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. 2024 Jun;52(7):1845-1854.
doi: 10.1177/03635465241247212. Epub 2024 May 14.

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Jeffrey A King  1 , Lindsay D Nelson  2 , Kelly Cheever  3 , Benjamin Brett  2 , Jordan Gliedt  2 , Aniko Szabo  4 , Huaying Dong  5 , Daniel L Huber  2 , Steven P Broglio  6 , Thomas W McAllister  7 , Michael McCrea  2 , Paul Pasquina  8 , Luis A Feigenbaum  9 , April Hoy  10 , Jason P Mihalik  11 , Stefan M Duma  12 , Thomas Buckley  13 , Louise A Kelly  14 , Chris Miles  15 , Joshua T Goldman  16 , Holly J Benjamin  17 , Christina L Master  18 , Justus Ortega  19 , Anthony Kontos  20 , James R Clugston  21 , Kenneth L Cameron  22 , Thomas W Kaminski  13 , Sara P Chrisman  23 , James T Eckner  24 , Nicholas Port  25 , Gerald McGinty  26   27
Affiliations

The Prevalence and Influence of New or Worsened Neck Pain After a Sport-Related Concussion in Collegiate Athletes: A Study From the CARE Consortium

Jeffrey A King et al. Am J Sports Med. 2024 Jun.

Abstract

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes.

Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport.

Study design: Cohort study; Level of evidence, 2.

Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018.

Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P < .001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P < .001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P = .592).

Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery.

Keywords: concussion; neck pain; sports medicine; whiplash.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This publication was made possible in part by the National Collegiate Athletic Association (NCAA) and the United States DOD. The United States Army Medical Research Acquisition Activity (USAMRAA) is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Combat Casualty Care Research Program, endorsed by the DOD, and the Joint Program Committee 6/Combat Casualty Care Research Program–Psychological Health and Traumatic Brain Injury Research Program (W81XWH-14-2-0151). J.A.K. has received research funding from the National Chiropractic Mutual Insurance Company (NCMIC) and speaking honoraria from the Wisconsin Chiropractic Association. L.D.N. has received funding for unrelated research from the National Institute of Neurological Disorders and Stroke (NINDS), the Centers for Disease Control and Prevention (CDC), the DOD, the Medical Technology Enterprise Consortium, and the Medical College of Wisconsin–Advancing a Healthier Wisconsin Endowment and consulting fees for grant reviewing (DOD) and research (NINDS). B.B. has received grants from the National Institute on Aging and the NINDS, travel reimbursements for presenting at conferences, and a $500 honorarium in 1 instance. J.G. has received funding for unrelated research from the NCMIC and consulting fees for chiropractic education accreditation reviewing from the Council on Chiropractic Education. S.P.B. has received research funding from the National Institutes of Health (NIH), the CDC, the DOD-USAMRAA, the NCAA, the National Athletic Trainers’ Association, National Football League (NFL)/Under Armour/GE, Simbex, and ElMindA; has consulted for US Soccer (paid), USA Cycling (unpaid), the University of Calgary SHRed Concussions external advisory board (unpaid), and medicolegal litigation cases; has received speaker honoraria and travel reimbursements for talks given; is a coauthor of Biomechanics of Injury, 3rd Edition; has a patent on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (US 11,529,091 B2); and is/was on the editorial boards (all unpaid) for the Journal of Athletic Training (2015-present), Concussion (2014-present), Athletic Training & Sports Health Care (2008-present), and the British Journal of Sports Medicine (2008-2019). T.W.M. has received research funding from the NCAA and the DOD to complete this work (travel funds to attend scientific conferences and present data were included in the budget of those grants), has received royalties from American Psychiatric Association Publishing for a textbook on traumatic brain injuries that he coedited, and is a member of the concussion scientific advisory committee for the Australian Football League (uncompensated). M.M. has received research funding through the Medical College of Wisconsin from the NIH, the DOD, the Department of Veterans Affairs, the CDC, NFL, the NCAA, and Abbott Laboratories; is a consultant to NeuroTrauma Sciences and a clinical consultant to the Green Bay Packers; and has received honoraria and travel support for professional speaking engagements. T.B. has received funding from the NCAA/DOD Concussion Assessment, Research and Education (CARE) Consortium as part of this study and industry funding from Statespace (no data from this study are related to that funding). J.T.G. has received honoraria from Pacira. H.J.B. has received support for education from Medwest Associates. C.L.M. has received a grant from DJO. A.K. has received book royalties from APA Books and research funding through the University of Pittsburgh from the CDC, the Chuck Noll Foundation for Brain Injury Research, the DOD (Congressionally Directed Medical Research Program, USAMRAA, Uniformed Services University of the Health Sciences), NFL, the NIH (National Institute of Child Health and Human Development, National Institute of Mental Health, NINDS), and private donors. N.P. has received funding from the NCAA/DOD CARE Consortium (W81XWH-14-2-0151), the DOD (W81XWH-20-1-0717), and the Indiana Spinal Cord and Brain Injury Research Fund and unrestricted funds from Statespace. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

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