Concussion Assessment and Management in Sports
Summary
Concussion in sport is a mild traumatic brain injury resulting from biomechanical forces transmitted to the head that produce transient neurological impairment without overt structural damage on routine imaging. Recent decades have seen a shift from undifferentiated rest towards more nuanced diagnostic, prognostic and therapeutic strategies. Sideline assessment protocols combine symptom checklists, neurocognitive testing, balance and oculomotor tasks to guide immediate management and graded return-to-play decisions. Novel objective methodologies, including helmet-mounted accelerometers, advanced neuroimaging techniques and fluid biomarkers, are refining our understanding of the biomechanical thresholds for injury, subclinical white matter changes and pathological sequelae. Recognition of persistent post-concussion syndrome has prompted the development of multidisciplinary rehabilitation pathways that address autonomic dysfunction, vestibular deficits and mood disturbances through individually tailored exercise and cognitive interventions. Globally, consensus statements inform policy development, risk reduction measures and youth sport guidelines, while longitudinal cohort studies continue to elucidate the long-term neurodegenerative risks associated with repetitive head impacts.
Research from Nature Portfolio
Recent studies have leveraged sensor-based exposure matrices to quantify lifetime cumulative head impact intensity and its association with chronic traumatic encephalopathy pathology. Using helmet accelerometry data across player positions and levels of play, models indicate that measures of linear and rotational acceleration provide superior prediction of tauopathy risk compared to simple counts of concussive events or years of play. Findings underscore the role of impact biomechanics in neurodegenerative sequelae and suggest new quantitative metrics for risk stratification and monitoring.
Concussion Assessment and Management in Sports publication trend
The graph below shows the total number of articles in concussion assessment and management in sports across all publications each year (not limited to Nature Index journals).
Technical terms
Concussion: A transient disturbance of brain function induced by biomechanical forces without overt structural injury on routine imaging.
Repetitive head impacts (RHI): Multiple sub-injurious or injurious blows to the head occurring over time in contact sports.
Chronic traumatic encephalopathy (CTE): A progressive tauopathy linked to cumulative head trauma, characterised by mood, cognitive and motor disturbances.
Post-concussion syndrome (PCS): Persistence of concussion symptoms—cognitive, vestibular or autonomic—beyond the expected recovery period.
Diffusion tensor imaging (DTI): An advanced MRI technique that measures directional water diffusion in white matter tracts to detect microstructural changes.
Linear acceleration: The rate of change of linear velocity of the head during impact, often measured in g.
Rotational acceleration: The rate of change of angular velocity experienced by the head during impact, associated with shear forces in brain tissue.
References
- Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study. The Lancet Public Health (2023).
- Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy in males. Nature Communications (2023).
- Dementia in former amateur and professional contact sports participants: population-based cohort study, systematic review, and meta-analysis. EClinicalMedicine (2023).
- Brain Injury Prediction: Assessing the Combined Probability of Concussion Using Linear and Rotational Head Acceleration. Annals of Biomedical Engineering (2013).
- Persistent, Long-term Cerebral White Matter Changes after Sports-Related Repetitive Head Impacts. PLOS ONE (2014).
- Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach. Frontiers in Neurology (2016).
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