawn R., et al. “Increased risk of musculoskeletal injury following sport-related concussion: a perception-action coupling approach”. Sports Medicine (Auckland, N.Z.)1 (2020): 15-23.