Brand new Evidence is now changing our approach!

Three high-quality studies published in 2025 mark a strategic shift in concussion rehabilitation. Collectively, they demonstrate that early, structured oculomotor therapy — particularly vergence and accommodative exercises — is both safe and effective in accelerating recovery after sport-related concussion.

The CONCUSS Trial – Alvarez et al., 2025 (BJSM)

The CONCUSS randomised clinical trial was the largest to date to evaluate vergence and accommodative therapy for concussion-related convergence insufficiency. Compared with usual care, participants receiving targeted vision therapy showed significant improvements in near-point convergence, symptom severity, and reading performance.
This study validates vergence/accommodative therapy as a priority evidence-based, neuro-optometric intervention, not merely an optional adjunct to general rehabilitation.

Haider et al., 2025 (Applied Sciences)

Haider and colleagues trialled a self-guided oculomotor rehabilitation program for adolescents early after concussion. Exercises were simple, short, and home-based, focusing on smooth pursuit, saccadic, and convergence control. The results were impressive: participants who began these tasks early recovered visual symptoms more rapidly and reported better functional outcomes than those in usual care.
Crucially, the study confirmed that early oculomotor training is feasible, safe, and well-tolerated, supporting a paradigm shift toward active early management with foundation exercises rather than just delayed visual rehabilitation.

Trbovich et al., 2025 (Journal of Neurotrauma)

Trbovich and colleagues conducted a randomised controlled trial of Brock string vision therapy for individuals with receded near-point of convergence (NPC >5cm) following concussion. Even with a short protocol, participants achieved measurable improvements in convergence and symptom reduction compared with controls.
This trial suggests that structured vergence exercises, long used in vision therapy, can be effective tools within mainstream concussion rehabilitation programs.

Our Updated Clinical Approach

We are evolving our concussion rehabilitation guidance to reflect this evidence.

– Continue sub-threshold aerobic and cervico-vestibular rehabilitation as foundational elements.
– Introduce very basic early oculomotor and vergence exercises such as near–far focus, smooth pursuits, saccadic training and even Brock string when tolerated.
– Maintain clear and early referral pathways to orthoptists, and ophthalmologists for complex or persisting visual deficits.
– Use longitudinal tracking to monitor recovery trajectories and guide rehabilitation progression.

This updated approach embraces an “early, active, and integrated” model of concussion care. One that aligns visual, vestibular, cervical, and cognitive systems from the earliest stages of recovery.

Key Takeaway

Concussion rehabilitation is evolving from “wait and refer” to “treat early, integrate and refer”
Just as sub-threshold aerobic and vestibular interventions transformed concussion outcomes over the past decade, early oculomotor therapy now stands as the next frontier — restoring efficient eye-brain coordination, accelerating recovery, and reducing long-term symptom burden.

So, what are we going to do in Your Brain Health? We will provide more guidance on early foundation oculomotor exercises within our courses. We encourage more orthoptists, ophthalmologists and some behavioral optometrists to join our network, as this is becoming a great ecosystem where clinicians can not only find each other but can share and ask important clinical questions.

Your Brain Health (YBH) has partnered with the OrthTeam Centre in Manchester, expanding access to data-driven concussion care for athletes and sports teams across the North of England – and further strengthening the UK’s national concussion care infrastructure at the forefront of digital brain health innovation.

Through the partnership, the OrthTeam Centre’s dedicated Concussion Clinic will now use ScreenIT, YBH’s digital brain health platform, to record and monitor players’ recovery through every stage of the concussion pathway. ScreenIT connects clinicians, clubs and schools through a single digital platform, creating living brain health records that make recovery measurable, trackable, and transparent – supporting safer, data-driven return-to-play decisions.

This partnership gives athletes across the North of England access to connected, evidence-based concussion care, aligning with efforts to create a consistent approach to brain health nationwide. Combining clinical expertise with real-world data helps enhance safety, recovery, and long-term brain health outcomes.

A North–South Alliance for Concussion Care

The collaboration builds on YBH’s existing partnership with Professor Mike Loosemore and the Institute of Sport, Exercise and Health (ISEH) in London – creating a north–south alliance that unites world-class clinical expertise and cutting-edge digital tools to strengthen the UK’s concussion care infrastructure.

