College of Health Sciences


Physical Therapy & Athletic Training


Kinesiology & Rehabilitation Ph.D.

Publication Date





Sport-related concussions are a prevalent injury that result in sensorimotor dysfunction and altered neuromuscular control. Individuals recovering from a concussion display decreased postural sway during balance assessment and may possess prolonged balance deficits after return-to-play (RTP). Athletes who are experiencing impairments following RTP after a concussion may be at increased risk of lower extremity (LE) injury. The purpose of this study was to conduct a systematic review and meta-analysis of studies examining risk of LE musculoskeletal injury following a concussion in high school and collegiate athletes. An electronic database search of PubMed, CINAHL, MEDLINE, and SPORTDiscus was conducted on November 19, 2019 using the following terms: (“lower extremity” AND “injury” AND “concussion”). Articles were included if they were published between January 2000 and November 2019 and examined high school or collegiate athletes’ risk of sustaining a LE musculoskeletal injury following a concussion. Methodological quality of included studies was performed with the modified Downs and Black Checklist. Random effects meta-analysis modeling calculated summative relative risk (RR) for studies that reported sufficient data. Sixtyfive studies were initially retrieved. Following removal of duplicates and abstract assessment, nine studies were included in the systematic review. Eight of the studies were of good or excellent quality. Five of the nine studies were included in the meta-analysis. High school and college athletes who suffered a concussion possessed a 49% greater risk of sustaining a LE musculoskeletal injury than those without a history of a concussion (RR = 1.49[1.04, 2.14]). Therefore, LE injury risk is potentially increased in high school and college athletes following a concussion compared to those without recent history of concussion. Further research is needed to investigate the mechanism behind this increased risk. Clinical assessments throughout the concussion RTP protocol may need to be improved in order to detect lingering impairments caused by concussions.


Concussion, Lower extremity injury, musculoskeletal injury, Injury risk, College athletics


Exercise Science | Rehabilitation and Therapy | Sports Sciences



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The Effect of Concussion History on Lower Extremity Injury Risk in High School and Collegiate Athletes: A Systematic Review and Meta-Analysis