The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Author:

King Jeffrey A.1ORCID,Nelson Lindsay D.2,Cheever Kelly3,Brett Benjamin2ORCID,Gliedt Jordan2,Szabo Aniko4,Dong Huaying5,Huber Daniel L.2,Broglio Steven P.6,McAllister Thomas W.7,McCrea Michael2,Pasquina Paul8,Feigenbaum Luis A.9,Hoy April10,Mihalik Jason P.11,Duma Stefan M.12,Buckley Thomas13,Kelly Louise A.14,Miles Chris15,Goldman Joshua T.16,Benjamin Holly J.17,Master Christina L.18,Ortega Justus19,Kontos Anthony20,Clugston James R.21ORCID,Cameron Kenneth L.22ORCID,Kaminski Thomas W.13,Chrisman Sara P.23,Eckner James T.24,Port Nicholas25,McGinty Gerald2627

Affiliation:

1. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA Lindsay

2. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

3. Applied Biomechanics Research Laboratory, Department of Kinesiology, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, Texas, USA

4. Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

5. Division of Biostatistics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

6. University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA

7. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA

8. Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA

9. Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA

10. Department of Athletics, School of Behavioral and Applied Sciences, Azusa Pacific University, Azusa, California, USA

11. Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

12. Institute for Critical Technology and Applied Science, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA

13. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA

14. Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA

15. Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

16. Departments of Family Medicine and Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA

17. Departments of Orthopaedic Surgery and Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA

18. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

19. School of Applied Health, California State Polytechnic University, Humboldt, Arcata, California, USA

20. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

21. Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA

22. Orthopaedic and Sports Medicine Research, United States Military Academy, West Point, New York, USA

23. Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA

24. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA

25. School of Optometry, Indiana University Bloomington, Bloomington, Indiana, USA

26. Department of Athletics, United States Air Force Academy, Air Force Academy, Colorado, USA

27. Investigation performed at the Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Abstract

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without ( P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days ( P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) ( P = .592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

Funder

U.S. Department of Defense

Publisher

SAGE Publications

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