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Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk

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Abstract

Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.

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Authors and Affiliations

  1. Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA

    Jason M. Avedesian & Harjiv Singh

  2. Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA

    Jason M. Avedesian, Jed A. Diekfuss & Gregory D. Myer

  3. Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA

    Jed A. Diekfuss & Gregory D. Myer

  4. Emory Sports Medicine Center, Atlanta, GA, USA

    Gregory D. Myer

  5. The Micheli Center for Sports Injury Prevention, Waltham, MA, USA

    Gregory D. Myer

  6. Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA

    Dustin R. Grooms

  7. Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA

    Dustin R. Grooms

  8. Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA

    Dustin R. Grooms

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  1. Jason M. Avedesian
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  2. Harjiv Singh
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  3. Jed A. Diekfuss
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  4. Gregory D. Myer
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  5. Dustin R. Grooms
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Correspondence to Jason M. Avedesian.

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Jason M. Avedesian, Harjiv Singh, Jed A. Diekfuss, Gregory D. Myer, and Dustin R. Grooms declare they have no conflicts of interest relevant to the content of this review.

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Avedesian, J.M., Singh, H., Diekfuss, J.A. et al. Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk. Sports Med 51, 2299–2309 (2021). https://doi.org/10.1007/s40279-021-01527-5

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