Fencing Response Not Predictive of Worse Concussion Recovery, Pitt Study Shows

This story was originally published on UPMC.com.

A clinical sign called “fencing response” was not associated with worse neurological symptoms or longer recovery following a concussion in professional American football players, University of Pittsburgh School of Medicine physician-scientists reported in Neurosurgery.

Athletes with a documented fencing response – an involuntary reaction to a high-force and high-speed blow to the head – completed the National Football League (NFL) protocol for return to play following concussion just as quickly as players without the fencing response between 2018 and 2023. Researchers found no differences on neurologic tests or in self-reported concussion symptoms, such as headache and fatigue, between the two player groups.

Named after its semblance to the fencer’s on-guard posture with one arm outstretched and the other bent at the elbow, fencing response has been documented in athletes who sustained concussions while engaging in a variety of contact sports, including boxing, rugby and soccer. 

“When we bear witness to a traumatic brain injury, we all have a natural reaction of deep concern for our fellow human being,” said lead author Dr. David Okonkwo, professor of neurological surgery at Pitt. “It is essential to apply well-validated approaches to assessing concussion recovery across the full spectrum of concussion manifestations. This study is only the beginning, and our focus remains on the health and safety of the athletes while centering on long-term recovery profiles.”

Commitment to expanding knowledge about long-term effects of sport-related brain injury drove Pittsburgh neurotrauma researchers to analyze the relationship between fencing response and recovery time following concussion. 

Pitt researchers conducted a systematic analysis of objective and subjective measurements of concussion severity to understand whether athletes who had a fencing response are worse off than those who did not. Because a concussion can present differently in different people, researchers analyzed independently administered assessments of orientation, short- and long-term memory, dizziness, and balance, as well as typical concussion symptoms.

Through analyzing medical records from the NFL injury analytics database, researchers identified 57 instances of fencing responses in athletes during the 2018-2023 seasons.

In analyses that were controlled by age, playing position and prior concussion history, researchers found no difference in days until return to the field between players who exhibited a fencing response and those who did not after concussion. Researchers also observed no differences in neurocognitive function or self-reported concussion symptoms between the two groups.

“We were surprised to find the paucity of data on fencing response in the sports medicine literature, and this study is another step in filling that knowledge gap,” said senior author Dr. Shawn Eagle, research assistant professor of neurological surgery at Pitt. “We have a lot more work to do to fully understand short-, medium- and long-term implications of fencing response on athletes’ health and well-being and are hoping to expand our analysis to other contact sports and include other factors, such as pre-injury risk, in future analyses.”