Musculoskeletal Injury History Is Associated With Lower Physical and Mental Health in a Historical Cohort of Former National Football League Players

in Journal of Sport Rehabilitation

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Zachary Y. Kerr
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Julianna Prim
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J.D. DeFreese
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Leah C. Thomas
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Janet E. Simon
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Kevin A. Carneiro
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Stephen W. Marshall
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Kevin M. Guskiewicz
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Context: Little research has examined health-related quality of life in former National Football League (NFL) players. Objective: Examine the association of musculoskeletal injury history and current self-reported physical and mental health in former NFL players. Setting: Cross-sectional questionnaire. Patients or Other Participants: Historical cohort of 2,103 former NFL players that played at least one season between 1940 and 2001. Intervention: Players were grouped by self-reported professional career musculoskeletal injury history and whether injuries affected current health: (1) no musculoskeletal injury history; (2) musculoskeletal injury history, currently affected by injuries; and (3) musculoskeletal injury history, not currently affected by injuries. Main Outcome Measure: The Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being (SF-36) yielded physical and mental health composite scores (PCS and MCS, respectively); higher scores indicated better health. Multivariable linear regression computed mean differences (MD) among injury groups. Covariates included demographics, playing history characteristics, surgical intervention for musculoskeletal injuries, and whether injury resulted in premature end to career. MD with 95% CI excluding 0.00 were deemed significant. Results: Overall, 90.3% reported at least one musculoskeletal injury during their professional football careers, of which 74.8% reported being affected by their injuries at time of survey completion. Adjusting for covariates, mean PCS in the “injury and affected” group was lower than the “no injury” (MD = −3.2; 95% CI: −4.8, −1.7) and “injury and not affected” groups (MD = −4.3; 95% CI: −5.4, −3.3); mean MCS did not differ. Conclusion: Many players reported musculoskeletal injuries, highlighting the need for developing and evaluating injury management interventions.

Kerr, DeFreese, and Guskiewicz are with the Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, USA. Kerr, DeFreese, Carneiro, Marshall, and Guskiewicz are with the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC, USA; and the Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, NC, USA. Kerr, Marshall, and Guskiewicz are also with the Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA. Prim is with the Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, USA. Thomas is with the Duke Cancer Institute, Durham, NC, USA. Simon is with the Division of Athletic Training, School of Applied Health Sciences and Wellness, Ohio University, Athens, OH, USA. Carneiro is also with the School of Medicine, Physical Medicine & Rehabilitation, University of North Carolina, Chapel Hill, NC, USA. Marshall is also with the Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.

Kerr (zkerr@email.unc.edu) is corresponding author.
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  • Expand
  • 1.

    Selden MA, Helzberg JH, Waeckerle JF. Early cardiovascular mortality in professional football players: fact or fiction? Am J Sports Med. 2009;122(9):811814. PubMed ID: 19699372 doi:10.1016/j.amjmed.2009.03.027

    • Search Google Scholar
    • Export Citation
  • 2.

    Halchin L. CRS Report for Congress: Former NFL Players: Disabilities, Benefits, and Related Issues. Washington, DC: Congressional Service; 2008.

    • Search Google Scholar
    • Export Citation
  • 3.

    Schwenk TL, Gorenflo DW, Dopp RR, Hipple E. Depression and pain in retired professional football players. Med Sci Sports Exerc. 2007;39(4):599605. PubMed ID: 17414796 doi:10.1249/mss.0b013e31802fa679

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

    Lynall RC, Pietrosimone B, Kerr ZY, Mauntel TC, Mihalik JP, Guskiewicz KM. Osteoarthritis prevalence in retired National Football League players with a history of concussion and lower extremity injury. J Athl Train. 2017;52(6):518525. PubMed ID: 28653870 doi:10.4085/1062-6050-52.2.03

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

    Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57(4):719726. PubMed ID: 16239884 doi:10.1227/01.NEU.0000175725.75780.DD

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

    Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39(6):903909. PubMed ID: 17545878 doi:10.1249/mss.0b013e3180383da5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Kerr ZY, Marshall SW, Harding HP, Guskiewicz KM. Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players. Am J Sports Med. 2012;40(10):22062212. PubMed ID: 22922518 doi:10.1177/0363546512456193

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Didehbani N, Munro Cullum C, Mansinghani S, Conover H, Hart J. Depressive symptoms and concussions in aging retired NFL players. Arch Clin Neuropsychol. 2013;28(5):418424. PubMed ID: 23644673 doi:10.1093/arclin/act028

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Cottler LB, Abdallah AB, Cummings SM, Barr J, Banks R, Forchheimer R. Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug Alcohol Depend. 2011;116(1–3):188194. PubMed ID: 21277121 doi:10.1016/j.drugalcdep.2010.12.003

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

    Bauman J. Returning to play: the mind does matter. Clin J Sport Med. 2005;15(6):432435. PubMed ID: 16278547 doi:10.1097/01.jsm.0000186682.21040.82

  • 11.

