The association of concussion history and symptom presentation in combat sport athletes

ObjectiveThe purpose of this study was to describe the concussion-related symptoms reported among combat sport athletes with and without a history of concussion, and a history of neck injury.DesignCross-sectional survey.SettingData were collected using an online survey instrument.ParticipantsThree hundred and nine adult combat sport athletes.Main outcome measuresSelf-reported 12-month concussion history and neck injury history and a 22-item symptom checklist.ResultsA history of concussion was reported by 19.1% of athletes, a history of neck injury was reported by 23.0%, and 13.6% reported both injuries. Neck pain was the most frequently reported symptom. Athletes with a history of injury had significantly greater proportions of ‘high’ total symptoms and symptom severity scores compared with athletes with no history of injury. Athletes with a history of concussion had 2.35 times higher odds of reporting ‘high’ total symptoms and symptoms severity scores.ConclusionAthletes with a history of concussion or neck injury have greater odds of presenting with higher symptom scores. The presence of high total symptom scores and high symptom severity scores may indicate a need for further investigation into domains commonly associated with concussion.     

Comparison of knowledge,perception and attitudes of concussion in previously concussed versus non-concussed youth soccer players

Objectives: To examine if history of concussion is correlated with a difference in knowledge, attitude, and perception of concussive injuries in youth soccer players.

Methods: A convenience sample of youth soccer athletes aged 14 to 18 years completed a survey assessing prior history of concussive injury, knowledge of concussive injury, self-reporting attitudes, and perception of the injury. The survey consists of 16 knowledge questions (eleven on a scale of 1–2, and five on a scale of 1–4) and 12 attitude questions (seven on a scale of 1–4, and five on a scale of 1–5). The primary outcomes are the total scores calculated by summing the standardized raw scores for all knowledge questions and attitude questions, respectively. Linear regression was used to estimate the mean difference in the primary outcomes between previously concussed and non-concussed athletes (calculated as previously concussed – non-concussed).

Results: Surveys were obtained from 90 athletes, with 32 (36%) previously sustaining at least one concussion. Thirty-one out of these 32 concussions were diagnosed by a medical provider. On average, the mean total raw scores of all knowledge questions are 34.6 (82.2% of 42 possible points) and 33.7 (80.2% of 42 total points) for previously concussed and non-concussed athletes, respectively, and the mean total raw scores of all attitude questions are 38.7 (72.9% of 53 possible points) and 39.6 (74.7% of 53 possible points), respectively. Mean differences estimated from univariate linear regression in the standardized total scores of knowledge questions and attitude questions are 1.56(95% confidence interval: ?1.52–4.65) and ?1.23 (%95 confidence interval: ?4.64–2.19), respectively. Adjusting for age and years of playing soccer gave similar results.

Conclusion: Although we did not find significant differences between previously concussed and non-concussed athletes in either the knowledge or the attitude questions as measured by their total scores, this study showed a high level of awareness of concussion in youth soccer players, while still highlighting a need for education. Limited distinctions were made among subgroups of players, suggesting directions of future research in investigating the role that outside factors may have on knowledge and perception of concussion.     

Grade 1 or "ding" concussions in high school athletes

BACKGROUND: Recent concussion management guidelines have suggested that athletes with mild (grade 1) concussions may be returned to play if asymptomatic for 15 minutes. The purpose of this study was to assess the utility of a current concussion management guideline in classifying and managing mild concussion. HYPOTHESIS: High school athletes diagnosed with a grade 1 concussion will demonstrate measurable decline in neuropsychological functioning that persists during the 1st week of recovery. STUDY DESIGN: Prospective study designed to evaluate neuropsychological functioning both prior to and following concussion. METHODS: Forty-three high school athletes completed neuropsychological test performance and symptom ratings prior to the season and at two times during the 1st week following mild concussion. RESULTS: Thirty-six hours after injury, mildly concussed high school athletes demonstrated a decline in memory (P < 0.003) and a dramatic increase in self-reported symptoms (P < 0.00001) compared to baseline performance. CONCLUSIONS: Athletes with grade 1 concussion demonstrated memory deficits and symptoms that persisted beyond the context in which they were injured. These data suggest that current grade 1 return-to-play recommendations that allow for immediate return to play may be too liberal. Clinical Relevance: A reconsideration of current concussion grading systems appears to be warranted.     

