Cervicovestibular Dysfunction in Concussion: New Evidence from Elite Female Athletes

By Associate Professor James McLoughlin

Concussion isn’t simply a brain injury – it’s a biomechanical event.

As Professor Mike Loosemore, MBE, aptly puts it: concussion is a “rapid head acceleration injury”. In practical terms, this means the impact is not confined to neural tissue alone. The same acceleration–deceleration forces can strain the cervical spine, disrupt vestibular networks, and impair proprioceptive control. These interconnected systems explain why patients often present with overlapping symptoms—headache, dizziness, balance disturbance, and neck pain—that cannot be attributed to brain injury in isolation.

New Research in Elite Female Athletes

A new Australian study published in Journal of Science and Medicine in Sport (Sept 2025) examined 94 elite and pre-elite female athletes (soccer, water polo, rugby-7s) using three key concussion screening tools:

SCAT6 (Sport Concussion Assessment Tool)
VOMS (Vestibular/Ocular Motor Screening)
Manual cervical spine assessment including joint proprioception

Athletes also reported concussion history over the past 12 months. The study highlights how cervical and vestibulo-ocular screening can reveal subtle dysfunction in athletes—particularly in groups with high exposure to collision and repetitive head acceleration events.

Importantly for us at Your Brain Health: every single one of these assessments can be digitised, tracked, and reported through ScreenIT, ensuring clinicians and researchers can measure outcomes transparently and consistently.

Why the Cervicovestibular System Matters

The evidence is now clear: concussion is rarely a single-system injury. Whiplash-type cervical involvement and central vestibular disruption often coexist, producing overlapping symptoms such as dizziness, headache, balance impairment, and neck pain.

Persistent Symptoms: RCTs (Schneider et al., 2014) show that patients receiving combined cervical physiotherapy and vestibular rehab were nearly four times more likely to be medically cleared within 8 weeks compared to rest plus aerobic exercise alone.
Objective Gains: More recent trials in adults demonstrate that while symptoms may improve similarly with aerobic exercise, the addition of cervicovestibular rehab improves objective function (vestibulo-ocular reflex, cervical ROM, proprioception).
Prognostic Relevance: Cervicogenic pain and dizziness in the early days after concussion are strong predictors of prolonged recovery. Early, targeted treatment may shorten this trajectory.

Clinical Application

So, what does this mean for practice?

1. Assessment

Combine SCAT6, VOMS, and cervical proprioceptive tests to identify system-specific deficits. We encourage physiotherapist to keep refining their cervical palpation, screening and manual therapy skills.
Use structured tools that capture both subjective symptoms and objective measures.

2. Rehabilitation

Address impairments directly with manual cervical therapy, vestibular rehabilitation, neuromotor control exercises, and graded aerobic progression.
Tailor interventions to the individual’s profile—acknowledging that no two concussions are the same.

3. Tracking & Integration

With ScreenIT, clinicians can now assess, track, and report on all these measures, creating a longitudinal record that supports both clinical decision-making and real-world research.

Conclusion

Concussion is heterogeneous. For some athletes, symptoms are driven primarily by vestibular dysfunction; for others, cervical whiplash is dominant; and often, both systems are involved. The new study in elite female athletes reinforces the importance of screening both domains systematically.

With the right tools and training, health professionals can identify cervicovestibular dysfunction early, target treatment precisely, and track recovery transparently. At Your Brain Health, we’re committed to equipping clinicians with the skills, confidence, and technology to make that possible.

References

Leung, F., Warner, E., Currie, B., King, M., Oostenbroek, T., Pearce, Y., Stiles, G., Brown, D., Mendis, M. D., & Hides, J. (2025). Cervical spine and vestibulo-ocular screening in elite female athletes with a history of concussion. Musculoskeletal Science & Practice, 103406, 103406.

Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., & Sparto, P. J. (2021). Vestibular rehabilitation for concussion: Clinical evidence and theoretical rationale. Sports Medicine, 51(6), 1053–1068. https://doi.org/10.1007/s40279-021-01469-y

Langevin, P., Frémont, P., Fait, P., Sirois, M.-J., Beauchamp, M.-H., Mercier, C., Boulanger, Y., … Gagnon, I. (2022). Aerobic exercise for adolescents and adults with persistent postconcussion symptoms: A randomized controlled trial. Journal of Neurotrauma, 39(7–8), 516–526. https://doi.org/10.1089/neu.2021.0061

Langevin, P., Frémont, P., Fait, P., et al. (2022). Cervicovestibular rehabilitation for adults with persistent postconcussive symptoms: A randomized clinical trial. World Physiotherapy Congress Proceedings. https://world.physio/congress-proceeding/randomised-clinical-trial-cervicovestibular-rehabilitation-adults-concussion-0

Patricios, J. S., Schneider, K. J., Dvorak, J., Ahmed, O. H., Blauwet, C., Cantu, R. C., Davis, G. A., Echemendia, R. J., Makdissi, M., Broglio, S., Emery, C. A., Feddermann-Demont, N., Fuller, G. W., Giza, C. C., Guskiewicz, K. M., Hainline, B., Iverson, G. L., Kutcher, J. S., Leddy, J. J., … Meeuwisse, W. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695–711.

Schneider, K. J., Meeuwisse, W. H., Nettel-Aguirre, A., Barlow, K., Boyd, L., Kang, J., & Emery, C. A. (2014). Cervicovestibular rehabilitation in sport-related concussion: A randomized controlled trial. British Journal of Sports Medicine, 48(17), 1294–1298. https://doi.org/10.1136/bjsports-2013-093267

How We Support Clinicians

At Your Brain Health, our Essential Practical course devotes significant time to hands-on cervicovestibular rehabilitation. We know that physiotherapists and allied health professionals are uniquely positioned to address these impairments—but confidence and skill in assessment and treatment are essential. The reality is that many physiotherapists that have experience in sports and musculoskeletal practice are less confident when it comes to vestibular practice. While many vestibular and neurological physiotherapists have less experience with cervical assessments and treatments. However, it does not take long for us to upskill both groups!