Background There is evidence that concussion can increase the risk of sustaining a subsequent musculoskeletal (MSK) injury up to 24-months post injury. The reason for increased risk is unknown although irregularities in brain and motor function post-concussion that are sustained beyond clinical recovery have been implicated.

Objective To determine the likelihood of UK High Performance System athletes sustaining a subsequent MSK injury within a 4-month period post-concussion.

Design Retrospective Cohort Study. A concussion was identified by a medical records diagnostic code of ‘concussion without loss of consciousness’, ‘concussion with loss of consciousness’, or ‘concussion not otherwise specified’. The attrition rate is the average occurrence of an MSK injury during the 4-month period. An attrition rate for all MSK injuries was determined using the formula; ‘Number of MSK Injuries’/‘Number of Athletes’. An attrition rate for all MSK injuries subsequent to a concussion was determined by the formula; ‘Number of MSK injuries that occur in the 4-months after a concussion’/‘Number of Athletes who sustained a concussion’.

Setting UK High Performance System Olympic and Paralympic athletes

Participants 1979 athletes from 33 sports

Main Outcome Measurements MSK attrition rate compared to MSK/Concussion attrition rate.

Results Athletes were found to have a 27% increased risk of suffering a MSK injury 4-months post-concussion, with the overall MSK attrition rate of 0.78, increasing to 0.99 post-concussion. A higher MSK/Concussion attrition rate was identified in 26 of 33 sports.

Conclusions There is an increased risk of sustaining a MSK injury post-concussion amongst UK Olympic and Paralympic programme athletes. Therefore, identifying and addressing risk factors for subsequent MSK injury should be considered during concussion rehabilitation. This might include visio-motor, oculo-motor, balance and neuromuscular impairments alongside screening, monitoring and programming physical preparation to ensure any work-load imbalances associated with time away from sport are addressed.