The Influence of Neck Pain During Recovery From Sport-Related Concussion

OBJECTIVE: This study aimed to: (1) identify predictors of post-SRC neck pain, (2) assess its impact on symptom severity, and (3) determine its association with prolonged recovery. SETTING: Data were collected from de-identified patient charts of those seen at a concussion clinic. PARTICIPANTS: Nine hundred nine athletes were assessed in total, with 135 patients with neck pain and 774 without neck pain. Specific inclusion criteria were as follows: (1) age 12-24 years at the time of SRC, (2) athletes who presented to clinic within 14 days after injury, and (3) diagnosis of an SRC by a provider consistent with the Concussion in Sport Group (CISG) guidelines, and (4) negative acute intracranial findings on CT scan. DESIGN: A retrospective, cohort study to compare SRC outcomes among de-identified patients grouped according to the presence or absence of neck pain. MAIN MEASURES: Data were analyzed among each group regarding concussion symptoms, recovery outcomes, demographics, injury characteristics, and personal/family medical histories. Primary outcomes assessed were recovery metrics. RESULTS: Of 909 athletes, 135 reported neck pain (14.9%). The Neck Pain Group experienced greater initial symptom severity (33.0 [17.0, 55.0] vs. 17.0 [4.0, 33.0], U = 25,762, P < .001) and had longer median recovery times by 1.0, 12.0, and 13.0 days for return to learn, symptom resolution, and return to play, respectively. The Neck Pain Group endorsed higher rates of prior concussions (53.3% vs. 36.3%, χ2 = 14.16, P ≤ .001), migraines (15.6% vs. 9.3%, χ2 = 4.77, P ≤ .001), psychological disorders (21.5% vs. 10.5%, χ2 = 8.75, P ≤ .001), and family history of migraines and psychological disorders. CONCLUSION: Neck pain occurred in approximately 15% of SRCs. Those who reported neck pain were more likely to have had prior concussions, migraines, and psychological disorders. Neck pain was independently associated with worse symptom severity and longer recovery time. These findings support that treatment of an SRC should include a cervical assessment and appropriate interventions when indicated.