{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:20:21Z","timestamp":1778768421366,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Sports-related concussion (SRC) is associated with elevated subsequent musculoskeletal (MSK) injury risk, yet no study has examined whether a mandatory post-concussion rest period mitigates this risk in professional Australian rules football. The aim of this study was to compare subsequent injury risk following SRC in Australian Football League (AFL) male athletes across two periods: a discretionary return-to-play period (2016 to 2019) and a mandatory 12-day non-competition period (2021 to 2024). Methods: Injury data were extracted from publicly available AFL injury reports across eight seasons (n = 4351 players). Risk ratios (RRs) with 95% confidence intervals were calculated using log-binomial methods, with pooled estimates derived via the Mantel\u2013Haenszel approach. Results: Across both periods, SRC significantly increased overall MSK injury risk compared to MSK-first injury risk (2016 to 2019: RR:1.59 [95%CI:1.31 to 1.92]; p &lt; 0.001; 2021 to 2024: RR:1.56 [95%CI:1.28 to 1.91]; p &lt; 0.001). Upper and lower limb injury risks were similarly elevated across both eras. Notably, the risk of subsequent concussion was significantly elevated during 2016 to 2019 (RR:3.14, p &lt; 0.001), whereas no statistically significant elevation was demonstrated during 2021 to 2024 (RR:1.30, p = 0.324). Conclusions: During the 12-day rest period, subsequent concussion risk was no longer significantly elevated, while MSK injury risk remained increased, suggesting longer recovery periods may be warranted for full neuromuscular recovery following SRC.<\/jats:p>","DOI":"10.3390\/jfmk11020195","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Subsequent Injury Risk Following Concussion in Australian Football League (AFL) Male Athletes: Is It a Case of a Player Being \u2018Luckless\u2019?"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9264-9880","authenticated-orcid":false,"given":"Alan J.","family":"Pearce","sequence":"first","affiliation":[{"name":"School of Health Sciences, Swinburne University of Technology, Melbourne 3122, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Hardy","sequence":"additional","affiliation":[{"name":"Independent Researcher, Melbourne 3000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4914-8570","authenticated-orcid":false,"given":"Kane","family":"Middleton","sequence":"additional","affiliation":[{"name":"School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doug","family":"King","sequence":"additional","affiliation":[{"name":"Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland 1142, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/bjsports-2023-106898","article-title":"Consensus statement on concussion in sport: The 6th International Conference on Concussion in Sport\u2013Amsterdam, October 2022","volume":"57","author":"Patricios","year":"2023","journal-title":"Br. J. Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1136\/bjsports-2013-093406","article-title":"Sports-related concussion increases the risk of subsequent injury by about 50% in elite male football players","volume":"48","author":"Ekstrand","year":"2014","journal-title":"Br. J. Sports Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1177\/0363546518785901","article-title":"Musculoskeletal injury risk after sport-related concussion: A systematic review and meta-analysis","volume":"47","author":"McPherson","year":"2019","journal-title":"Am. J. Sports Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.msksp.2019.04.004","article-title":"History of concussion and risk of subsequent injury in athletes and service members: A systematic review and meta-analysis","volume":"42","author":"Reneker","year":"2019","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1080\/00913847.2024.2327275","article-title":"NCAA football players are at higher risk of upper extremity injury after first-time concussion","volume":"52","author":"Gardner","year":"2024","journal-title":"Phys. Sportsmed."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1007\/s40279-020-01262-3","article-title":"Effect of a concussion on anterior cruciate ligament injury risk in a general population","volume":"50","author":"McPherson","year":"2020","journal-title":"Sports Med."},{"key":"ref_7","first-page":"264","article-title":"Anterior Cruciate Ligament Injury Does Not Increase the Risk for a Future Concussion: A Unidirectional Phenomenon","volume":"34","author":"McPherson","year":"2025","journal-title":"J. Sports Rehab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jsams.2014.07.010","article-title":"Acute motor, neurocognitive and neurophysiological change following concussion injury in Australian amateur football. A prospective multimodal investigation","volume":"18","author":"Pearce","year":"2015","journal-title":"J. Sci. Med. Sport."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/00913847.2025.2541579","article-title":"Time-course responses following sports-related concussion: A multi-modality study","volume":"54","author":"Pearce","year":"2025","journal-title":"Physician Sportsmed."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1080\/24733938.2022.2103177","article-title":"Effects of concussion on technical performance in professional Australian football","volume":"7","author":"Clarke","year":"2023","journal-title":"Sci. Med. Footb."