At the heart of this alliance is a shared vision: to build a national network of “super-centres” for brain health in sport, where players can access the most advanced assessment, treatment, and monitoring – supported by a single, connected digital system.

The OrthTeam Centre’s Concussion Clinic, part of the wider Sport and Exercise Medicine Clinics network, is led by some of the UK’s most respected Sport and Exercise Medicine consultants, including Dr John Rogers, Dr Rebecca Robinson, Dr David White, Dr Jim Kerss, and Dr Bevin McCartan. It represents one of the largest multidisciplinary groups in UK sport and exercise medicine, dedicated to improving safety, recovery, and long-term brain health outcomes for athletes of all ages and abilities.

Together, YBH and the OrthTeam Centre are setting new standards for concussion management – integrating evidence-based clinical practice, connected digital infrastructure, and national collaboration to improve player welfare and long-term brain health outcomes.

Rachael Dawe, SEM Strategy Consultant at OrthTeam Centre, said: “I’m delighted by this partnership, which strengthens how concussion care is connected and delivered. By combining clinical expertise with digital innovation, we’re creating a more consistent, informed approach that supports both clinicians, patients and athletes throughout recovery.”

Dr Rebecca Robinson, Consultant in Sport and Exercise Medicine at OrthTeam Centre, said: “Your Brain Health is an asset for concussion recovery, which adds precision to the clinical approach and a digital interface at the forefront of concussion technology. Working within a multidisciplinary system with YBH and using Screen IT will enable us as clinicians to bring better recovery services to all our patients – adults and young people – experiencing concussion, and enhance how we collaborate with colleagues nationally to drive research in this important area.”

Professor Mike Loosemore MBE, Consultant in Sport and Exercise Medicine, Institute of Sport & Exercise Health (ISEH), said: “ScreenIT has transformed how we manage athletes with concussion. Its enabled seamless digital communication between clubs and the concussion clinic at ISEH, ensuring that every clinician involved has real-time access to accurate, connected data. This has improved the quality of care, enhanced collaboration, and allowed us to monitor and track recovery safely and effectively.”

David Bartlett, Chief Operating Officer at Your Brain Health, said: “Through ScreenIT, we’re building a world-leading concussion care infrastructure across the UK. This partnership with OrthTeam brings world-class clinical expertise to the North West and ensures that every player can access the best possible care. And this isn’t just for elite athletes – clubs and schools can run free baseline brain screens with ScreenIT to build a clearer picture of brain health and support safer, stronger recoveries and better-informed return-to-play decisions.”

Following my colleague David Bartlett’s recent review of the Townsend et al. (2025, BJSM) paper, which quantified real-world heading forces using instrumented mouthguards across Premier League and WSL players, I turned my attention to the next logical question: how do we reduce those loads safely and effectively?

Townsend’s work confirmed that match-like drills (crosses and long balls) produce the highest rotational accelerations, and that female players consistently experience greater rotational forces than males. These findings gave us the most objective dataset yet on what happens when players head the ball. But measurement is only half the story; the real challenge lies in translating that knowledge into modifiable protective strategies.

Why Rotational Load Matters

Rotational acceleration has long been implicated as the more injurious component of head motion. Finite-element brain models show that rotational strain, particularly in cortical sulci, better predicts diffuse axonal injury and potentially chronic traumatic encephalopathy (CTE). Townsend et al. note that cumulative exposure to these rotations may predict pathology more accurately than a history of diagnosed concussions.

For clinicians, this reinforces that sub-concussive load management should focus on quality of movement, neck control, and task design, not only symptom surveillance.

The Role of Neck Strength and Control

Complementary evidence now strengthens this message.

• Fownes-Walpole et al. (2025) combined systematic review and Delphi consensus to outline the essential components of neck-training programs for impact mitigation. Their expert panel emphasised that effective training should target:
• • Multi-planar strength and endurance
  • Dynamic stabilisation and anticipatory control
  • Sport-specific movement patterns rather than isolated static holds
• Garrett et al. (2023, JOSPT) meta-analysed team-sport data and found a moderate negative correlation between neck strength and head-impact magnitude. Stronger necks absorb and redirect more of the incoming force, but only when activation is well-timed and directional.
• Kavyani et al. (2025) reported that athletes with a prior concussion history demonstrate persistent neck-strength deficits, highlighting the importance of post-injury reconditioning before return to contact drills.
• Peek (2022) provided a clear clinical framework for measurement, recommending handheld dynamometry or fixed-rig setups that capture flexion, extension, and lateral strength in neutral head posture. Reliable measurement underpins both screening and training progression.

