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When hockey players are knocked out on the ice, medical personnel often look to computerized cognition tests to determine when concussed athletes can return to play.

But according to a University of Toronto study by the Faculty of Kinesiology and Phyiscal Education’s Michael Hutchison, a post-doctoral fellow, and professors Paul Comper, Lynda Mainwaring and Doug Richards, a concussion isn’t the only injury that can muddy an athlete’s mind. Common injuries like a sprained ankle also appear to impact an athlete’s cognitive performance.

In their study, published in the American Journal of Sports Medicine, 72 Varsity Blues athletes were given a commercially-available, 20-minute computerized test. Half of the players were injured. Eighteen of the athletes had suffered a concussion in the past three days and 18 were out of the game because of a muscle or tendon injury. The other 36 were uninjured.

The concussed athletes showed slower reaction times and worse results on memory tests than their uninjured peers. More surprising, though, was that the athletes who had muscle or tendon injury also performed poorly on the cognitive tests, with most of their scores falling in between those of the non-injured and head-injured athletes.

Hutchison said the findings emphasize the many variables, including emotional distress, frustration or depression, that can affect these test results.

“It’s important to keep in mind that you can’t automatically assume everything you find on these computerized tests is head-injury related.”

This story first appeared inmagazine.