Concussion, Postural Control, and Lower Extremity Injury Risk: A Comparison of Postural Control Tests

OBJECTIVE: Evidence suggests that individuals with sports-related concussion (SRC) may experience lingering postural control deficits, which could increase the risk of lower extremity musculoskeletal (LEMSK) injury. Mixed findings in current literature may stem from inconsistent assessment methods. This study aimed to investigate postural control in athletes with a history of SRC using multiple assessment tools to identify which, if any, best predict LEMSK injury. DESIGN: Cross-sectional. METHODS: A total of 110 NCAA Division II student-athletes (67 with SRC history, 43 without; 56 males, 54 females; mean age 19.8 yrs) were recruited via purposeful sampling. Baseline postural control assessments included the Balance Error Scoring System (BESS; single and dual-task), computerized Modified Clinical Test of Sensory Interaction in Balance (M-CTSIB), and tandem gait test (TGT; single and dual-task). Participants were monitored for LEMSK injury over one competitive season. Logistic regression determined whether preseason postural performance predicted injury. RESULTS: BESS dual-task performance significantly predicted LEMSK injury (b = 0.045, p = 0.047). BESS single-task performance trended toward significance (b = 0.054, p = 0.056). No significant predictive value was found for M-CTSIB or TGT (single/dual-task). CONCLUSION: Among the postural control assessments, BESS dual-task performance was the most sensitive predictor of LEMSK injury. These findings suggest dual-task postural control testing may be valuable in identifying athletes at elevated injury risk post-SRC.