Together, these studies shift the conversation: neck training is not an optional extra, but a primary prevention and rehabilitation strategy for athletes exposed to repetitive head loads.

Technique and Tactical Preparation

Prevention also extends beyond musculature.

• Peek et al. (2025) urged a “re-think” of head-injury prevention through tactics and technique. Coaching points such as body positioning, timing of jump, and angle of approach can meaningfully alter both impact location and rotational torque.
• Ross et al. (2025, HeaderPrep) demonstrated that targeted heading-readiness programs for youth female players are both feasible and well-accepted, improving confidence and technique while limiting high-force exposures.

For practitioners, these findings support a progression model: prepare before exposure. Blending neuromuscular control, technical education, and measured load increments.

Translating Evidence Into Practice

Quantify and Monitor

Whenever possible, use objective measures such as validated digital tools like instrumented mouthguards or video coding to track exposure patterns over time. Even periodic sampling can highlight positional or drill-specific risk.

Structure Heading Drills

• Begin with low-velocity, “thrown” headers, focusing on timing and neck control.
• Progress to aerial crosses and long-ball scenarios only once mechanics and anticipatory activation are stable.
• Limit overall high-force exposures, particularly across congested training weeks or in younger players.

Integrate Neck Training Year-Round

• Combine isometric holds, dynamic perturbation exercises, and multi-directional resistance (e.g., band or partner drills).
• Train in football-relevant postures: semi-flexed trunk, reactive stance, rather than supine positions.
• Review progress every 4–6 weeks using consistent testing positions.

Educate and Communicate

Ensure players understand why load management matters. Encourage disclosure of dizziness, neck fatigue, or delayed headache after repetitive headers, symptoms that can reflect both musculoskeletal and vestibular strain.

Implications for Female and Youth Athletes

Townsend et al. found higher rotational loads in female players, aligning with other data showing increased concussion incidence in women’s football. Potential contributors include lower baseline neck strength, smaller head-to-ball mass ratios, and different heading mechanics.
Clinicians should therefore:

• Establish sex-specific baselines for neck strength and control.
• Introduce graduated “header readiness” programs for adolescent and female players before exposure to match-like drills.
• Advocate for equitable inclusion in future research. Female cohorts remain markedly under-represented.

The Bigger Picture

Collectively, these studies provide the framework football has long needed:

• Townsend 2025 quantifies how much and how hard players head the ball.
• Fownes-Walpole, Garrett, and Kavyani explain how the neck contributes to mitigating load.
• Peek and Ross show how to coach and measure it in real settings.

For clinicians, this convergence of evidence allows more precise conversations with coaches, strength staff, and governing bodies about “smart exposure” — protecting brain health without losing the skill of heading.

Take-Home Summary

Closing Thought

As Townsend et al. conclude, the aim is not to eliminate heading but to guide it. With a deeper biomechanical understanding, targeted neck-training protocols, and modern monitoring technology, clinicians can lead football toward a future where every header is both skilful and safe.

The recent British Journal of Sports Medicine paper by Townsend et al. (2025) marks a significant step forward in our understanding of heading exposure during football training. For the first time, elite male and female footballers were monitored using instrumented mouthguards (iMGs) to capture the real-world frequency and intensity of headers, moving beyond laboratory estimates and self-report data that have long limited this area of research.

Across 63 professional training sessions, the study recorded nearly 1,500 heading events. The results revealed average peak linear accelerations of 18 g and rotational accelerations of ~1,000 rad/s², with female players consistently experiencing higher rotational accelerations than males. Crucially, match-like scenarios such as crosses and long balls produced the highest forces, while throw-ins, more common in training drills, resulted in lower impacts.

A step forward for football science

This research represents tangible progress. The methodology adheres to the Consensus Head Acceleration Measurement Practices (CHAMP) framework, using a validated iMG technology (Protecht) to produce the most reliable dataset yet on heading in elite football. It provides an evidence base for training-load management and begins to inform guidance on limiting repetitive head impacts, a necessary foundation for future policy and practice.

