Search tips
Search criteria 


Logo of jathtrainLink to Publisher's site
J Athl Train. 1996 Oct-Dec; 31(4): 300–306.
PMCID: PMC1318912

Effect of Mild Head Injury on Postural Stability in Athletes



Athletic trainers and team physicians are often faced with the dilemma of when to return athletes to participation following mild head injury. Unfortunately, clinicians rarely have quantitative information on which to base their decisions. The purpose of this investigation was to identify postural stability changes in athletes with acute mild head injury.

Design and Setting:

High school and college male athletes were prescreened for postural stability before the start of their season. Subjects suffering injury during the season returned for testing on days 1, 3, 5, and 10 following injury, and 1 month postseason. Control subjects were selected for comparisons.


Ten prescreened subjects (age = 17.4 ± 2.2 yr; ht = 183.8 + 8.1 cm; wt = 87.7 + 17.3 kg) returned for testing following an injury. Ten matched control subjects (age = 18.6 ± 2.6 yr; ht = 185.7 ± 6.7 cm; wt = 84.5 ± 19.5 kg) were selected for comparisons. Additionally, nine subjects (eight male and one female) (age = 19.9 ± 4.2 yr; ht = 182.3 + 10.9 cm; wt = 89.6 ± 25.2 kg) who had sustained a mild head injury from other varsity sports teams were recruited. Nine matched controls (age = 22.1 ± 3.3 yr; ht = 181.0 ± 9.9 cm; wt = 84.9 ± 25.6 kg) were again utilized.


Sway index and center of balance were measured using the Chattecx Balance System during three eye conditions and three surface conditions for all subjects.


Repeated measures analyses of variance (ANOVA) for each prescreened subject's sway index revealed significant differences between injured subjects and control subjects on day 1 postinjury as compared with the prescreening and/or subsequent tests. The analysis for sway index and center of balance inclusive of all 19 subjects with mild head injury and all 19 control subjects demonstrated increased postural sway compared with control subjects on day 1 postinjury during all plafform conditions, and on day 3 during the foam platform condition. The analysis for center of balance using the same subjects revealed that injured subjects maintained their center of balance farther away on day 1 postinjury compared with subsequent tests (p < .05).


These findings suggest that computerized dynamic posturography is a useful tool in objectively assessing postural stability in subjects with mild head injuries. Subjects with mild head injury appear to demonstrate impaired postural stability 1 to 3 days following injury. This information should aid clinicians in determining when an athlete can safely return to participation.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.7M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Images in this article

Click on the image to see a larger version.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Arcan M, Brull MA, Najenson T, Solzi P. FGP assessment of postural disorders during the process of rehabilitation. Scand J Rehabil Med. 1977;9(4):165–168. [PubMed]
  • Bruce DA, Schut L, Sutton LN. Brain and cervical spine injuries occurring during organized sports activities in children and adolescents. Prim Care. 1984 Mar;11(1):175–194. [PubMed]
  • Nies N, Sinnott PL. Variations in balance and body sway in middle-aged adults. Subjects with healthy backs compared with subjects with low-back dysfunction. Spine (Phila Pa 1976) 1991 Mar;16(3):325–330. [PubMed]
  • Cantu RC. Cerebral concussion in sport. Management and prevention. Sports Med. 1992 Jul;14(1):64–74. [PubMed]
  • Cantu RC. Minor Head Injuries in Sports. Adolesc Med. 1991 Feb;2(1):141–154. [PubMed]
  • Gerberich SG, Priest JD, Boen JR, Straub CP, Maxwell RE. Concussion incidences and severity in secondary school varsity football players. Am J Public Health. 1983 Dec;73(12):1370–1375. [PubMed]
  • Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet. 1975 Nov 22;2(7943):995–997. [PubMed]
  • Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet. 1974 Sep 14;2(7881):605–609. [PubMed]
  • Haaland KY, Temkin N, Randahl G, Dikmen S. Recovery of simple motor skills after head injury. J Clin Exp Neuropsychol. 1994 Jun;16(3):448–456. [PubMed]
  • Ingersoll CD, Armstrong CW. The effects of closed-head injury on postural sway. Med Sci Sports Exerc. 1992 Jul;24(7):739–743. [PubMed]
  • Klonoff PS, Costa LD, Snow WG. Predictors and indicators of quality of life in patients with closed-head injury. J Clin Exp Neuropsychol. 1986 Oct;8(5):469–485. [PubMed]
  • Lehmann JF, Boswell S, Price R, Burleigh A, deLateur BJ, Jaffe KM, Hertling D. Quantitative evaluation of sway as an indicator of functional balance in post-traumatic brain injury. Arch Phys Med Rehabil. 1990 Nov;71(12):955–962. [PubMed]
  • Mauritz KH, Dichgans J, Hufschmidt A. Quantitative analysis of stance in late cortical cerebellar atrophy of the anterior lobe and other forms of cerebellar ataxia. Brain. 1979 Sep;102(3):461–482. [PubMed]
  • Nashner LM. Adapting reflexes controlling the human posture. Exp Brain Res. 1976 Aug 27;26(1):59–72. [PubMed]
  • Nashner L, Berthoz A. Visual contribution to rapid motor responses during postural control. Brain Res. 1978 Jul 14;150(2):403–407. [PubMed]
  • Nashner LM, Black FO, Wall C., 3rd Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J Neurosci. 1982 May;2(5):536–544. [PubMed]
  • Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. JAMA. 1984 Jul 27;252(4):538–539. [PubMed]
  • Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986 Oct;66(10):1548–1550. [PubMed]

Articles from Journal of Athletic Training are provided here courtesy of National Athletic Trainers Association