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Risk of Injury After Concussion.

Increased risk of injury after concussion

Did you know athletes are at increased risk of a lower extremity injury after concussion?

Here’s a summary of a 2017 study of high school athletes:

  • Over a 3 year period, data was collected on 18 216 high school athletes.

  • There were 46 217 injuries recorded.

Key findings:

  • The odds of sustaining a subsequent time-loss lower extremity injury increased 34% after a concussion.

  • Time loss injuries are those that require the person to miss at least one day of playing a sport.


Well, researchers don’t have a definite answer yet.

But we can make some educated guesses:

  • There may be difficulty with activities requiring divided attention.

  • There may be difficulty with the visual system in recognizing objects or people in the peripheral fields or outer edges of your vision.

  • There may be delayed reaction time to unexpected events or obstacles.

  • There may be difficulties with dynamic balance.

This last item of dynamic balance may be quite important in the rehabilitation of concussion and for the clearance to return to play for a sport.

Assessing Balance after Concussion

Many balance assessments use static balance tests like standing stationary with feet together, or standing in a heel to toe position, or standing on one foot. These are certainly beneficial for the ease of testing, and simple observation of the person's difficulty with the test. You can use apps on a mobile device to measure sway in a stationary balance test. You can even use a force plate that a person stands on to accurately measure the amount and direction of sway as well as where the average centre of pressure is located.

But during a sport related injury, it is unlikely that the person is standing quietly, or even simply walking slowly heel to toe.


Even though these simple static balance tests after concussion are easily reproducible and don’t take much training to assess, it may be more important to observe and train dynamic balance. This means observing a person while they are moving quickly and turning and changing direction, as well as incorporating head motion and reacting to unexpected situations. This, unfortunately, is not so easily studied nor easily transferred into an accessible clinical test. For now, we will need to rely on the keen eyes of an expert in human motion, like a physical therapist.

Testing in a dynamic way means that sufficient space is required to allow an athlete to run, hop, throw / catch / kick a ball. Unfortunately physician offices, and many health care clinics, are not built with this concept in mind. They have limited space to test or train athletes in a dynamic way. This, of course, is concerning when determining the timing for a safe return to practice in sport after a concussion

So, if there’s a plan for a return to sport after concussion, make note of whether the clinic has sufficient space for this type of dynamic training and assessment.

Unfortunately, research hasn’t been done to demonstrate the most effective ways to measure and evaluate dynamic balance after concussion, so for now we are reliant on the clinician’s observational skills in determining the athlete’s coordination and balance during dynamic sport tasks.

Training and testing in this way could go a long way to better identify a safe time to return to sport practice, as well as preventing future injuries.


You can learn a little more about concussion or look to book an appointment on our Concussion page of the website if you click the button here.


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