There is an elevated rate of post-concussion lower extremity musculoskeletal injury (LE MSK), however the underlying mechanism has not been elucidated. Existing approaches have investigated physical characteristics despite poorer mental health being a common post-concussion complaint and linked to musculoskeletal injuries.


The purpose of this study was to investigate the role of mental health as a predictor of post-concussion subsequent LE MSK.


Case-Control Study.


Intercollegiate Athletic Training Room

Patients or Other Participants

67 NCAA Division I student-athletes (N=39 Female) who were diagnosed with a sports-related concussion.

Main Outcome Measures

The Brief Symptom Inventory-18 (BSI-18), the Hospital Anxiety and Depression Scale (HADS), and the Satisfaction with Life Scale (SWLS) measures were completed at baseline (pre-season) and on the day they were cleared for unrestricted return to participation (RTP) following a concussion. Two binary logistic regressions were used to predict post-concussion LE MSK within a year, one for the baseline time point and the second for RTP time point. A 2 (Group: LE MSK, No LE MSK) by 2 (Time: Baseline, RTP) repeated measures ANOVA compared performance between baseline and RTP.


There were 44 participants with subsequent LE MSK (65.7%). The only significant predictor of post-concussion LE MSK was SWLS at RTP (Exp(B): 0.64) indicating an increased (improved) SWLS was associated with lower LE MSK injury rate. There were no significant interactions between any of the mental health measures (p=0.105 – 0.885).


There was limited associations for post-concussion LE MSK from commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with decreased injury risk which warrants further attention. The results of this study suggest that these measures of anxiety, depression, and satisfaction with life have limited value for assisting sports medicine clinicians in determining which student-athletes are at elevated risk of post-concussion LE MSK.

This content is only available as a PDF.

Author notes

Buckley:, @ConcussionUD

Bryk:, @shesabrykhouse

Enrique:, N/A

Kaminski:, @UD_ATEP

Hunzinger:, @KatieHunzinger

Oldham:, @jroldham