Background Evaluation of multiple sensory and motor domains at time of return to play (RTP) may inform risk of recurrent concussion and injury following concussion.

Objective To evaluate if measures of (1) cervical spine function, (2) vestibulo-ocular reflex (VOR) function, (3) dynamic balance and (4) tasks of divided attention have returned to preinjury levels at medical clearance to RTP in elite youth ice hockey players.

Design Case series nested in a prospective cohort study (n=559).

Setting Canadian youth ice hockey.

Participants Youth ice hockey players [13–17 years; n=45 (8 female, 37 male)].

Interventions Players who were diagnosed with an ice hockey-related concussion completed preseason and RTP measures.

Main Outcome Measurements Cervical spine measures (cervical flexor endurance test, head perturbation test, anterolateral strength, cervical flexion rotation test, joint position error), VOR tests [head thrust test, dynamic visual acuity (clinical and computerized)], dynamic balance tests (functional gait) and divided attention tasks (walking-while-talking-test WWTT) were included. Non-parametric (Wicoxon signed-rank, Stuart-Maxwell) analyses compared preseason to RTP scores.

Results Symptoms of dizziness, neck pain, and headache were reported by 29%, 18% and 20% fewer players at RTP than preseason respectively. Anterolateral cervical muscle strength (z=-5.16, p<0.0001) and joint position error (left) (z=2.91, p=0.0036) were poorer at RTP compared to preseason. The WWTT time (z=-2.66, p=0.0079) and FGA scores were improved at RTP (z=-2.55, p=0.011).

Conclusions Anterolateral cervical spine strength and joint position error (left) did not return to preseason values at RTP and may suggest incomplete recovery not indicated by symptoms at RTP. WWTT and dynamic balance were improved at RTP. Further evaluation of clinical outcomes on risk of subsequent injury following concussion is warranted.