Diagnosed concussion is associated with increased risk for lower extremity injury in community rugby players

Objectives: To determine (1) the association between lifetime diagnosed concussion and lower extremity musculoskeletal injury (LE-MSI) among community rugby union players and (2) the sex specific risk of LE-MSI given concussion history among males and females. Design: Retrospective survey. Methods: 1037 (59.0% male, (612/1037), age: 31.6 +/- 11.3 years) rugby players (10.1 +/- 8.1 years played) completed an online survey to ascertain injury history. A chi-squared test of association was performed between concussion and LE-MSI; significant outcomes were followed-up with an odds ratio. A binary logistic regression with any LE-MSI (yes/no) as the outcome and concussion (yes/no) and sex (male/female) as predictors was performed to determine if there was a sex by concussion interaction. Results: There was an overall significant association between concussion and any LE-MSI(chi(1)= 13.055, p < 0.001, OR =2.30 [95%CI: 1.45, 3.65]). Both male (OR =2.21) and females (OR = 2.49) had significant associations for concussion and LE-MSI, but there were no differences between sex for risk of LE-MSI (R-2 =0.024, p =0.999). Conclusions: Community rugby players with a history of concussion are >2 x more likely to also experience an LE-MSI than those without a history of concussion. There were no differences in the odds of LE-MSI between males and females with a history of diagnosed concussion. In line with current World Rugby injury prevention programs, future research should aim to reduce LE-MSI incidence to maximize player safety and wellness through targeted injury prevention and teams should utilize a conservative return to play protocols following concussion. (C) 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.