Relationship between postconcussion headache and neuropsychological test performance in high school athletes

BACKGROUND: The relevance of headache to outcome after sports-related concussion is poorly understood. HYPOTHESES: High school athletes reporting headache approximately 1 week after injury will have significantly more other concussion symptoms and will perform more poorly on neuropsychological tests than athletes not experiencing headache. STUDY DESIGN: Prospective cohort study. METHODS: Study participants included 109 high school athletes who had sustained concussion and who were divided into two groups: those reporting headache 7 days after injury and those reporting no headaches. The two groups were compared regarding on-field markers of concussion severity at the time of injury and symptoms and neurocognitive test results collected via ImPACT, a computerized neuropsychological test battery and postconcussion symptom scale, at a mean of 6.8 days after injury. RESULTS: Athletes reporting posttraumatic headache demonstrated significantly worse performance on reaction time and memory ImPACT neurocognitive composite scores. These athletes also reported significantly more symptoms other than headache and were more likely to have demonstrated on-field anterograde amnesia. CONCLUSIONS: Findings suggest that any degree of postconcussion headache in high school athletes 7 days after injury is likely associated with an incomplete recovery after concussion.     

Concussion reporting and perceived knowledge of professional fighters

Objective: For concussions to be effectively managed in sports, they need to be correctly identified and reported. The extent to which professional athletes correctly recognize concussions, and their willingness to report symptoms, is not yet well understood. Given the risk of head injuries leading to concussions across combat sports, insight into professional fighters’ knowledge and reporting of concussive symptoms is essential to improve concussion management.

Methods: To investigate understanding and reporting patterns of concussions sustained while training or competing, 257 fighters completed a self-report questionnaire assessing self-perception of concussion knowledge, trust of ringside medical providers, and reported number of previous head injuries. Fighting history, including number of knockouts, was obtained from self-report (amateur) and published (professional) records.

Results: Significant gaps in fighters’ perceived knowledge of concussion symptoms and long-term effects of multiple concussions emerged. Approximately 40% of fighters reported returning to training or competition the same day a head injury was sustained, while 21% of fighters endorsed concealing symptoms of head injury from medical providers and coaches.

Conclusions: Confusion surrounding terms used to describe head injuries amongst fighters (e.g., concussions, knockouts), coupled with limited understanding of concussive symptoms and a desire to return to competition, likely contributes to significant underreporting of symptoms.     

Catastrophic head injuries in high school and college football players

BACKGROUND: Catastrophic head injuries in football are rare but tragic events. PURPOSE: To update the profile of catastrophic head injuries in high school and college football players and to describe relevant risk factors. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed 94 incidents of severe football head injuries reported to the National Center for Catastrophic Sports Injury Research during 13 academic years (September 1989 through June 2002). RESULTS: In the study period there were an average of 7.23 (standard deviation = 2.05) direct high school and college catastrophic head injuries in scholastic football participants per year. There were 0.67 injuries per 100 000 (95% confidence interval: 0.54, 0.81 per 100 000) high school and 0.21 injuries per 100 000 (95% confidence interval: 0.0, 0.49 per 100 000) college participants for a risk ratio of 3.28 (95% confidence interval: 0.81, 13.3). The injuries resulted in subdural hematoma in 75 athletes, subdural hematoma with diffuse brain edema in 10 athletes, diffuse brain edema in 5 athletes, and arteriovenous malformation or aneurysm in 4 athletes. Fifty-nine percent of the contacts reported that the athlete had a history of a previous head injury, of which 71% occurred within the same season as the catastrophic event. Thirty-nine percent of the athletes (21 of 54) were playing with residual neurologic symptoms from the prior head injury. There were 8 (9%) deaths as a result of the injury, 46 (51%) permanent neurologic injuries, and 36 (40%) serious injuries with full recovery. Most players sustained a major impact to the head either from tackling or being tackled. CONCLUSION: The incidence of catastrophic head injuries in football has remained low since the advent of the modern day football helmet in the early 1970s. The incidence of catastrophic head injuries in football is dramatically higher at the high school level than at the college level. Although the reason for this discrepancy is unclear, an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury. Coaches, athletes, athletic trainers, and medical personnel need to adhere to the guideline that an athlete with any neurologic symptoms from a head injury should be strongly discouraged from returning to play.     

