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Concussion and the lower limb and as a public health issue

Discussion in 'Biomechanics, Sports and Foot orthoses' started by toomoon, Oct 17, 2012.

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    Articles:
    1
    Effect of a Concussion on Anterior Cruciate Ligament Injury Risk in a General Population
    April L. McPherson, Matthew B. Shirley, Nathan D. Schilaty, Dirk R. Larson & Timothy E. Hewett
    Sports Medicine volume 50, pages1203–1210(2020)
     
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    Youth With Concussion Have Less Adaptable Gait Patterns Than Their Uninjured Peers: Implications for Concussion Management
    Journal of Orthopaedic & Sports Physical Therapy: May 22, 2020
     
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    Lower Extremity Musculoskeletal Injury Is Associated with Increased Risk of Concussion in High School Athletes
    Adam Lutz, Charles Thigpen, R. Gil Gilliland, ...
    Orthopaedic Journal of Sports Medicine July 31, 2020
     
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    The Effects of Concussion
    and the Risk for Subsequent
    Musculoskeletal Injuries

    Derek Charles et al
    Orthopaedic Practice volume 32 / number 1 / 2020
     
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    NEWS RELEASE 10-SEP-2020
    Concussion discovery reveals dire, unknown effect of even mild brain injuries

    UVA researchers have discovered that concussions and traumatic brain injuries, even when mild, cause swelling that blocks the brain's ability to clean itself of harmful toxins and debris.
    In addition to an immediate impact on memory and brain inflammation, this may seed the brain for Alzheimer's, dementia and other neurodegenerative diseases.
    The discovery helps explain why repeated brain injuries are so harmful and suggests they increase the risk of long-term problems.
    It also suggests a reason why blows to the head affect different people differently.
    The findings point to a new approach to treating brain injury and could lead to a better way to determine when it is safe for athletes and military personnel to resume their duties.
    Even mild concussions cause severe and long-lasting impairments in the brain's ability to clean itself of toxins, and this may seed it for Alzheimer's disease, dementia and other neurodegenerative problems, new research from the University of Virginia School of Medicine reveals.

    The discovery offers important insights into traumatic brain injury (TBI), a poorly understood condition that has become a major public concern, particularly in sports and for the military. The findings help explain why TBI is so harmful and why it can have such long-term effects. The research also suggests that certain patients are at greater risk of a decline in brain function later in life, and it paves the way for new and better treatments.

    "This provides some of the best evidence yet that if you haven't recovered from a brain injury and you get hit in the head again, you're going to have even more severe consequences," said John Lukens, PhD, of UVA's Department of Neuroscience and the Center for Brain Immunology and Glia (BIG). "This reinforces the idea that you have to give people an opportunity to heal. And if you don't, you're putting yourself at a much higher risk for long-term consequences that you might not see in a year but could see in a couple of decades."

    New Understanding of TBI

    Lukens' research identifies a previously unknown consequence of TBI that can have long-lasting effects. When the brain swells, it presses against the skull; trapped in-between are tiny lymphatic vessels that clean the brain. This pressure on the vessels, the UVA researchers found, causes serious and long-lasting impairment of the brain's ability to purge itself of toxins. Working with lab mice, one of the best models of TBI available, the scientists found the impairment could last at least two weeks - a long time for mice - and possibly much longer.

    These lymphatic vessels were identified by Jonathan Kipnis, PhD, and his collaborators at UVA in 2015. Until then, medical textbooks insisted the vessels did not exist and that the brain was "immune privileged," meaning that it did not interact with the immune system. Kipnis' discovery changed all that, and he has since determined the vessels play important roles in both Alzheimer's and the cognitive decline that comes with age.

    Now they emerge as an important player in TBI. "We know that traumatic brain injury carries an increased risk for a bunch of long-term issues like dementia, Alzheimer's disease and CTE [chronic traumatic encephalopathy], and this has really been made extra public because of the NFL," said researcher Ashley C. Bolte, an MD/PhD student. "Then there's also anxiety, depression, suicide. The reasons why TBI results in increased risk for this isn't totally known, and we think that our findings might provide a mechanism as to why."

    People Most at Risk

    The research suggests that people who have pre-existing problems with their brain drainage, either from prior concussions or naturally, are likely to suffer much more severe consequences from TBI. In mice, this led to more brain inflammation and worse outcomes, including memory impairment. "If you have a pre-existing kink in the pipes and you get hit in the head, then everything is taken to a higher level - the impacts on memory, the neuroinflammation," Lukens said. "There are a lot of implications to it."

