Concussion Alters Neuromuscular Function in Collegiate Athletes

Despite being cleared to return to play following a concussion, research has suggested that athletes may be at a greater risk for other kinds of injuries – namely, those affecting the lower extremities. However, the mechanism for this increased risk of a lower extremity injury after a concussion is unclear. Neuromuscular changes following concussion that persist beyond return to play may contribute to this increased injury risk.


In this study, the investigators identified altered lower extremity stiffness in the hip, knee and leg stiffness in a jump-landing task – finding this increased stiffness in athletes who had sustained a concussion when compared to uninjured matched teammates.


Changes in lower extremity stiffness have been shown to be a risk factor for lower extremity injury. Clinicians may need to include neuromuscular measures during concussion treatment programs. This may improve patient outcomes and decrease risk of lower extremity injury when these individuals return to sports activity.

For more information, view the abstract

Customize Your Protection with DonJoy Defender Skin

It’s your padding, your way. With DEFENDER SKIN, you can create and apply custom shaped hex strips that act like a protective second skin. It’s the padding that stays in place to avoid bumps and abrasions from your sport.

THE TECHNOLOGY BEHIND DEFENDER

When it comes to protecting your body during sport, you should never sacrifice comfort or performance. DEFENDER SKIN is the lightest, most flexible, and most versatile form of protection available to athletes today, no matter what game they play. It’s a uniquely engineered, breathable adhesive second skin designed to defend the body against cuts, scrapes, burns, pain and bruising often associated with the impact and abrasion of rigorous sports.

  • A – PAD ORIENTATION

    Pad Orientation allows wearer to customize their protection and place anywhere

  • B – EVA FOAM

    1/8″ thick EVA foam pads protect against impact and abrasion

  • C – TAPE THINNER THAN HUMAN HAIR

    Ultra thin PU Skin with 4-way stretch properties and micro perforations moves with you

Also available in Elbow and Knee Pads

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DonJoy Performance

Medial Knee Ligament Injury

A medial ligament sprain or MCL injury is a tear of the ligament on the inside of the knee, usually a result of twisting or direct impact. Medial ligament injuries are common in contact sports such as football and rugby, as well as martial arts. They can also occur in daily life through falls and twists of the knee joint.

Anatomy: The medial collateral ligament or MCL for short connects the thigh bone (or femur) to the shin bone (or tibia) on the inside of the knee and prevents the knee joint from moving sideways, particularly from forces on the outside of the knee.

The medial knee ligament itself has two parts to it; a deep inner section which attaches to the cartilage meniscus at the top of the shin bone, and a superficial band that originates higher up on the femur to an area lower down on the inner surface of the tibia.

Causes: Injury to the MCL often occurs after an impact to the outside of the knee when the knee is slightly bent. The ligament on the inside of the knee becomes stretched and if the force is great enough, some or even all of the fibres will tear. The deep part of ligament is prone to becoming damaged first and this may lead to a medial cartilage meniscus injury.

Twisting the knee can also cause a medial ligament sprain as well as the possibility of an ACL tear. If the foot is planted and the player tries to turn quickly this can also lead to stressing the joint causing the inside of the joint to open and tear the ligament. Whilst repetitive valgus forces can gradually over time lead to a MCL sprain, pain on the inside of the knee which does not occur after a sudden injury, should be considered for pes anserine tendinopathy or bursitis.

Symptoms: Graded 1, 2 or 3 depend on on severity of the injury.

Grade 1 symptoms: For a grade 1 MCL injury there may be mild tenderness on the inside of the knee over the ligament. There is usually no swelling. When the knee is bent to 30 degrees and an outward force applied to the lower leg to stress the medial ligament, pain is felt but there is no joint laxity (play valgus stress test video). A grade one tear consists of fewer than 10% of the fibres being torn.

Grade 2 symptoms: Significant tenderness will be felt on the inside of the knee along the medial ligament. Some swelling may seen over the ligament. When the valgus stress test is applied there is pain with mild to moderate laxity in the joint, although there is a definite end point (the knee cannot be bent sideways completely).

Grade 3 symptoms: This is a complete tear of the ligament. Pain can vary and is sometimes not as bad as that of a grade 2 MCL sprain. The valgus stress test will reveal significant joint laxity and the patient may complain of having a very wobbly or unstable knee.

Treatment for medial ligament sprains: Treatment can be divided into immediate first aid during the acute stage and longer term rehabilitation.

Immediate first aid

  • Apply P.R.I.C.E. principles (Rest, Ice, Compression, Elevation) to the injured knee.
  • Rest from training or any activities or movements which are painful to allow healing to take place
  • Apply ice or cold therapy wrap for 10 to 15 minutes every hour initially reducing frequency as symptoms allow. Ice should not be applied directly to the skin but use a wet tea towel or similar. Specialist cold therapy knee wraps are convenient to use and will apply compression as well.
  • Wear a compression bandage or knee support to help reduce any swelling and protect the joint. A hinged knee brace is best particularly for grade 2 and 3 injuries.

Wear a hinged knee brace: A hinged knee brace is a strong knee support which has solid metal supports down the sides to prevent sideways movement of the joint and protect the knee ligaments while healing. More severe grade 2 and full grade 3 injuries may require a limited motion hinged knee brace which restricts the amount of movement or knee bend in the joint whilst healing.