The "value added" of neurocognitive testing after sports-related concussion

BACKGROUND: Neurocognitive testing has been endorsed as a "cornerstone" of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group. Neurocognitive testing is important given the potential unreliability of athlete self-report after injury. Relying only on athletes' reports of symptoms may result in premature return of athletes to contact sport, potentially exposing them to additional injury. HYPOTHESIS: Use of computer-based neurocognitive testing results in an increased capacity to detect postconcussive abnormalities after injury. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: High school and college athletes with a diagnosed concussion were tested 2 days after injury. Postinjury neurocognitive performance (Immediate Postconcussion Assessment and Cognitive Testing) and symptom (postconcussion symptom) scores were compared with preinjury (baseline) scores and with those of an age- and education-matched noninjured athlete control group. "Abnormal" test performance was determined statistically with Reliable Change Index scores. RESULTS: Sixty-four percent of concussed athletes reported a significant increase in symptoms, as judged by postconcussion symptom scores, compared with preinjury baseline at 2 days after injury. Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance. The addition of neurocognitive testing resulted in a net increase in sensitivity of 19%. Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms, relative to their own baseline; 30% of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms, as judged by postconcussion symptom scores. For the concussed group, use of symptom and neurocognitive test results resulted in an increased yield of 29% overreliance on symptoms alone. In contrast, 0% of the control group had both symptoms and abnormal neurocognitive testing. CONCLUSION: Reliance on patients' self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play. Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms.     

Symptoms after sport-related concussions alter gestural functions

ObjectivesSymptoms after sport-related concussions (SRC) are common. Because post-concussion symptoms are often not clearly visible, speech-accompanying gestures may help clinicians to gain additional information about the patient’s history and symptoms during medical consultation. We hypothesized that athletes with SRC and who suffered from persisting symptoms would display more gestures during concussion assessment protocols when compared to non-concussed athletes because of the athletes’ previous motor-sensory experiences made during the concussive event.DesignA retrospective cross-sectional study.MethodsThree matched groups of 40 (active) athletes were investigated in the context of concussion assessment (/and baseline) protocols: 14 symptomatic and 14 asymptomatic athletes with a SRC, and 12 non-concussed athletes. Certified raters using a standard analysis system for nonverbal behaviour analysed videotaped hand movements and gestures during a standardized concussion assessment protocol.ResultsSymptomatic athletes spent significantly more time with in space hand movements, i.e., movements that act in the body-external free space without touching anything and specifically, motion quality presentation gestures than non-concussed athletes.ConclusionsIncreased in space movements, which are functionally gestures, and specifically, motion quality presentation gestures in symptomatic athletes indicate that the more vivid sensory motor experience of the head trauma is reflected in more gestural expressions. Thus, hand movements and gestures differentiate athletes who suffer from post-concussion symptoms from non-concussed athletes indicating the athletes’ motor-sensory experiences of the event and its aftereffects. The present study highlights the fact that gestures can be employed as behavioural markers of symptoms after sport-related concussions.     

The association of padded headgear with concussion and injury risk in junior Australian football: A prospective cohort study

ObjectivesTo assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football.DesignProspective cohort injury surveillance.MethodsThere were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match.ResultsThere were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40–3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41–2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06–1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79–2.53).ConclusionsHeadgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players.     

Comparison of mouth guard designs and concussion prevention in contact sports: a multicenter randomized controlled trial.

