Relationship Between Cognitive Performance and Lower Extremity Biomechanics: Implications for Sports-Related Concussion

Orthop J Sports Med. 2021 Sep;


Avedesian, J. M., Covassin, T., Baez, S., Nash, J., Nagelhout, E., & Dufek, J. S..



Background: Collegiate athletes with prior sports-related concussion (SRC) are at increased risk for lower extremity (LE) injuries; however, the biomechanical and cognitive mechanisms underlying the SRC-LE injury relationship are not well understood. Purpose: To examine the association between cognitive performance and LE land-and-cut biomechanics among collegiate athletes with and without a history of SRC and to determine the association among multiple cognitive testing batteries in the same athlete cohort. Study Design: Controlled laboratory study. Methods: A cohort of 20 collegiate athletes with prior SRC (9 men, 11 women; mean +/- standard deviation [SD] age, 20.5 +/- 1.3 years; mean +/- SD time since last SRC, 461 +/- 263 days) and 20 matched controls (9 men, 11 women; mean +/- SD age, 19.8 +/- 1.3 years) completed land-and-cut tasks using the dominant and nondominant limbs. LE biomechanical variables and a functional visuomotor reaction time (FVMRT) were collected during each trial. Athletes also completed the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and Senaptec Sensory Station assessments. Results: In the SRC cohort, Pearson correlation coefficients indicated slower FVMRT was moderately correlated with decreased dominant limb (r = -0.512) and nondominant limb (r = -0.500) knee flexion, while increased dominant limb knee abduction moment was moderately correlated with decreased ImPACT Visual Memory score (r = -0.539) and slower ImPACT Reaction Time (r = 0.515). Most computerized cognitive measures were not associated with FVMRT in either cohort (P > .05). Conclusion: Decreased reaction time and working memory performance were moderately correlated with decreased sagittal plane knee motion and increased frontal plane knee loading in collegiate athletes with a history of SRC. The present findings suggest a potential unique relationship between cognitive performance and LE neuromuscular control in athletes with a history of SRC injury. Last, we determined that computerized measures of cognitive performance often utilized for SRC management are dissimilar to sport-specific cognitive processes. Clinical Relevance: Understanding the relationship between cognitive performance and LE biomechanics in athletes with prior SRC may inform future clinical management strategies. Future research should prospectively assess cognitive and biomechanical measures, along with LE injury incidence, to identify mechanisms underlying the SRC-LE injury relationship.

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