The relationship between concussion and subsequent upper body musculoskeletal injury in NFL players

To determine whether National Football League (NFL) players who sustain a concussion are at increased risk of same-season upper body musculoskeletal injury (UBMSI) compared to matched controls.

Injuries were identified using publicly available NFL.com injury reports from the 2015-2017 regular seasons. Concussions were verified, required return to ≥1 subsequent game, and only the first per season was analyzed; cases with concurrent concussion and UBMSI were excluded. Each concussed player was matched to a teammate of the same or closely related position without reported injury. Descriptive statistics were calculated, a chi-square test compared UBMSI frequencies, and a Cox proportional hazards model estimated the relative risk of post-concussion UBMSI.

A total of 322 concussed players and 322 matched controls were included (N = 644). UBMSI occurred in 14.3% of concussed players versus 8.1% of controls, χ² (1) = 6.25, p = 0.012. Across 4,585 participant-weeks, 72 post-return-to-play UBMSI events occurred. Concussed players had a significantly higher hazard of UBMSI (HR = 1.83, 95% CI: 1.13-2.96, p = 0.014).

Concussed NFL players were 83% more likely to sustain a same-season post-return-to-play UBMSI. This is the first league-level evidence linking concussion to elevated UBMSI risk in professional football, highlighting the need to address post-concussive injury vulnerability in return-to-play protocols.