The use of wearable technology across both men’s and women’s elite tiers should be recognised as a milestone for player welfare. For the first time, we can meaningfully quantify what a “typical” training exposure looks like, rather than relying on conjecture or extrapolation from match data.

But peak force understanding remains limited

While the study provides robust quantification of how often and how hard players head the ball, it stops short of answering the critical question; what do these forces mean for the brain?

The peak linear and rotational accelerations recorded remain well below concussive thresholds, yet our understanding of the cumulative or sub-concussive impact of repetitive exposure remains incomplete. Rotational acceleration, in particular, is thought to exert greater strain on neural tissues, but the clinical consequence of these training-related exposures remains speculative.

This is especially relevant for women’s football, where the study identified significantly higher rotational accelerations but could not determine why. Possible explanations include differences in neck strength, head-neck segment mass, or heading technique, all of which demand closer biomechanical and neuromuscular scrutiny.

The practical takeaway: neck strength and neuromuscular control matter

What this study reinforces, perhaps more than anything, is the need for targeted cervical spine conditioning as part of concussion-prevention and performance programmes.

Strong, well-coordinated neck musculature could reduce head acceleration by stabilising the head–neck complex at the moment of impact. In practical terms, this means progressive strength and proprioceptive training, ideally integrated into existing strength and conditioning or physiotherapy routines.

For female athletes, who may be more susceptible to higher rotational forces, this may carry even greater importance. Tailored neuromuscular interventions that improve timing, co-contraction, and dynamic control could be key to mitigating risk without compromising performance.

Progress made

Townsend et al. should be commended for delivering the most comprehensive quantification of training-related heading to date. Their findings are a clear advance in the ongoing effort to understand, and ultimately manage, the neurological load placed on footballers.

But quantification is not the same as comprehension. Until we better understand how these forces translate into brain strain, metabolism, and long-term neurodegenerative risk, our response must combine data-driven exposure management with proactive neck-control conditioning.

In short: progress has been made, but the science of protection is only just beginning.

By David Bartlett, Physiotherapist at Welsh Fire

When Jordan Cox sprinted toward the boundary and plucked a soaring ball to dismiss Steve Smith in the Hundred this summer, the crowd saw a moment of pure athletic brilliance.
Those of us working at the intersection of brain health and performance saw something more: a live demonstration of world-class gaze stability.

The Invisible Work Behind the Catch

Tracking a cricket ball that is descending at over 100 km/h while your own body is accelerating is a neuromechanical challenge of the highest order. As Cox turned and ran back, his cervical spine moved from deep extension and left rotation to a neutral posture, all while the visual backdrop shifted abruptly from the uniform blue of the sky to the high-contrast chaos of a packed grandstand.

For the ball to remain sharply focused on his fovea, Cox’s vestibulo-ocular reflex (VOR), cervico-ocular reflex (COR) and smooth pursuit eye tracking functions all had to perform flawlessly. These oculomotor functions integrate information from semicircular canals of the inner ear, neck muscle spindles, and joints to control extra-ocular muscles, driving equal-and-opposite eye movements within roughly ten milliseconds of head motion. Any deficit in gaze stability gain, even mild, would have produced compensatory corrective saccades, causing the ball to blur or “jump” in his visual field. In that scenario, the catch simply doesn’t happen.

Implications for Performance

This is where what we know from concussion management and performance science needs to converge. We know from both clinical research and daily practice that even subtle vestibular, cervical and oculomotor impairments after head trauma degrades oculomotor functions and dynamic visual acuity. Cervico-vestibular dysfunction, common after rapid head acceleration injuries, together with physiological injury to brain and brainstem pathways, adds another layer, as proprioceptive input from the neck is essential for accurate gaze control.

Yet traditional return-to-play assessments often stop at symptom checklists or static balance tests. Cox’s catch is a compelling reminder that sport demands far more. If an athlete cannot maintain visual clarity while sprinting, rotating, and reacting to a shifting background, they are not truly match-ready.

Training and Screening the Invisible System

The good news is that gaze stability can be trained and measured. Dynamic visual-acuity tests, head-impulse assessments, oculomotor tests and progressive vestibular rehabilitation (the classic X1 and X2 drills, for example) and sports specific gaze stability exercises provide both objective metrics and effective interventions. Embedding these in pre-season screening and post-concussion protocols should now be as routine as hamstring strength testing.

