The Effect of Ball Heading and Subclinical Concussion On the Neuromuscular Control Of The Lower Limb: A Systematic Review.
Georgios Kakavas, Ioannis Giannakopoulos, Athanasios Tsiokanos and 2 others
PMID 37795323WHAT IT FOUND
Athletes with concussion appear more likely to injure a lower limb after return to play in several studies, but the evidence is observational and not consistent across all studies.
Key findings
01Four included biomechanics studies linked worse cognitive performance to lower-limb movement patterns that suggest greater risk for musculoskeletal injury.
02Six included injury studies were not uniform: two found no cognitive group differences, while four found baseline cognitive differences or cognition predicted later injury.
03One included study found 2.48 times higher odds of a lower-limb injury in the 90 days after return to play compared with controls.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only English-language peer-reviewed studies were included, so relevant work in other languages may have been missed. The review included 10 studies, and no meta-analysis was possible because designs and outcomes were heterogeneous. Included studies were prospective, retrospective, or cross-sectional, so they show association rather than cause. Risk of bias was not uniform: five studies were rated high, three moderate, and two low; blinding was often not feasible or not done. Some included studies relied on self-report or could not determine the order of injury occurrence. The stated eligibility criteria mention long-term sequelae beyond 10 years, but the included studies tracked shorter periods such as 90 days, 180 days, and 12 months, so the scope is not internally consistent. It is unclear whether athletes were cleared strictly according to current concussion consensus. The mechanism for increased lower-limb injury risk is unclear.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that ball heading or concussion directly caused the lower-limb injuries, or that return-to-play clearance makes an athlete safe. The review included observational studies of athletes who had been cleared by sports medicine staff, and it found associations with injury risk, not a tested effect of heading or a treatment.