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Concussion history is associated with increased lower-extremity injury incidence in Reserve Officers’ Training Corps cadets
  1. Katherine J Hunzinger1,2,
  2. K N Radzak3,
  3. K M Costantini1,
  4. C B Swanik1,2 and
  5. T A Buckley1,2
  1. 1Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
  2. 2Interdisciplinary Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
  3. 3Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, Nevada, USA
  1. Correspondence to Dr T A Buckley, Kinesiology & Applied Physiology, University of Delaware, Newark, DE 19702, USA; tbuckley{at}


Introduction Concussions have been associated with an increased risk of lower-extremity musculoskeletal injury (LE-MSI) in athletes and US Army soldiers, creating an added economic, physical and social burden. Yet, there is a paucity of evidence on this relationship among Reserve Officers’ Training Corps (ROTC) cadets, a group which engages in activities with high-injury risk and will subsequently commission as active duty officers. This study aimed to examine the association between concussions and LE-MSI in ROTC cadets.

Methods 125 (83 were male) Army and Air Force ROTC cadets (19.8±2.0 years) from two large state universities’ Army and Air Force ROTC programmes participated in this study. Cadets completed a reliable injury history questionnaire to ascertain the following variables of interest: (1) any concussion history, (2) reported concussions, (3) undiagnosed concussions, and (4) potentially unrecognised concussion history and LE-MSI history (eg, ankle sprain, knee sprain or muscle strain). Data were analysed using a χ2 test for association and binary logistic regression to determine ORs.

Results Cadets with any concussion history (n=42) had a significantly (p=0.035) higher association with LE-MSI (OR 2.47, 95% CI 1.05 to 5.83) than those without. Cadets who had a reported concussion (n=33) had a significantly (p=0.026) higher association with LE-MSI (OR 2.95, 95% CI 1.11 to 7.84) compared to cadets without.

Conclusions ROTC cadets with a history of diagnosed concussion were more likely to have suffered an LE-MSI than cadets without a concussion history. ROTC cadre should be aware of this relationship and incorporate injury prevention protocols.

  • neurological injury
  • epidemiology
  • sports medicine
  • epidemiology

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  • Contributors KJH, KNR, CBS and TAB were involved in the planning, conduct and design of the study. KJH and KMC were involved in data collection for site 1 and KNR for site 2. KJH and KMC were involved in the overall data analysis. All authors contributed to data interpretation and manuscript writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board at both institutions approved the study, and written informed consent was obtained from cadets prior to enrolment.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data may be requested via email request made to author Katherine J Hunzinger (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.