A Broader Lesson

What fans celebrated as a spectacular dismissal was, at its core, a triumph of incredible neuro-ocular-vestibular-cervical integration. For performance and medical teams, it highlights a simple but critical truth: protecting and optimising the brain–eye–neck axis is not a niche clinical concern, it is a competitive necessity.

Elite catches are born not only of athletic talent but of a nervous system tuned to keep a stable gaze on moving targets, while the body moves at speed. In professional sport, that is as worthy of training and safeguarding as any other physical skill.

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.

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.

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.

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!

The recent Herald Sun article¹, based on a new Swinburne University study using transcranial magnetic stimulation (TMS)², highlights what many clinicians have long recognised: concussion recovery is not as simple as counting down the days.

In sport, return-to-play (RTP) rules are often based on arbitrary timelines; 12 days in elite AFL, 21 days in community levels, rather than an accurate picture of brain recovery. This study found that while athletes reported feeling symptom-free after about 12 days, measures of cortical inhibition (via TMS) were still abnormal for up to 26 days.

Every day in Australia, we hear that an athlete is sidelined due to “concussion protocols”, rather than what is really happening; the athlete is recovering from a concussion injury. Concussion is a rapid head acceleration injury with neurophysiological, musculoskeletal, and psychological consequences. Just like a hamstring or shoulder injury, recovery requires an individualised, multimodal assessment, not an arbitrary timeline. You don’t hear of players out with “hamstring protocols”, they are recovering from a hamstring injury. And running without pain symptoms certainly does not mean you have fully recovered!

This reinforces what we see clinically every week: symptom resolution does not necessarily mean full recovery.

Why This Matters

Every athlete deserves recovery care that is:

• Individualised – no two concussions recover the same way
• Comprehensive – covering brain, body, and psychological health
• Transparent – so players, families, and clinicians can track progress together

This is one of the reasons we built ScreenIT, software that integrates all these clinical measures, streamlining care for the individual while also creating robust, longitudinal datasets to advance concussion research.

References

1. Clarke, B. (2025, August 17). When do you recover from a concussion? Shock new findings. Herald Sun. https://www.heraldsun.com.au/health/mental-health/concussion-recovery-periods-may-be-too-short-new-brain-study-suggests/news-story/73aa4cf85aa55e875b42c3497f96651b
2. Pearce, A. J., Middleton, K., & Clarke, A. (2025). Time-course responses following sports-related concussion: a multi-modality study. The Physician and Sportsmedicine, 00913847.2025.2541579, 1–9.
3. Fong, D. H. C., Cohen, A., Boughton, P., Raftos, P., Herrera, J. E., Simon, N. G., & Putrino, D. (2020). Steady-state visual-evoked potentials as a biomarker for concussion: A pilot study. Frontiers in Neuroscience, 14, 171.

Over the past decade, vestibular education has strongly emphasized the role of the Head Impulse Test (HIT) and its video-based cousin (vHIT), particularly in acute settings. This focus stems from their pivotal role in the Head Impulse, Nystagmus, Test of Skew (HINTS) protocol, which—when applied accurately and in the right context—can help differentiate central causes (e.g., stroke) from peripheral vestibulopathies (e.g., vestibular neuritis). Rightly so: it’s a powerful, bedside decision tool in emergency neurology. 

However, I have noticed over the past 5 years, this stroke-centric application of HIT/vHIT taught in many vestibular courses has disproportionately shaped the broader clinical conversation—especially in rehabilitation and sports medicine. Too often, clinicians are left with the impression that a normal vHIT rules out significant dysfunction. In reality, this is where functional vestibular assessment should begin. 

Functional Gaze Stability = Everyday Brain Performance 

Patients don’t live in a vHIT lab. They live in dynamic environments—navigating busy streets, scanning playing fields, or walking through supermarkets. These real-world tasks require gaze stability across a variety of head speeds, directions, and cognitive loads. 

We must assess gaze stability across a range of speeds and tasks to: 

• Identify direction and speed specific subtle deficits 

• Track rehab progress 

• Assessing cervical-vestibular coordination and compensatory strategies 

• Tailor VOR retraining 

• Guide return-to-play and return-to-learn decisions 

Even simple tools like Dynamic Visual Acuity (DVA) and the VOMS battery can reveal critical deficits missed by vHIT. 

