Department of Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Avenue B060, Aurora, CO, 80045, USA.
The Micheli Center for Sports Injury Prevention, Waltham, MA, USA.
Sports Med. 2018 May;48(5):1097-1115. doi: 10.1007/s40279-018-0871-y.
An emerging area of research has identified that an increased risk of musculoskeletal injury may exist upon returning to sports after a sport-related concussion. The mechanisms underlying this recently discovered phenomenon, however, remain unknown. One theorized reason for this increased injury risk includes residual neuromuscular control deficits that remain impaired despite clinical recovery. Thus, the objectives of this review were: (1) to summarize the literature examining the relationship between concussion and risk of subsequent injury and (2) to summarize the literature for one mechanism with a theorized association with this increased injury risk, i.e., neuromuscular control deficits observed during gait after concussion under dual-task conditions. Two separate reviews were conducted consistent with both specified objectives. Studies published before 9 December, 2016 were identified using PubMed, Web of Science, and Academic Search Premier (EBSCOhost). Inclusion for the objective 1 search included dependent variables of quantitative measurements of musculoskeletal injury after concussion. Inclusion criteria for the objective 2 search included dependent variables pertaining to gait, dynamic balance control, and dual-task function. A total of 32 studies were included in the two reviews (objective 1 n = 10, objective 2 n = 22). According to a variety of study designs, athletes appear to have an increased risk of sustaining a musculoskeletal injury following a concussion. Furthermore, dual-task neuromuscular control deficits may continue to exist after patients report resolution of concussion symptoms, or perform normally on other clinical concussion tests. Therefore, musculoskeletal injury risk appears to increase following a concussion and persistent motor system and attentional deficits also seem to exist after a concussion. While not yet experimentally tested, these motor system and attentional deficits may contribute to the risk of sustaining a musculoskeletal injury upon returning to full athletic participation.
一个新兴的研究领域已经确定，在与运动相关的脑震荡后重返运动时，肌肉骨骼损伤的风险可能会增加。然而，这一最近发现的现象的潜在机制尚不清楚。造成这种受伤风险增加的一个理论原因包括，尽管临床康复，但仍然存在残留的神经肌肉控制缺陷。因此，本综述的目的是：（1）总结检查脑震荡与随后受伤风险之间关系的文献；（2）总结与这种增加的受伤风险有理论关联的一个机制的文献，即脑震荡后双任务条件下步态中观察到的神经肌肉控制缺陷。根据这两个具体目标，进行了两次独立的综述。使用 PubMed、Web of Science 和 Academic Search Premier（EBSCOhost）于 2016 年 12 月 9 日之前确定发表的研究。目标 1 搜索的纳入标准包括脑震荡后肌肉骨骼损伤的定量测量的因变量。目标 2 搜索的纳入标准包括与步态、动态平衡控制和双重任务功能有关的因变量。这两项综述共纳入了 32 项研究（目标 1 n = 10，目标 2 n = 22）。根据各种研究设计，运动员在脑震荡后似乎有更高的肌肉骨骼损伤风险。此外，在患者报告脑震荡症状缓解或在其他临床脑震荡测试中表现正常后，双任务神经肌肉控制缺陷可能仍然存在。因此，脑震荡后肌肉骨骼损伤风险似乎会增加，而且脑震荡后似乎也存在持续的运动系统和注意力缺陷。虽然尚未经过实验测试，但这些运动系统和注意力缺陷可能会导致在恢复全面运动参与时遭受肌肉骨骼损伤的风险增加。