OBJECTIVES: To compare the effectiveness of the WIPSS mouth guard to other currently used mouth guards in the prevention of concussion injuries in athletes participating in varsity football and rugby. DESIGN:: Multicenter, cluster-randomized, controlled trial comparing the WIPSS Brain-Pad mouth guard against the standard use mouth guard of choice. Teams were monitored by their respective athletic therapist, trainer, or sports physician for 1 playing season to diagnose and record incident concussion injuries and dental trauma. Concussion symptoms were also recorded at the time of injury. SETTING: Five Ontario universities. PARTICIPANTS: University male football (394) and university male (129) and female (123) rugby athletes reporting to 2003 fall training camps. MAIN OUTCOME MEASUREMENTS: The primary end point was the incidence of any diagnosed concussion events during the 2003 playing season as defined by the American Academy of Neurology Concussion Guidelines. Secondary endpoints included the incidence of dental trauma events and observed concussion symptoms. RESULTS: There was no significant difference in the number of concussions observed between the intervention and control arms of this trial (P = 0.79; odds ratio, 1.06, in favor of controls; 95% CI, 0.51, <1.61). No dental trauma events occurred. The 5 most common symptoms experienced by concussed athletes were dizziness, general headache, nausea, loss of visual focus, and personality changes. CONCLUSIONS: In this study, concussion rates were not significantly different for varsity football and rugby players who wore the WIPSS Brain-Pad mouth guard compared with other types of mouth guards.     

Sport-related concussion misunderstandings among youth coaches.

OBJECTIVE: To determine the understanding of sport-related concussion among youth sports coaches. DESIGN: Cross-sectional survey. SETTING: The survey was administered at coaches' meetings, following practices, and via mail. PARTICIPANTS: 156 active youth sports coaches, with 5.88 +/- 3.16 years (range 1-22) of coaching experience. INTERVENTIONS: An original survey instrument developed to assess concussion knowledge. Internal validity of the instrument was established prior to the study (Cronbach's alpha = 0.83). MAIN OUTCOME MEASUREMENTS: Scores on the survey instrument reflecting symptom recognition and management knowledge. RESULTS: For the 16 items comprising the symptom recognition survey, the mean number of correct responses was 9.78 +/- 2.07. Previous coaching education was predictive of better symptom recognition. On the true/false portion, between 49.4% and 61.5% of coaches correctly answered the 4 statements. CONCLUSION: This investigation revealed that, among youth sports coaches, coaching education was predictive of the ability to recognize signs and symptoms of sport-related concussion. However, several misconceptions about concussion still exist, highlighting that education regarding concussion is necessary. The presence of qualified health care personnel, such as an athletic trainer, at the youth organization level may enhance early recognition, treatment, and referral of concussions.     

Detecting altered postural control after cerebral concussion in athletes with normal postural stability

Objective: To determine if approximate entropy (ApEn), a regularity statistic from non-linear dynamics, could detect changes in postural control during quiet standing in athletes with normal postural stability after cerebral concussion. Methods: The study was a retrospective, case series analysis of centre of pressure (COP) data collected during the Sensory Organization Test (SOT) from NCAA Division I (USA) athletes prior to and within 48 h after injury. Subjects were 21 male and six female athletes from a variety of sports who sustained a cerebral concussion between 1997 and 2003. After injury, athletes displayed normal postural stability equivalent to preseason levels. For comparison, COP data also were collected from 15 male and 15 female healthy non-athletes on two occasions. ApEn values were calculated for COP anterior-posterior (AP) and medial-lateral (ML) time series. Results: Compared to healthy subjects, COP oscillations among athletes generally became more regular (lower ApEn value) after injury despite the absence of postural instability. For AP time series, declines in ApEn values were much larger in SOT conditions 1 and 2 (approximately three times as large as the standard error of the mean) than for all other conditions. For ML time series, ApEn values declined after injury in all sensory conditions (F_1,55 = 6.36, p = 0.02). Conclusions: Athletes who demonstrated normal postural stability after concussion nonetheless displayed subtle changes in postural control. Changes in ApEn may have represented a clinically abnormal finding. ApEn analysis of COP oscillations may be a valuable supplement to existing concussion assessment protocols for athletes.     

