Association of physiological variables with football subconcussive head impacts: Why measure?

Abstract

Subconcussive head impacts, defined as impacts to the cranium that do not result in clinical symptoms of concussion, are gaining traction as a major public health concern. Researchers begin to suggest subconcussive impact-dependent changes in various neurological measures. However, a contribution of physiological factors such as physical exertion and muscle damage has never been accounted. We conducted a prospective longitudinal study during a high school American football season to examine the association between physiological factors and subconcussive head impact kinematics. Fifteen high-school American football players volunteered in the study. A sensor-installed mouthguard recorded the number of head impacts, peak linear (PLA: g) and peak rotational (PRA: rad/s2) head accelerations from every practice and game. Serum samples were collected at 12 time points (pre-season baseline, five in-season pre-post games, and post-season) and assessed for the creatine kinase skeletal muscle-specific isoenzyme (CK-MM), as a surrogate for skeletal muscle damage. Physical exertion was estimated in the form of excess post-exercise oxygen consumption (EPOC) from heart rate data captured during five games via a wireless heart rate monitor. A total of 9,700 hits, 214,492 g, and 19,885,037 rad/s2 were recorded from 15 players across the study period. Mixed-effect regression models indicated that head impact kinematics (frequency, PLA, and PRA) were significantly and positively associated with CK-MM increase, but not with EPOC. There was a significant and positive association between CK-MM and EPOC. These data suggest that skeletal muscle damage effects should be considered when using outcome measures that may have an interaction with muscle damage, including inflammatory biomarkers and vestibular/balance tests.