Concussions and Repetitive Head Impacts

The most competitive athletes will be drawn to the most impact-driven part of the game. This makes them much more susceptible to concussions and repetitive head impacts (sub-concussive impacts that can accumulate to the same after-effects of a concussion). We give these players the tools to protect their head and make their play more effective while reducing loss of playing time due to injury.

It is no coincidence that contact sport athletes sustain more ACL tears than non-contact sport athletes. With level of professional competition and gender variables removed, the simple fact is that professional female soccer players tear their ACL’s 10x more often than professional tennis players. Tennis players run, cut, change direction, and experience a high level of agility in the lower leg, similar to soccer players. We have focused on lateral hip strengthening and lower extremity biomechanics as contributing factors; now it’s time to pay attention to how the muscles surrounding the knee joint get their signals to engage and shut off: the neuromuscular firing patterns.

We know through research (Journal of Arthroscopy and Related Surgery, Jildeh et al, 2021) that after a concussion a professional athlete is 4.5 times more likely to sustain a lower body injury. The whip-lash nature of sports-related concussions damage the upper cervical musculature resulting in weakness and lack of coordination in these muscles. We now understand this is connected to dysfunction in the nerve firing that is responsible for feeding instantaneous information to the brain about muscle action and position of the body, our neuromuscular firing patterns.

This approach to concussion and lower body injury prevention holds value for all contact sport athletes. We recognize the need to get these resources to female athletes first, due to the predisposition for increased repetitive head impacts. Females have less natural cushioning (less cerebrospinal fluid) in their head compared to males as well as greater ratio of head size to neck size. Think of stabilizing a pumpkin on a broom stick (female) versus stabilizing a pumpkin on a 2-inch diameter PVC pipe (male). Which pumpkin would endure more force or movement if there was an impact? Clearly the wider, or stronger, base (neck) is more stable for the pumpkin (head). The repetitive head impacts that occur as a normal part of competitive play (impact with the ground, another player, the ball) relate to dysfunction in the muscles at that top of the neck that are trying to decelerate the head. Over time, this disrupts the neuromuscular firing patterns in the lower extremities, relating to what has been termed the “ACL crisis” in professional female soccer players.