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Context: This case study demonstrates the effectiveness of early surgical excision of the traumatic myositis ossificans of the vastus intermedius muscle in an elite football player and return to sports activity within 3 months from the initial injury. Case presentation: A 27-year-old male professional football player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion 4 weeks earlier. After unsuccessful conservative therapy, the differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. MRI revealed significant edema encompassing a substantial portion of the vastus intermedius muscle. Management and outcomes: Surgical treatment was considered for the right thigh mass, being symptomatic 1 month after the onset and refractory to conservative treatment and rehabilitation program. At 2 months postsurgery, the patient was asymptomatic and had completed a rehabilitation program. Conclusion: Early surgical treatment followed-up with a rehabilitation program results with a complete recovery of muscle strength and range of motion. At 3 months postinitial injury, the patient was considered fully recovered and had returned to the match without reporting pain or other symptoms.

Context: In line with emerging research, an interprofessional specialty concussion clinic instituted a policy change permitting earlier physiotherapy-based treatment entry. Our objective was to determine the effect of this policy change on concussion recovery outcomes. Design: Secondary analysis of prospectively collected clinical data. Methods: 600 youth with concussion were included. Active rehabilitation was initiated ≥4 weeks (prepolicy) or ≥2 weeks (postpolicy) postconcussion based on institutional policy. Cox proportional hazard models, linear mixed models, and chi-square analyses were conducted. Results: The postpolicy group (median = 22 d [interquartile range: 17–27]) started treatment earlier than the prepolicy group (median = 26 d [interquartile range: 24–30], P < .001). Length of episode of care (χ ²(1) = 11.55, P < .001, odds ratios = 1.49; 95% confidence interval, 1.19–1.88); rehabilitation (χ ²(1) = 9.47, P = .002, odds ratios = 1.73, 95% confidence interval, 1.22–2.45]); and total recovery (χ ²(1) = 11.53, P < .001, odds ratios = 1.49; 95% confidence interval, 1.18–1.88) were reduced in patients postpolicy change. A significant interaction effect was found for total postinjury symptom (F _2,320 = 3.59, P = .03) and symptom change scores (F _2,315 = 5.17, P = .006), with the postpolicy group having faster symptom resolution over time. No group differences were observed for persisting symptoms. Conclusions: Earlier rehabilitation initiation occurred as intended following an institutional policy change, which had small, but significant, effects on recovery outcomes in youth with concussion. Health care providers should adopt policies to encourage early active rehabilitation services after concussion.

Context: Athletes with a history of concussion (CON) have been demonstrated to have heightened levels of anxiety and depression that may continue well beyond the resolution of concussion symptoms. The global events of 2020 resulted in elevated levels of anxiety and depression in the general population, which may have unequally presented in collegiate athletes with (CON) than those without a history of concussion (NoCON). Using a deception design, our survey-based study compared levels of anxiety and depression in CON and NoCON collegiate athletes in response to the pandemic and social injustices. We hypothesized that the CON group would have significantly elevated anxiety and depression as compared to the NoCON group in response to events of 2020. Design and Methods: Collegiate athletes (N = 106) during the academic 2020–2021 academic year were divided into CON and NoCON groups based on their preinjury (baseline) concussion assessment. Participants completed the Social Readjustment Rating Scale (SSRS), Center for Epidemiologic Studies Depression Scale (CES-D), and Generalized Anxiety Disorder Scale-7 (GAD-7) via an electronic survey pertaining to the events of 2020. The term “concussion” was not used in any study materials which was the basis for our deception-based design. An analysis of covariance was used to compare group CES-D and GAD-7 outcome scores while controlling for the SSRS outcome score. Results: Our survey response rate was 14.2% (48/337 [77.1% female]) and 10.1% (58/580 [67.2% female]), for the NoCON and CON groups, respectively. The NoCON group had significantly (F ₁ = 5.82, P = .018, ${\eta }_{\mathrm{p}}^2=.06$ ) higher anxiety (8.3 [5.89]) as compared to the CON group (5.5 [2.85]). The NoCON group also had significantly (F ₁ = 13.7, P < .001, ${\eta }_{\mathrm{p}}^2=.12$ ) higher levels of depression (21.0 [12.52]) as compared to the CON group (16.07 [9.10]). Discussion: Our deception-based study revealed NoCON participants had elevated and clinically relevant mood states as compared to CON participants in response to the events of 2020.

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG’s low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician–scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.

Context: Targeted and directed rehabilitation with a healthcare provider can be an effective approach in the treatment of concussion, particularly for patients with protracted recovery, high symptom reporting, cervicogenic dysfunction, musculoskeletal involvement, and/or vestibular/oculomotor dysfunction. While many environmental and intrinsic medical history factors may influence concussion recovery, little is known about whether an individual’s recovery trajectory can be influenced by the amount of time taken to receive rehabilitation. The purpose of this study was to evaluate recovery trajectories of concussion patients requiring targeted multimodal rehabilitation after a specialty concussion clinic visit within ≤3 days, 4 to 7 days, and >7 days. We also sought to evaluate risk factors for protracted recovery. Design and Methods: The study involved a retrospective chart review of 103 patients (mean age = 13.78 [2.89]; 55% female) who, after their initial specialty concussion clinic visit, received rehabilitation in ≤3 days, 4 to 7 days, and >7 days. Patients were evaluated at a pediatric specialty concussion clinic between April 2021 and December 2023, and diagnosed with concussion by a specialist (primary care sports medicine physician, nurse practitioner, and/or neuropsychologist), referred for rehabilitation via physical therapy services, completed more than one rehabilitation session, and received medical clearance to initiate the return-to-sport protocol. Groups were compared based on relevant clinical factors, Vestibular Ocular Motor Screening, neurocognitive testing (Trails B-A), Post-Concussion Symptom Scale, days from injury to concussion evaluation, days from concussion evaluation to rehabilitation, number of rehabilitation sessions, recovery days after rehabilitation, and total recovery days (ie, days from injury to medical clearance to initiate return-to-sport protocol). Data analysis included chi-square, correlations, 1-way analysis of variance, and general linear regression. Adjusted odds ratios for protracted recovery were derived from a logistic regression model. Discussion: Days from injury to concussion evaluation (P < .001), days from concussion evaluation to rehabilitation (P = .006), and Trails B-A (P = .009), were significant predictors of total recovery time among pediatric concussion patients who required multimodal rehabilitation. Risk of protracted recovery increased by 34% each day from injury to concussion evaluation a patient did not receive treatment (Nagelkerke Pseudo R ² = .45; P < .001). Previous studies have also shown that time to concussion evaluation is an important prognostic indicator of recovery. Correspondingly, prompt referral to concussion care and rehabilitation for patients with a need for multimodal rehabilitation can improve recovery outcomes.