Electrotherapy: Ultrasound treatment involves applying high frequency sound waves to the injured tissues. A professional therapist may do this in the early more acute stages to help control swelling and pain. Interferential or tens involves applying electric currents to the tissue around the injury which can also help with pain and swelling.

Knee tapingTaping: Taping the knee joint can also provide a high level of support and protection. It can be done in the early stages as well as later on when returning to full training. A good taping technique can provide excellent support and often more support than some of the cheaper hinged knee braces, but the effectiveness of tape will reduce over time as the tape stretches slightly. It will need to be re-applied to maintain good support for the joint, particularly during competitive sport.

Knee rehabilitationExercises: A full rehabilitation program consisting of mobility and strengthening exercises should begin as soon as pain allows. Initially range of motion mobility exercises are done to restore full pain free range of movement. In the early stages isometric strengthening exercises (static muscle conractions) can be done to help maintain muscle strength and prevent muscle wasting whilst the ligament heals.

As the ligament heals strengthening exercises such as mini squats, leg press and step ups can be done but movements involving change of direction or sideways stresses should be avoided until much later in the rehabilitation program. A hinged knee brace should be worn to protect the ligament whilst exercising.

Massage: Manual therapy techniques including massage may be used as part of a rehabilitation program. Massage to the injured tissues should be avoided in the early acute stages. Later as the ligament starts to heel then light cross friction massage may be used and in particular if there is persistant pain in the later stages of rehabilitation then cross friction massage may be beneficial.

Do I need surgery? Most medial ligament injuries do not require surgical treatment. If there is additional damage to the joint for example an ACL tear as well then surgery may be considered. However, it is thought there is no advantage even with grade 3 injuries to treating them surgically as opposed to bracing and rehabilitation exercises.

How long will it take to recover?

  • A mild MCL injury or grade one sprain should take 3 to 6 weeks to make a full recover.
  • A more severe grade 2 or grade 3 injury may take 8 to 12 weeks.

Contributed by: Sports Injury Clinic

SPLEEN INJURIES – SNEAKY AND POSSIBLY DANGEROUS

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • The spleen is the most commonly injured abdominal organ during sports
  • An enlarged spleen, such as from mononucleosis, places an athlete at additional risk of injury to the spleen
  • Emergency treatment is critical to ensure the health of the athlete after a possible spleen injury

This week I was working with a college lacrosse player who was seeing me for ongoing lacrosse stick checkissues with groin pain. Unrelated to that he indicated to me that in the past season he was hospitalized for a week due to a laceration of his spleen. The laceration occurred during a lacrosse game when he was diving for a ball and an opposing player’s stick hit him just underneath his left rib cage. My patient was fortunate in that he has made a full recovery and should go on to have normal function of his spleen. But others have not been quite so lucky.

A young man named Evan Murray, a 17-year-old three-sport athlete at Warren Hills Regional High School in New Jersey took a hit in the backfield during a football game in 2015. According to witnesses who spoke to the media, Murray walked off under his own power but later collapsed. As he was placed on a stretcher to be taken to a local hospital, he told his teammates he would be fine and gave them the thumbs-up sign.

But tragically, Evan Murray didn’t make it.

According to the County Coroner’s Office, the cause of death was a lacerated spleen that caused massive internal bleeding. Dr. Ronald Suarez found that Murray’s spleen was abnormally enlarged, making it more susceptible to injury.

What is the spleen?

The spleen is an organ in the upper far left part of the abdomen, to the left of the stomach. The spleen plays multiple supporting roles in the body. It acts as a filter for blood as part of the immune system. Old red blood cells are recycled in the spleen, and platelets and white blood cells are stored there. The spleen also helps fight certain kinds of bacteria that cause pneumonia and meningitis.

Some medical conditions can result in an enlarged spleen, and an enlarged spleen is a risk for rupture. One of these conditions commonly seen in young athletes is mononucleosis, otherwise known as “mono”. For this reason, most physicians will require an athlete to rest for several days after mono before return to sports. This gives the spleen a chance to return to normal size.

Mechanism of spleen injuries

While death from spleen injuries is thankfully rare, the spleen is actually the most frequently injured abdominal organ in sports. A direct blow to the left side of the upper abdomen in contact or collision sports like football, lacrosse, or hockey, can injure the spleen in a healthy athlete.

Recognition of spleen injuries

A huge amount of blood travels through the spleen. Laceration or rupture can lead to massive bleeding into the abdomen that can be catastrophic.

Spleen injuries can be hard to diagnose at the time of injury. A player might have upper left abdominal pain after a hard tackle to the body, or being hit by the backend of a stick. He might complain of left shoulder pain from blood irritating the diaphragm. A doctor or athletic trainer might find tenderness when feeling the abdomen or ribs over the spleen.

Recognition and treatment of athletes with spleen injuries

Immediately after the injury, the athlete may have very few complaints and the exam could look nearly normal. It’s incredibly important therefore to pay close attention and act quickly if the young athlete develops any signs of abdominal pain. Evaluation of the athlete at a hospital is critical if there is any question of a serious injury.

SideLineSportsDocMany athletes with ruptured spleens require surgery and sometimes removal of the spleen. Some types of spleen injuries can be successfully treated without surgery. My young patient required a week in the hospital. These athletes usually do well and lead healthy lives, often returning to sports.

Evan Murray’s death was devastating for his hometown. Maybe one positive outcome will result from this tragedy. Parents, coaches and athletes can become more aware of these injuries so that no more athletes die from them in the future.