BACKGROUND: Existing data suggest that after concussion, athletes experience an increased risk of subsequent injury. Exploring methods that may reduce injury risk after successful postconcussion return to play may lead to new treatment approaches. PURPOSE: To examine the efficacy of a neuromuscular training (NMT) intervention on acute sports-related time-loss injury over the subsequent year relative to standard of care. STUDY DESIGN: Randomized clinical trial; level of evidence, 1. METHODS: A total of 27 youth athletes were assessed initially postconcussion (median 7 days postconcussion; interquartile range (IQR) 5 to 10) and after return-to-play clearance (median 40 days postconcussion; IQR 15 to 52). After return-to-play clearance, they were randomly assigned to NMT intervention (n = 11; mean +/- SD age 14.7 +/- 1.7 years; 36% female) or standard of care (n = 16; mean +/- SD age 15.3 +/- 1.8 years; 44% female). The intervention (duration 8 weeks; frequency 2 times per week) included guided strength exercises with landing stabilization focus. Standard of care received no recommendations. For the subsequent year, athletes prospectively completed a monthly log of sports-related injuries and organized sports competitions. RESULTS: During the first year after postconcussion return-to-play clearance, sports-related time-loss injuries were more common among standard of care relative to NMT intervention (75%; 95% CI 48% to 93% versus 36%; 95% CI 11% to 69%). After adjusting for age and sex, the hazard of subsequent injury in the standard-of-care group was 3.56 times (95% CI 1.11 to 11.49; p = 0.0334) that of the NMT intervention group. Sports participation was similar between NMT intervention and standard of care during the year-long monitoring period (hours of organized sports per month; median 12; IQR 2.6 to 32.1 versus 15.6; IQR 3.5 to 105.9; p = 0.55). The age- and sex-adjusted incidence of injuries was 10.2 per 1,000 competitive exposures (95% CI 3.7 to 28.4) in the standard-of-care group as opposed to 3.4 per 1,000 (95% CI 0.9 to 13.4) in the NMT intervention group. After adjusting for age and sex, incidence of injuries was higher for standard of care versus NMT intervention (rate ratio 2.96; 95% CI 0.89 to 9.85; p = 0.076). CONCLUSION: Although preliminary, our findings suggest that an NMT intervention initiated after return-to-play clearance may significantly reduce sports-related time-loss injuries over the subsequent year. REGISTRATION: NCT03917290 ClinicalTrials.gov.

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