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1177\/0363546508328118","article-title":"A prospective study of postconcussive outcomes after return to play in Australian football","volume":"37","author":"Makdissi","year":"2009","journal-title":"Am. J. Sports Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.jsams.2023.03.013","article-title":"The impact of concussion on subsequent injury risk in elite junior Australian football athletes","volume":"26","author":"Bennett","year":"2023","journal-title":"J. Sci. Med. Sport"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s40798-021-00301-1","article-title":"Evolution of physical demands of Australian football league matches from 2005 to 2017: A systematic review and meta-regression","volume":"7","author":"Janetzki","year":"2021","journal-title":"Sports Med. Open"},{"key":"ref_14","unstructured":"AFL (2026, January 13). AFL Statement on Updated Concussion Guidelines. Available online: https:\/\/www.afl.com.au\/news\/543223\/afl-statement-on-updated-concussion-guidelines."},{"key":"ref_15","unstructured":"McClure, S. War brewing over AFL\u2019s concussion protocol. The Age, 19 February 2020."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1007\/s40279-021-01484-z","article-title":"Effects of stricter management guidelines on return-to-competition timeframes following concussion in professional Australian rules football: An exploratory analysis","volume":"51","author":"Pearce","year":"2021","journal-title":"Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/bjsports-2019-100579","article-title":"Return to play and risk of repeat concussion in collegiate football players: Comparative analysis from the NCAA Concussion Study (1999\u20132001) and CARE Consortium (2014\u20132017)","volume":"54","author":"McCrea","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_18","unstructured":"Australian Football League (2026, February 21). Concussion in Australian Football. Available online: http:\/\/s.afl.com.au\/staticfile\/AFL%20Tenant\/AFL\/Files\/Respect%20and%20Responsibility\/2017_Community_Concussion_Guidelines.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","article-title":"Consensus statement on concussion in sport\u2014The 5th international conference on concussion in sport held in Berlin, October 2016","volume":"51","author":"McCrory","year":"2017","journal-title":"Br. J. Sport Med."},{"key":"ref_20","first-page":"51","article-title":"Data structures for statistical computing in Python","volume":"445","author":"McKinney","year":"2010","journal-title":"SciPy Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy","volume":"585","author":"Harris","year":"2020","journal-title":"Nature"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: Fundamental algorithms for scientific computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat. Methods"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23259671231163570","DOI":"10.1177\/23259671231163570","article-title":"Risk of upper extremity musculoskeletal injury within the first year after a concussion","volume":"11","author":"Roach","year":"2023","journal-title":"Orthop. J. Sports Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1136\/bjsports-2017-098417","article-title":"On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches","volume":"53","author":"Rafferty","year":"2019","journal-title":"Br. J. Sports Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1177\/0363546515622387","article-title":"Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes","volume":"44","author":"Brooks","year":"2016","journal-title":"Am. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1007\/s40279-016-0607-9","article-title":"Concussion may increase the risk of subsequent lower extremity musculoskeletal injury in collegiate athletes","volume":"47","author":"Herman","year":"2017","journal-title":"Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"533","DOI":"10.2519\/jospt.2018.8053","article-title":"Risk for Lower Extremity Injury After Concussion: A Matched Cohort Study in Soldiers","volume":"48","author":"Kardouni","year":"2018","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s40279-018-0871-y","article-title":"Neuromuscular control deficits and the risk of subsequent injury after a concussion: A scoping review","volume":"48","author":"Howell","year":"2018","journal-title":"Sports Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.neulet.2005.04.039","article-title":"Alteration of posture-related cortical potentials in mild traumatic brain injury","volume":"383","author":"Slobounov","year":"2005","journal-title":"Neurosci. Lett."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"87","DOI":"10.2519\/jospt.2018.7432","article-title":"Dual-task assessment protocols in concussion assessment: A systematic literature review","volume":"48","author":"Kleiner","year":"2018","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1001\/jama.290.19.2549","article-title":"Cumulative effects associated with recurrent concussion in collegiate football players: The NCAA Concussion Study","volume":"290","author":"Guskiewicz","year":"2003","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/01.PHM.0000083666.74494.BA","article-title":"Two-year prospective study of relative risk of a second cerebral concussion","volume":"82","author":"Zemper","year":"2003","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_33","first-page":"1","article-title":"A cohort study to identify and evaluate concussion risk factors across multiple injury settings: Findings from the CARE Consortium","volume":"6","author":"Allred","year":"2019","journal-title":"Inj. Epidemiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"23259671241276447","DOI":"10.1177\/23259671241276447","article-title":"Concussion in female athletes of contact sports: A scoping review","volume":"12","author":"Fahr","year":"2024","journal-title":"Orthop. J. Sports Med."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/195\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:51:39Z","timestamp":1778766699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/2\/195"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jfmk11020195"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11020195","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}