A comprehensive and cost-effective preparticipation exam implemented on the World Wide Web

Mandatory preparticipation examinations (PPE) are labor intensive, offer little routine health maintenance and are poor predictors of future injury or illness. Our objective was to develop a new PPE for the Stanford University varsity athletes that improved both quality of primary and preventive care and physician time efficiency. This PPE is based on the annual submission, by each athlete, of a comprehensive medical history questionnaire that is then summarized in a two-page report for the examining physician. The questionnaire was developed through a search of MEDLINE from 1966 to 1997, review of PPE from 11 other institutions, and discussion with two experts from each of seven main content areas: medical and musculoskeletal history, eating, menstrual and sleep disorders, stress and health risk behaviors. Content validity was assessed by 10 sports medicine physicians and four epidemiologists. It was then programmed for the World Wide Web (http:// www.stanford.edu/dept/sportsmed/). The questionnaire demonstrated a 97 +/- 2% sensitivity in detecting positive responses requiring physician attention. Sixteen physicians administered the 1997/98 PPE; using the summary reports, 15 found improvement in their ability to provide overall medical care including health issues beyond clearance; 13 noted a decrease in time needed for each athlete exam. Over 90% of athletes who used the web site found it "easy" or "moderately easy" to access and complete. Initial assessment of this new PPE format shows good athlete compliance, improved exam efficiency and a strong increase in subjective physician satisfaction with the quality of screening and medical care provided. The data indicate a need for improvement of routine health maintenance in this population. The database offers opportunities to study trends, risk factors, and results of interventions.     

Concussion reporting,knowledge and attitudes in Irish amateur gaelic games athletes

ObjectivesTo examine self-reported concussion history, knowledge and attitudes towards concussion reporting and education in Irish adult Gaelic games players.DesignCross-sectional survey.SettingData were collected using an online survey instrument.ParticipantsTwo hundred and sixteen adult Gaelic games athletes (106 male, 110 female).Main outcome measuresSelf-reported concussion history for the previous season, reporting history for participants’ most recent concussion, concussion knowledge, willingness to report future concussions in a variety of situations and desire for further concussion education.ResultsSeventy-three percent of participants suspected they had sustained a concussion in the past. Most (72.2%) informed someone of their most recent concussion, although two-thirds continued to play during their most recent concussion. Participants had a good overall understanding of concussion, although concussion knowledge score was not associated with safer behaviour following participants’ most recent concussion. While most agreed that concussion is a serious injury (95.8%), 46.8% would not report a concussion during important games.ConclusionsThe high proportion of participants playing following concussion and their reluctance to report concussions during important games is concerning. Interventions aimed at improving attitudes towards concussion reporting among athletes and other stakeholders are required to improve concussion management in amateur Gaelic games athletes.     

Sex-Specific Differences in the Severity of Symptoms and Recovery Rate following Sports-Related Concussion in Young Athletes

Abstract

Introduction: While research on adult recovery from concussion indicates sex-specific symptoms and recovery rates, there is little existing data on younger patient populations. Objective: To determine sex-specific differences in the severity of presenting symptoms and recovery rate between groups of young athletes who presented ≤ 7 or > 7 days after sports-related concussion. Methods: This study was a retrospective review of athletes aged 9 to 17 years who were referred for evaluation of a sports-related concussion over a 24-month period. The study groups were divided by sex and post-injury presentation to the clinic at ≤ 7 days and > 7 days from the date of injury. Athletes with learning disabilities were excluded from the study and data analysis. Age, height, and weight were recorded for each subject. Each subject also reported their initial degree of confusion, amnesia, or loss of consciousness, and whether a helmet was worn when the injury was sustained. A 22-item post-concussion symptom score (SS) scale was completed by both groups on initial assessment (SS1) and follow-up visit (SS2). The recovery rate (SSR) was calculated as (SS2–SS1)/days between SS2 and SS1. Sex and group comparisons for SS1 and SSR were performed using 2 × 2 analysis of variance. A similar analysis was also performed for effects of sex on SS1 and SSR in patients who were not wearing a helmet. Results: Thirty-seven athletes aged 15.0 ± 1.9 years were evaluated. Males, regardless of day of presentation, had a lower SS1 evaluation than females (15.8 vs 30.9; P < 0.05). Males without helmets did not differ from females without helmets, but this was not significantly different (14.1 vs 29.6; P = 0.1). There was not a significant difference in SS1 evaluation between the groups who presented at ≤ 7 or > 7 days. The overall mean SSR was ?1.2/day, with no significant difference seen between groups or sex. There were no significant differences in degree of loss of consciousness, amnesia, confusion, or age between the sexes or groups. Conclusion: Whether presenting at ≤ 7 or > 7 days following a sports-related concussion, female athletes reported a higher SS1 evaluation. With SSR being similar between sexes, the current data suggest that young, female athletes may take longer to become symptom free following sports-related concussion. This information may be an important factor in returning a young athlete to sport after sports-related concussion.     

