Sports activities: neurologic complications

Richard S Polin MD (Dr. Polin of George Washington University has no relevant financial relationships to disclose.)
Randolph W Evans MD, editor. (Dr. Evans of Baylor College of Medicine received honorariums from Allergan, Amgen, Avanir, DepoMed, and Novartis for speaking engagements and honorariums from Alder, Amgen, Lilly, Novartis, and Promius for advisory board membership.)
Originally released December 2, 2003; last updated September 13, 2017; expires September 13, 2020

Overview

Injuries to the central and peripheral nervous system due to sporting activities are incredibly diverse and numerous. Sports such as golf and bodybuilding have unique peripheral nerve lesions, whereas some sports such as football and hockey have extremely high incidences of concussion, more severe head injuries, and spinal injuries. In this article, the author has provided an update on novel imaging techniques and detection of chronic brain damage in athletes.

Key points

 

• Neurologic injury in athletics can involve the brain, spinal cord, and peripheral nerves.

 

• Athletic head injury guidelines exist to help grade concussions and direct timing of return to participation.

 

• Chronic brain damage may result from repetitive minor traumas suffered during athletic competition.

Historical note and terminology

The study of sports and its biomechanics have been evident for millenniums. Much of Greek artistry contains images of athletes such as long-distance runners and sprinters. Early scientists such as Aristotle and artists such as Leonardo da Vinci were interested in athletic biomechanics. Aristotle studies human and animal gait, whereas da Vinci also made observations regarding human motion that considered factors such as grade locomotion, the effect of running towards wind, centers of gravity, and standing and stepping studies. Following these early notions, Etienne Jules Marey (Cavanagh 1990) became an authority on locomotor biomechanics. Marey used instruments such as the first force platform, a device that was able to visualize the forces between the foot and the floor, and air accelerometers to record signals on chart recorders carried by the subject. Marey also demonstrated concepts such as energy and work, and discussed the storage of elastic energy in muscles and tendons.

Since these early years, sports medicine has developed and grown with the appearance of new sports, new levels of competition, and new applications of biomechanics and human sports. With time, new recognition of excessive problems within sports has developed, such as with concussion in hockey and football, spinal cord problems within winter sports, and excessive pediatric injury associated with trampoline usage. The most unique notion about sporting-related neurologic injuries is the variety of injuries seen within different sports. Some sports, such as racquet sports and volleyball, have nearly exclusive injuries to the peripheral nervous system around the dominant hand. Other sports, such as boxing, have a high frequency of central nervous system abnormalities, both acute and chronic.

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