Neurology and injuries research shows that athletes of all levels have a greater risk of lower body injury issues for more than a year following a sport-related concussion
AN NFL PLAYER HAS A 41% RISK of developing a lower body injury issue at some point in the season, according to a 2020 study published in the American Journal of Sports Medicine. Combined, this results in a loss of 56,700 days of play each year. This research found that the knee is injured most often in pro football, accounting for 29.3% of lower-body injuries. The ankle is next at 22.4%, followed by injuries to the thigh (17.2%) and foot (9.1%).
A 2019 study in the Orthopaedic Journal of Sports Medicine adds that sports lower body injury issues are also relatively common in high school-level athletes, especially those playing soccer and basketball. This research further noted that female players tend to sustain these injuries at a higher rate than their male counterparts.
While the general tendency may be to go to the site of the lower body injury when looking for the cause and/or to create a treatment plan, one DC says the best approach involves starting much higher in the body.
Lower body injury issues: a ‘top-down’ treatment model
“Recent research has correlated concussion injury during sport and an increased incidence of lower extremity injury,” says Michael Bagnell, DC, DACNB, FABBIR, functional neurologist and chiropractic physician at the Bagnell Brain Center in Pinecrest, Fla.
One study Bagnell is referencing was published in the International Journal of Exercise Science in 2020. This comprehensive review noted that athletes of all levels — high school, collegiate and pro — have a greater risk of lower body injury issues for more than a year following a sport-related concussion. In some cases, this risk is as high as 67%.
Based on these findings, the researchers decided to take a closer look at biomechanical function and the possible connection between concussion and lower-extremity issues. They found that athletes with a history of concussion had greater knee valgus and internal rotation when doing a jump-cut. They also noticed changes in the players’ lower-extremity stiffness when landing from a jump. This suggests there is a neuromuscular component that, post-concussion, could place these athletes at a greater risk of sustaining a lower-body issue.
A 2018 cohort study found similar results, except this time the subjects studied were soldiers versus athletes. After analyzing medical data from 23,044 active-duty U.S. Army personnel, researchers reported that the soldiers were 38% more likely to sustain a lower-extremity injury within the two years following a concussion when compared to soldiers who were non-concussed. Within 15 months post-concussion, this risk was greater at 45%.
Studies such as these highlight the importance of looking at an athlete’s history of head injury when presenting with a lower-extremity injury.
A thorough diagnosis
Making this connection for each individual patient begins with a thorough diagnosis. This often includes the standard evaluations most common in a chiropractic setting, such as looking at the patient’s ranges of motion and joint movements. It also involves considering the stabilization to mobility links between the foot, ankle, knee, hip and spine. But for Bagnell and his team, it doesn’t stop there.
“We also include a brain-based consideration or a neurological model which tests cerebellar function on each side as well as vestibular and cortical neurological relationships to lower extremities,” he says. This is important not only when considering the best treatment protocol, but also as a preventive.
“Consider a vision/brain evaluation from a chiropractic neurologist (functional neurologist) prior to sport season,” suggests Bagnell, “for a deeper understanding of areas for potential improvement to mitigate chances of injury.”
What happens if a suspected connection exists?
Vision training for lower body issues
“Where many in rehabilitation would work with soft tissue, ligament rehabilitation, functional muscle movement improvement and control around the joint, rocker board applications for ankle proprioception, we add in vision training for improving brain map accuracy to these lower-extremity regions,” Bagnell explains.
Bagnell also likes to have athletes perform vision training activities prior to returning to play. This provides “gradual and progressive demands on the lower limb,” he says, adding that, “by working a ‘top-down’ model combined with a more traditional ‘bottom-up’ therapy, we are seeing improved outcomes.”
CHRISTINA DEBUSK is a freelance writer who specializes in content related to natural health and wellness, personal development and small-business marketing. She can be contacted through ChristinaMDeBusk.com.
 Mack C, Kent R, Coughlin M, et al. Incidence of lower extremity injury in the National Football League: 2015-2018. Am J Sports Med. https://pubmed.ncbi.nlm.nih.gov/32485114/. Published Jun 2, 2020. Accessed May 21, 2020.
 Brant J, Johnson B, Brou L, et al. Rates and patterns of lower extremity sports injuries in all gender-comparable US high school sports. Orthop J Sports Med. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775559/. Published Oct 2019. Accessed May 21, 2020.
 Avedesian J, Covassin T, Dufek J. The influence of sport-related concussion on lower extremity injury risk: a review of current return-to-play practices and clinical implications. Int J Exerc Sci. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449327/. Published 2020. Accessed May 21, 2021.
 Kardouni J, Shing T, McKinnon C, et al. Risk for lower extremity injury after concussion: a matched cohort study in soldiers. J Orth Sports Phys Ther. https://www.jospt.org/doi/abs/10.2519/jospt.2018.8053. Published June 30, 2018. Accessed May 21, 2021.