    McAllister DR, Motamedi AR, Hame SL, Shapiro MS, Dorey FJ. Quality of life assessment in elite collegiate athletes. Am J Sports Med. 2001;29(6):806810. PubMed ID: 11734497 doi:10.1177/03635465010290062201

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

    McGuine TA, Winterstein A, Carr K, Hetzel S, Scott J. Changes in self-reported knee function and health-related quality of life after knee injury in female athletes. Clin J Sport Med. 2012;22(4):334340. PubMed ID: 22627649 doi:10.1097/JSM.0b013e318257a40b

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Kuehl MD, Snyder AR, Erickson SE, McLeod TCV. Impact of prior concussions on health-related quality of life in collegiate athletes. Clin J Sport Med. 2010;20(2):8691. PubMed ID: 20215889 doi:10.1097/JSM.0b013e3181cf4534

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

    Simon JE, Docherty CL. Current health-related quality of life is lower in former Division I collegiate athletes than in non-collegiate athletes. Am J Sports Med. 2014;42(2):423429. PubMed ID: 24318608 doi:10.1177/0363546513510393

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Expert Panel. Psychological issues related to injury in athletes and the team physician: a consensus statement. Med Sci Sports Exerc. 2006;38(11):20302034.

    • Search Google Scholar
    • Export Citation
  • 16.

    Walker N, Thatcher J, Lavallee D. Psychological responses to injury in competitive sport: a critical review. J R Soc Promot Health. 2007;127(4):174180. PubMed ID: 17711063 doi:10.1177/1466424007079494

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016;50(3):145148. PubMed ID: 26719498 doi:10.1136/bjsports-2015-095586

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Clancy CM, Eisenberg JM. Outcomes research: measuring the end results of health care. Science. 1998;282(5387):245246. PubMed ID: 9841388 doi:10.1126/science.282.5387.245

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

    Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med. 1996;334(13):835840. PubMed ID: 8596551 doi:10.1056/NEJM199603283341306

  • 20.

    Stodden DF, Galitski HM. Longitudinal effects of a collegiate strength and conditioning program in American football. J Strength Cond Res. 2010;24(9):23002308. PubMed ID: 20703166 doi:10.1519/JSC.0b013e3181dc4255

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

    Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis. New York City, NY: Macmillan; 1995.

  • 22.

    Harrell F. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. New York, NY: Springer; 2015.

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

    McKee AC, Cantu RC, Nowinski CJ, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709735. PubMed ID: 19535999 doi:10.1097/NEN.0b013e3181a9d503

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

    Filbay S, Pandya T, Thomas B, McKay C, Adams J, Arden N. Quality of life and life satisfaction in former athletes: a systematic review and meta-analysis. Sports Med. 2019;49(11):17231738. PubMed ID: 31429036 doi:10.1007/s40279-019-01163-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Cowee K, Simon JE. A history of previous severe injury and health-related quality of life among former collegiate athletes. J Athl Train. 2019;54(1):6469. PubMed ID: 30657720 doi:10.4085/1062-6050-377-17

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

    Kerr ZY, DeFreese J, Marshall SW. Current physical and mental health of former collegiate athletes. Orthop J Sports Med. 2014;2(8):232596711454410. PubMed ID: 26535354 doi:10.1177/2325967114544107

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Carey JL, Huffman GR, Parekh SG, Sennett BJ. Outcomes of anterior cruciate ligament injuries to running backs and wide receivers in the National Football League. Am J Sports Med. 2006;34(12):19111917. PubMed ID: 16870822 doi:10.1177/0363546506290186

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Shah VM, Andrews JR, Fleisig GS, McMichael CS, Lemak LJ. Return to play after anterior cruciate ligament reconstruction in National Football League athletes. Am J Sports Med. 2010;38(11):22332239. PubMed ID: 20610771 doi:10.1177/0363546510372798

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

    Bodkin SG, Werner BC, Slater LV, Hart JM. Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020;28(3):790796. PubMed ID: 30887068 doi:10.1007/s00167-019-05461-y

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

    Lie MM, Risberg MA, Storheim K, Engebretsen L, Øiestad BE. What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review. Br J Sports Med. 2019;53(18):11621167. PubMed ID: 30936063 doi:10.1136/bjsports-2018-099751

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Lam KC, Thomas SS, Valier ARS, McLeod TCV, Bay RC. Previous knee injury and health-related quality of life in collegiate athletes. J Athl Train. 2017;52(6):534540. PubMed ID: 26565422 doi:10.4085/1062-6050-50.5.01

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407415. PubMed ID: 2691207 doi:10.1016/0197-2456(89)90005-6

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

    Valovich McLeod TC, Snyder AR, Parsons JT, Curtis Bay R, Michener LA, Sauers EL. Using disablement models and clinical outcomes assessment to enable evidence-based athletic training practice, part II: clinical outcomes assessment. J Athl Train. 2008;43(4):437445. PubMed ID: 18668177 doi:10.4085/1062-6050-43.4.437

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Barlow J, Turner A, Wright C. Comparison of clinical and self-reported diagnoses for participants on a community-based arthritis self-management programme. Br J Rheumatol. 1998;37(9):985987. PubMed ID: 9783764 doi:10.1093/rheumatology/37.9.985

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    El Fakiri F, Bruijnzeels MA, Hoes AW. No evidence for marked ethnic differences in accuracy of self-reported diabetes, hypertension, and hypercholesterolemia. J Clin Epidemiol. 2007;60(12):12711279. PubMed ID: 17998082 doi:10.1016/j.jclinepi.2007.02.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Straus SE, Mc Alister FA, Sackett DL, Deeks JJ, Group CC. Accuracy of history, wheezing, and forced expiratory time in the diagnosis of chronic obstructive pulmonary disease. J Gen Intern Med. 2002;17(9):684688. PubMed ID: 12220364 doi:10.1046/j.1525-1497.2002.20102.x

    • Crossref
    • Search Google Scholar
    • Export Citation
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