To explore relationship of concussion history, career status, and cumulative years of contact football exposure on total symptoms, symptom severity, neurocognitive function, and balance in elite football players.

61% of retired football players report sustaining a concussion during their professional career. However, the influence of concussion history, career status and cumulative years played on total symptoms, symptom severity, neurocognitive function, and balance is largely unexplored.

Elite football players (n=102; age M=27.75±6.95 years) without a concussion (>30 days) underwent SCAT-3 assessments. Players were placed into a low (0–1) or multiple concussion (2+) history group and categorized by career status (draft prospects, active professional players and retired professional players). Data were analyzed using negative binomial regression and multiple linear regression analyses.

58.8% of players reported symptoms. Most common symptoms were fatigue (33.3%), trouble falling asleep (31.4%), difficulty remembering (29.4%), and difficulty concentrating (20.6%). Multiple concussions group reported 3.07 times greater total symptoms (p<.001), 3.58 times higher symptom severity (p<.001), and lower SAC scores (1.42 points) (p=.033) compared to low concussion group. Professionals reported 1.88 times greater total symptoms (p=.038) and 2.35 times higher symptom severity compared to draft prospects (p=.001). Retired players reported 7.07 times greater total symptoms (p<.001), 8.97 times higher symptom severity (p<.001), lower SAC scores (1.98 points) (p=.025), and 3.67 more m-BESS errors (p=.002), compared to draft prospects. Players with 11-19 years football exposure reported 3.83 times higher symptom severity compared to players with <11 years football exposure (p=.001). Players with >19 years football exposure had 6.87 times higher symptom severity than players with <11 years football exposure (p<.001).

Retired players with multiple concussions and 19+ years of contact football exposure are likely to have more symptoms, higher symptom severity, and lower neurocognitive scores.