Recalibrating Our Focus 

vHIT is a starting point. To support recovery, clinicians could incorporate: 

• Smooth pursuit and VOR cancellation 

• DVA at varied speeds 

• Active VOR tools (e.g., NeuroFlex®) 

• Head precision and proprioceptive control (e.g., HeadX Kross) 

• Functional movement with gaze tasks 

Final Thought 

If symptoms persist, dig deeper than just HIT and vHIT. Gaze stability is not binary. Like all brain functions, it must be assessed across varied speeds, loads, and contexts to understand and treat it most effectively. 

In 2022, Your Brain Health (YBH) was in its embryonic stages as an organisation. At that time, we held clear ambitions to promote a multimodal, community‑focused approach to brain health. By combining clinical experience, domain expertise, and emerging technologies, our goal was to enable better, evidence‑informed care.

We recognised an urgent need for integrated brain‑health solutions across diverse settings—concussion, mental health, ageing, and neurorehabilitation. This vision became the foundation for developing digital tools and clinical pathways that empower both healthcare professionals and the people they serve.

YBH was born from the belief that optimal outcomes are achieved when brain health is assessed and managed using a collaborative, multidisciplinary, and data‑driven model. From this initial vision, our future direction began to take shape.

Driven by this unmet need and our clinical insights, we developed ScreenIT software to address these challenges. ScreenIT is designed to:

Easily capture previously fragmented data from validated questionnaires and objective multimodal outcome measures, alongside emerging assessment technologies. A selection of trusted tools allowing for clinician choice and autonomy to suit their contextual needs.

Automate comprehensive reports within seconds, saving administrative time.

Track measures longitudinally with intuitive timeline graphs.

Support clinics, clubs, and organisations through flexible permission structures for clinical and administrative staff, enhancing multidisciplinary collaboration.

Securely store a scalable, real‑world longitudinal database that can power future research and AI/machine‑learning insights.

When an athlete sustains a potential concussion, the decisions made in the moments that follow are critical. Healthcare Professionals and medical staff are often required to act quickly, using the best tools available to assess injury severity and guide next steps. The SCAT6 (Sport Concussion Assessment Tool, 6th Edition) has emerged as the leading sideline and clinical evaluation tool—but is it truly the best we have?

SCAT6 is widely used as the go-to concussion assessment tool for the acute phase of injury. It encourages a holistic view of the athlete, prompting clinicians to consider symptom progression, cognitive status, and observable signs rather than relying on any one domain.

It also reinforces a culture of athlete safety. The emphasis on standardised removal-from-play protocols and serial assessments helps mitigate the risks associated with premature return-to-play decisions.

Persistent Limitations

Despite its strengths, SCAT6 is not without limitations. It remains a tool—not a diagnostic verdict—and is dependent on the clinical judgment and skill of the person administering it. Its validated window of utility is confined to the first 72 hours post-injury, limiting its role in ongoing management.

That distinction—tool, not diagnosis—is crucial, yet often misunderstood. Many research studies still use SCAT6 outcomes as de facto diagnostic criteria for inclusion or exclusion, despite the fact that SCAT6 was never intended to serve as a standalone diagnostic standard. This creates inconsistencies in the literature and can contribute to overreliance on thresholds that were meant to guide, not define, clinical decision-making.

Practical barriers also persist. The tool’s comprehensiveness can be a double-edged sword in time-pressured environments. Administering SCAT6 efficiently requires training, familiarity, and ideally, baseline data—which not all settings can support.

Historically, one of the major constraints has been the lack of a digital format. Paper-based assessments can be cumbersome, prone to inconsistencies, and difficult to integrate into broader EMR systems or performance tracking platforms.

A Tool That Keeps Improving

So, is SCAT6 the best we have? For the acute assessment of sport-related concussion, it is certainly the most complete tool currently available. And with the shift to digital formats, some of its practical limitations are being actively addressed—making it more accessible, efficient, and clinically useful.

But like any tool, its effectiveness depends on context, competence, and careful application. SCAT6 should support—not replace—clinical judgment. As our understanding of concussion continues to evolve, so too must our tools and technologies.