Head and spine injuries in the young athlete

Recent studies have shown a decrease in the mortality rates from head and neck injuries, especially in American football. This has resulted because of rule changes and their enforcement, equipment modifications, improved coaching and training techniques, and educational programs for coaches, trainers, and team physicians on the early recognition of head and neck injuries. However, morbidity data is not as complete, particularly as it applies to concussion, the most frequent type of head injury in contact sports. Questions on this condition that still need to be answered before a sound medical disposition can be made are the possible cumulative damage from repeated concussions, and whether one concussion renders a player more susceptible to a second. Presently, decisions on when to allow a football player to return to a game or participate in future contests are arbitrary and based primarily on the experience of the team physician. Data on the incidence, mechanisms, and prognosis of transient spinal cord signs and symptoms, such as spinal cord concussion and the central core symptoms, is also incomplete. What is the long-term prognosis for players who suffer frequent "burners"? Certainly, further studies are essential before these questions can be answered. Thus, the pioneer work of Richard Schneider needs to be continued.     

Concussion knowledge,attitudes and behaviour in equestrian athletes

ObjectiveTo determine knowledge, attitudes and behaviour towards concussion in adult equestrian athletes.DesignNationwide, cross-sectional, questionnaire.MethodsParticipants were recruited via advertisements circulated through social media, community presentations and equestrian organisations. Participants were sent a web link to an online questionnaire previously designed for high school athletes and modified to ensure relevance to equestrian activities. The percentage of correct responses per item and a total knowledge score were calculated. Differences in concussion knowledge by age, sex, level of experience and previous history of concussion were explored using t-tests, 95% confidence intervals (CI) and effect sizes.ResultsThe questionnaire was completed by 1486 participants (Mean age = 39.1 ± 15.4). Knowledge of what concussion was, how to recognise it and key symptoms (except poor sleep) was high (>80%). In contrast, awareness of guidelines was moderate (56%) and inability of helmets to prevent concussion was low (12%). Significantly higher levels of knowledge of concussion were identified in females compared with males (t=-6.55 p < 0.001, 95%CI=-3.26 to -1.75). The majority (87%) of participants reported that a helmet should be replaced after a fall, yet 46% reported re-using a helmet following a hit to the head.ConclusionsKnowledge of and attitudes towards concussion were positive. However, there were knowledge gaps and discrepancies between some attitudes and behaviour on some aspects of concussion. Targeted campaigns to promote awareness of concussion and improve recognition and onward management are needed. Education related to equestrian activities such as helmet use and injury mechanisms is needed to change behaviour and minimise the risk of injury.     

Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study.

OBJECTIVE: To examine the mechanisms of injury for concussions in university football, ice hockey, and soccer. DESIGN: Prospective analysis. SETTING: McGill University. PATIENTS: All athletes participating in varsity football, ice hockey, and soccer. MAIN OUTCOME MEASURES: Athletes participating in university varsity football, ice hockey, and soccer were followed prospectively to determine the mechanisms of injury for concussions, whether certain mechanisms of injury causing concussions were more common in any of the three sports, whether different areas of the body seem to be more vulnerable to a concussion after contact, and whether these areas might be predisposed to higher grades of concussion after contact. RESULTS: There were 69 concussions in 60 athletes over a 3-year period. Being hit in the head or helmet was the most common mechanism of injury for all 3 sports. The side/temporal area of the head or helmet was the most probable area to be struck, resulting in concussion for both football and soccer. When examining the body part or object delivering the concussive blow, contact with another player's helmet was the most probable mechanism in football. CONCLUSION: The mechanisms of injury for concussions in football are similar to previously published research on professional football players. The mechanisms of injury for concussions in soccer are similar to past research on Australian rules football and rugby.