Posturing Responses in Concussions Sustained by Elite American Football Players

in International Journal of Athletic Therapy and Training
Restricted access

Purchase article

USD  $24.95

Student 1 year subscription

USD  $74.00

1 year subscription

USD  $99.00

Student 2 year subscription

USD  $141.00

2 year subscription

USD  $188.00

Current literature indicates loss of consciousness occurs in about 10% of concussions. Posturing presentations represent brain injuries and a loss of consciousness. The purpose of this study was to observe video evidence of football-game-related concussions to determine the rate in which a posturing presentation occurs in reported concussion. Over the course of three National Football League and three National Collegiate Athletic Association football seasons, 103 videos of 805 reported concussions met the inclusion criteria; 35 videos demonstrated a posturing presentation, for a rate of 33.98%. Our study indicates that the published statistic regarding loss of consciousness (occurring only about 10% of the time) may be too conservative.

Bruce is an associate professor/director of research, Arkansas State University, Jonesboro, AR, USA. Dorney is a staff athletic trainer with Troy High School, Upper Valley Medical Center, Premier Health, Troy, OH, USA.

Bruce (slb.atc1984@gmail.com) is corresponding author.
  • 1.

    Echemendia RJ, Meeuwisse W, McCrory P, et al. The sport concussion assessment tool 5th edition (SCAT5): Background and rationale. Br J Sports Med. 2017;51(11):848850. PubMed ID: 28446453 doi:10.1136/bjsports-2017-097506

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Garcia GGP, Broglio SP, Lavieri MS, McCrea M, McAllister T. Studies from University of Michigan further understanding of sports medicine (quantifying the value of multidimensional assessment models for acute concussion: an analysis of data from the NCAA-DoD Care Consortium). September 21, 2018. 15316459.

    • Search Google Scholar
    • Export Citation
  • 3.

    Lawrence JB, Haider MN, Leddy JJ, Hinds A, Miecznikowski JC, Willer BS. The King-Devick test in an outpatient concussion clinic: assessing the diagnostic and prognostic value of a vision test in conjunction with exercise testing among acutely concussed adolescents. J Neurol Sci. 2019;398:9197. PubMed ID: 30690413 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Resch JE, Schneider MW, Cullum CM. The test-retest reliability of three computerized neurocognitive tests used in the assessment of sport concussion. Int J Psychophysiol. 2018;132:3138. PubMed ID: 28935224 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Cournoyer J, Hoshizaki TB. Abnormal motor response associated with concussive injuries: biomechanical comparison between impact seizures and loss of consciousness. J Athl Train. 2019;54(7):765771. PubMed ID: 31343274 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Phys Sportsmed. 1986;14(10):7583. PubMed ID: 27432133 doi:

  • 7.

    Jordan BD, Tsairis P, Warren RF. Sports neurology. Aspen, CO: Aspen Pub; 1989.

  • 8.

    Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology. 1997;48(3):575580. PubMed ID: 9065529 doi:

  • 9.

    Nelson WE, Jane JA, Gieck JH. Minor head injury in sports: a new system of classification and management. Phys Sportsmed. 1984;12(3):103107. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Ommaya AK. Biomechanics of head injury: experimental aspects. In: Nahum AM, Melvin J, eds. The Biomechanics of Trauma. Norwalk, CT: Appleton & Lange; 1985:245269.

    • Search Google Scholar
    • Export Citation
  • 11.

    Roberts WO, Johnson R. Who plays? Who sits? Managing concussions on the sidelines. Phys Sportsmed. 1992;20(6):6672. PubMed ID: 27438927 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Torg JS. Athletic injuries to the head, neck, and face. Mosby Year Book; 1991:345350.

  • 13.

    Cantu RC. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train. 2001;36(3):244. PubMed ID: 12937491

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the management of concussion in sports. Denver, CO: Colorado Medical Society; 1990.

    • Search Google Scholar
    • Export Citation
  • 15.

    McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):25562563. PubMed ID: 14625332 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Casson IR, Viano DC, Powell JW, Pellman EJ. Twelve years of National Football League concussion data. Sports Health. 2010;2(6):471483. doi:

  • 17.

    Mullally WJ. Concussion. Am J Med. 2017;130(8):885892. PubMed ID: 28502817 doi:

  • 18.

    Schulz MR, Marshall SW, Mueller FO, et al. Incidence and risk factors for concussion in high school athletes, North Carolina, 1996–1999. Am J Epidemiol. 2004;160(10):937944. PubMed ID: 15522850 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med. 2003;13(4):222229. PubMed ID: 12855924 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003;290(19):25492555. PubMed ID: 14625331 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Kelly JP. Loss of consciousness: pathophysiology and implications in grading and safe return to play. J Athl Train. 2001;36(3):249. PubMed ID: 12937492

  • 22.

    Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. 2005;57(1):128134. PubMed ID: 15987548 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Davis GA, Makdissi M, Bloomfield P, et al. International study of video review of concussion in professional sports. Br J Sports Med. 2019;53:12991304. PubMed ID: 30262454 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport-related concussion. Clin Sports Med. 2011;30(1):117. doi:

  • 25.

    Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546553. PubMed ID: 12756388 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Hosseini AH, Lifshitz J. Brain injury forces of moderate magnitude elicit the fencing response. Med Sci Sports Exerc. 2009;41(9):16871697. doi:

  • 27.

    McCrory PR, Berkovic SF. Concussive convulsions. Incidence in sport and treatment recommendations. Sports Med. 1998;25(2):131136. doi:

  • 28.

    McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ. 1997;314(7075):171174. PubMed ID: 9022428 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Kuhl NO, Yengo-Kahn AM, Burnette H, Solomon GS, Zuckerman SL. Sport-related concussive convulsions: a systematic review. Phys Sportsmed. 2018;46(1):17. PubMed ID: 29280684 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Tényi D, Gyimesi C, Horváth R, et al. Concussive convulsions: a YouTube video analysis. Epilepsia. 2016;57(8):13101316. doi:

  • 31.

    Elovic E, Baerga E, Galang GF, Cuccurullo SJ, Reyna M, Malone RJ. Traumatic brain injury. In: Cuccurullo SJ, ed. Physical Medicine and Rehabilitation Board Review. New York, NY: Demos Medical Publishing; 2004:53100.

    • Search Google Scholar
    • Export Citation
  • 32.

    McCrory PR, Berkovic SF. Video analysis of acute motor and convulsive manifestations in sport-related concussion. Neurology. 2000;54(7):14881491. PubMed ID: 10751264 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Bella T. Interactive: The 2014 College Football Concussion Map. 2014. http://america.aljazeera.com/watch/shows/america-tonight/articles/2014/8/28/explore-the-2014collegefootballconcussionmap.html. Accessed November 12, 2016.

    • Export Citation
  • 34.

    Bella T. Interactive: The 2015 NCAA Football Concussion Map. 2015. http://america.aljazeera.com/watch/shows/america-tonight/multimedia/2015/9/2015-ncaa-football-concussion-map.html. Accessed November 12, 2016.

    • Export Citation
  • 35.

    Shrout PE. Measurement reliability and agreement in psychiatry. Stat Methods Med Res. 1998;7(3):301317. PubMed ID: 9803527 doi:

  • 36.

    LaRoche AA, Nelson LD, Connelly PK, Walter KD, McCrea MA. Sport-related concussion reporting and state legislative effects. Clin J Sport Med. 2016;26(1):3339. PubMed ID: 25894530 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Baugh CM, Meehan WP III, Kroshus E, McGuire TG, Hatfield LA. College football players less likely to report concussions and other injuries with increased injury accumulation. J Neurotraum. 2019;36(13):20652072. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998;13(2):2735. PubMed ID: 9575254 doi:

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 151 151 28
Full Text Views 11 11 0
PDF Downloads 4 4 0