Statement of purpose This study examined differences in post-injury psychological symptoms between collegiate athletes who sustained concussions and orthopaedic injuries.

Method A cohort of athletes was recruited at the beginning of each sports season from 2007 to 2011. Study participants were collegiate athletes from 9 sports teams at two Big Ten Conference universities. Upon injury, injured athletes were followed prospectively at multiple intervals to measure psychological symptoms (e.g., 1 week, and 1, 3, 6, and 12 months) until the injured athlete’s return to play. Differences in post-injury psychological symptoms, including symptoms of depression and anxiety, pain, fear of re-injury, and fear of return-to-play were compared between athletes with concussions and orthopaedic injuries, both at one week after injury and at return-to-play.

Results Of a total of 597 injuries sustained, 71 (11.9%) were concussions and 526 (88.1%) were orthopaedic injuries. One-fourth of concussions (n = 18, 25.4%) were sustained by females. Football had the largest number of concussions (n = 42) and orthopaedic injuries (n = 196). No differences in post-injury symptoms of depression and anxiety were found between athletes with concussions and orthopaedic injuries. While 88.7% of concussed athletes returned to play one week following injury, only 59.1% of athletes with orthopaedic injuries did so. Furthermore, concussed athletes were less likely to report pain (p < 0.0001), fear of re-injury (p < 0.0001), and fear of return-to-play (p < 0.0001) at one week following injury, than athletes with orthopaedic injuries. These differences remained significant at return-to-play as well as after adjusting for covariates.

Conclusions While post-injury psychological symptoms are often not evident for concussed athletes, these symptoms need to be addressed to ensure successful injury recovery.

Significance and contributions Our findings provide empirical evidence on differences in psychological symptoms between athletes with concussions and orthopaedic injuries, and have practical implications for psychological recovery from injuries.