Objective Describe tandem gait score performance in concussed elite athletes as compared to asymptomatic baselines.

Design Within subjects, repeated measures.

Setting United States Olympic Committee Sports Medicine Clinics

Participants Six hundred forty-one elite athletes (291 women and 350 men, mean age 24.9±5.2 years) representing 23 Olympic sports participated in this study.

Intervention The SCAT3 was administered during a preseason baseline and repeated as clinically indicated during initial evaluations and serially as part of a multimodal concussion management program.

Outcome measures SCAT3 performance measures of concussed elite athletes were compared to baseline SCAT3 performance.

Results Tandem gait performance was significantly better in concussed elite athletes than on athletes tested for healthy asymptomatic baselines (9.6 vs. 11.7, P<0.001), despite concussed athletes reporting significantly higher total number of symptoms (6.4 vs. 2.1, P<0.001) and symptom severity scores (13.1 vs. 3.4, P<0.001) during concussion recovery.

Conclusions There is a paradoxical relationship between concussion status and tandem gait performance in elite athletes, with concussed athletes performing better on average than athletes evaluated for a baseline SCAT3 evaluation.

Clinical Relevance Tandem gait performance is not impaired in athletes with symptoms of concussion. Intrinsic motivation to return to play may result in enhanced tandem gait performance in concussed athletes.

Competing interests None.