Somatosensory function is not deficient at the point of return to
play following concussion in female rugby players
Abstract
Background: Concussion is a common injury in professional women’s rugby union with an
incidence of 19.6 per 1000 match player hours. It is a complex pathophysiological process
affecting the brain, induced by traumatic biomechanical forces. Altered postural sway
following concussion could be one of the reasons players who return to play from
concussion are at a 60% greater risk of a time loss injury. The SWAY medical phone
application allows for objective, reliable and low-cost analysis of postural sway, the most
commonly used assessment method to measure somatosensory deficits following
concussion.
Objective: To establish if a trend is present in pre- and post-concussion measures of
postural sway for female rugby players.
Methods: 44 rugby players had postural sway measurements taken pre-concussion and 8
had scores taken post-concussion at the point of return to play in the 2021/2022 season.
Statistical analysis took place to find trends pre and post-concussion in anthropometric data
as well as mean values for mBESS.
Results: There was no significant difference in age, height, weight or BMI in those who
suffered concussion and those who did not. However, there was a significant association
between previous concussion and concussion this season as well as MSK injury in the past
year and concussion. There is no trend between postural sway scores pre and post-
concussion.
Conclusion: No postural sway deficit is present at the point of return to play following
concussion but further research on this topic with larger sample sizes are necessary.
, Introduction
Sports Related Concussion (SRC) is defined by the Concussion in Sport Group as an injury
caused by traumatic biomechanical forces affecting the brain. (1) It can be caused by a
direct impact or from a transmitted impulsive force to the head and results in rapid onset
impairment of neurological function which resolves spontaneously. Neuroimaging after
concussion is typically normal but some athletes may experience prolonged or persistent
symptoms. (1) Concussion commonly causes impairments to balance, reaction time and
neuromuscular control. (2) For this reason, a mandatory six stage Graduated Return to Play
(GRTP) protocol exists in most sports, involving a progressive exercise programme to re-
introduce athletes into the sport in a stepwise manner, with stage 6 being a return to game
play. (3)
There is currently limited evidence to support the use of objective measures of
somatosensory function as part of the GRTP process (4). This is in spite of a body of
evidence available demonstrating the large increased risk of musculoskeletal (MSK) injury in
the months following return to play from concussion. (5-7)
In women’s rugby union concussion is a common injury with the incidence being 19.6 per
1000 player match hours (8) and accounting for 9.7% of overall reported injuries. (9)
Male rugby union players at the professional level who returned to play in the same season
following a concussion are 60% more likely to suffer from a subsequent injury resulting in
time-loss from play when compared to those who did not suffer concussion. (10) Female
rugby players with a history of concussion are 2.5 times more likely to suffer a lower
extremity MSK injury compared to those without and at present, the mechanism behind this
is unclear. (2, 11)
Evidence suggests that female athletes suffer from symptoms which are more severe and
can take longer to recover from following a concussion compared to their male
counterparts. (9) Research shows that accessing medical treatment earlier can reduce time
required for symptom recovery highlighting opportunities to improve prevention and
recovery for female rugby players in the future. (9)
Postural sway, a measure of somatosensory function, is used within athletic populations as a
measure of preparedness for return to play following injury (12) with evidence
demonstrating that higher levels of postural sway are associated with increased injury
incidence. (13-15)
Somatosensory deficits are known to occur following sports related concussion.
Impairments to motor function, including those affecting postural control may persist and
are often difficult to measure. (16) At present the Modified Balance Error Scoring System
(mBESS) is the most commonly used assessment method used as a measure of
somatosensory assessment following concussion and forms part of the SCAT5, (16, 17) one
of the most commonly used concussion assessment tools. Research suggests that the
reliability and sensitivity of the mBESS ranges from poor to good (18) and recent advances in
technology, such as in the field of accelerometery, enable a more reliable analysis of
postural sway, allowing detection of subtle impairments, objectively and at a low cost. (19)
Postural sway when measured using the Sway Medical phone application has demonstrated
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