    Emerging imaging technology may eventually make it possible for doctors to identify people who will suffer the greatest consequences of TBI. More good news: Lukens also believes that doctors may one day be able to rejuvenate the impaired lymphatic vessels with drugs to improve patients' outcomes and possibly stave off long-term consequences. (This also may prove useful in the battle against the cognitive decline that naturally occurs with age.)

    In addition, Lukens said, it eventually may be possible for doctors to evaluate brain drainage after injury to determine when it is safest for patients to return to action.

    "Right now, we really don't know what to tell these kids who want to get back out on the field, or even members of the military," Lukens said. "It would be important to have empirical tests to say you can continue or never to do those things ever again."
     
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    Gait Performance Is Associated with Subsequent Lower Extremity Injury following Concussion
    OLDHAM, JESSIE R et al
    Medicine & Science in Sports & Exercise: November 2020 - Volume 52 - Issue 11 - p 2279-2285
     
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    Diagnosed Concussion is Associated with Increased Risk for Lower Extremity Injury in Community Rugby Players
    Katherine J. Hunzinger et al
    October 28, 2020
     
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    Concussion history is associated with increased lower-extremity injury incidence in Reserve Officers’ Training Corps cadets
    Katherine J Hunzinger et al
    BMJ Mil Health Published Online First: 29 October 2020
     
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    Concussion Is Associated With Increased Odds of Acute Lower-Extremity Musculoskeletal Injury Among National Basketball Association Players
    Toufic R.Jildeh et al
    Arthroscopy, Sports Medicine, and Rehabilitation; 27 December 2020
     
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    Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes
    Kevin M.Biese et al
    Physical Therapy in Sport; Volume 48, March 2021, Pages 76-82
     
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    Musculoskeletal Injuries and Their Association With Previous Concussion History: A Prospective Study of High School Volleyball and Soccer Players
    Kevin M. Biese, MA, ATC, Stephanie A. Kliethermes, PhD, Andrew M. Watson, MD, MS,
    The American Journal of Sports Medicine March 15, 2021
     
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    Single Season Re-Injury Risk after Concussion and Lower Extremity Injury among Male, Collision Sport, High School Athletes
    Julie C.Wilson et al
    Journal of Science and Medicine in Sport; 5 May 2021
     
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    Relationship Between Cognitive Performance
    and Lower Extremity Biomechanics
    Implications for Sports-Related Concussion

    Jason M. Avedesian,et al
    The Orthopaedic Journal of Sports Medicine
     
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    AN INCREASE IN LOWER EXTREMITY INJURY AS A RESULT OF COGNITIVE AND
    PSYCHOLOGICAL DEFECITS OF CONCUSSION

    Caitlin Schult
    July, 2021
    Masters Thesis
     
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    This clinical trial was just registered:
    Post-Concussion Musculoskeletal Injury Risks
     
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    A predictive paradigm for identifying elevated musculoskeletal injury risks after sport-related concussion
    MisaghMansouri et al
    Sports Orthopaedics and Traumatology; 24 December 2021
     
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    An Analysis of the Increased Risk for Lower Extremity Injury Within 12 Months After Concussion and Utilization of Lower Extremity Measures for Return to Sport
    Claire Switzer, PT, DPT, Nicole Melfi, PT, DPT, Katy Mitchell, PT, PhD, ...
    Orthopaedic Journal of Sports Medicine May 13, 2022
     
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    The association between sport-related concussion and musculoskeletal injury in university rugby athletes
    NumanYeneraKerryGlendonabMatthew T.G.Paina
    Physical Therapy in Sport; Volume 55, May 2022, Pages 264-270
     
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    Concussion is not associated with elevated rates of lower-extremity musculoskeletal injuries in National Football League Players
    Thomas A. Buckley et al
    The Physician and Sportsmedicine: 27 May 2022
     
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    Lower Extremity Injury Following Return to Sport from Concussion: A Systematic Review
    Toufic Jildeh, MD, Patrick Buckley, Muhammad Abbas, ...
    Orthopaedic Journal of Sports Medicine July 28, 2022
     
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    The Effect of Concussion History on Lower Extremity Injury Risk in College Athletes: A Systematic Review and Meta-Analysis
    Ryan McCann , Eric Schussler , Jessica Martinez , Vanessa Ramirez
    IJSPT. 2022;17(5):753-765. doi:10.26603/001c.36810
     
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    Kinesiophobia Is Related to Acute Musculoskeletal Injury Incidence Following Concussion
    Xavier D. Thompson et al
    Journal of Sport Rehabilitation 01 Sep 2022
    on of athletes with a time-loss MSK injury reported a TSK score greater than the clinical cutoff. Our results suggest that factors such as kinesiophobia should be considered following a SC.
     
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