1. Bimanual Upper Limb Rehabilitation for Stroke

Stroke upper limb recovery research is finally moving beyond basic reach-and-grasp movements to address the complexity of real-world activities. Historically, much of the research has been overly simplified, with improvements demonstrated in functional outcome measures, particularly in higher-functioning stroke survivors, but with limited translation into meaningful real-world activity.

New approaches are now beginning to address this gap. Recent data shows that bimanual performance (using both hands together) improves most significantly within the first six months post-stroke. Importantly, admission grasp function and stroke severity have been identified as the strongest predictors of how well a patient will manage two-handed tasks at one year.

The introduction of clinical decision trees offers a more structured and realistic way for therapists to set goals, helping to better align rehabilitation outcomes with the demands of daily life.

Key paper:
Van Gils, A., Zou, Y., Meyer, S., Michielsen, M., Lafosse, C., Beyens, H., Schillebeeckx, F., Kos, D., & Verheyden, G. (2025). Tracking bimanual recovery after stroke: Grasp function and stroke severity predict 1-year performance. Clinical Rehabilitation.

2. Non-Invasive Brain Stimulation (NIBS): Precision and Synergy

After decades of development within research settings, non-invasive brain stimulation (NIBS) is now moving closer to mainstream clinical application, driven by advances in precision targeting and combined treatment approaches.

In Alzheimer’s care, meta-analyses demonstrate that repetitive Transcranial Magnetic Stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC), alongside transcranial Direct Current Stimulation (tDCS) targeting temporal regions, can significantly improve memory symptoms.

In depression treatment, 2025 saw a notable breakthrough in combination therapy. Using tDCS to “precondition” neuronal activity prior to rTMS has produced response rates of up to 85% within two weeks in treatment-resistant cases.

As understanding of functional brain networks continues to improve, increasingly precise and synergistic applications of these techniques are expected to drive further clinical impact.

Key paper:
Rektorová, I., Pupíková, M., Fleury, L., Brabenec, L., & Hummel, F. C. (2025). Non-invasive brain stimulation: current and future applications in neurology. Nature Reviews Neurology, 21(12), 669–686.

3. A Shift in Managing Migraine

The International Headache Society (IHS) has called for a fundamental shift in migraine management; from treating individual attacks to preventing disease progression.

With the emergence of highly effective anti-CGRP therapies, there is now a strong emphasis on early intervention. Treating migraine proactively, before it becomes chronic or high-frequency, offers the potential to reduce both individual burden and wider societal impact, while preserving long-term brain health.

This shift aligns closely with ongoing efforts to improve clinical education and standards across both pharmacological and non-pharmacological management of migraine, supporting a more preventative and holistic approach to care.

Key paper:
Pozo-Rosich, P., et al. (2025). Early treatment in migraine – A call to shift prevention from attacks to disease progression: A position statement from the International Headache Society. Cephalalgia.

4. Exercise for Cognition: The Power of the “Weekend Warrior” and Beyond

With up to 50% of dementia cases now considered preventable, exercise has become a central pillar of brain health and longevity.

New longitudinal research has validated the “weekend warrior” model, showing that individuals who complete their physical activity in one or two sessions per week achieve a 25% reduction in mild dementia risk, outperforming the 11% reduction seen in those who exercise more frequently. This suggests that total volume of activity may be more important than frequency, particularly for individuals with time constraints.

Further strengthening this evidence base, a large umbrella review and meta-meta-analysis published in 2025 confirms that exercise delivers measurable improvements in cognition, memory, and executive function, reinforcing its role as a key intervention in both prevention and treatment.

Key papers:
O’Donovan, G., et al. (2024). Associations of the ‘weekend warrior’ physical activity pattern with mild dementia. British Journal of Sports Medicine.
(2025). Effectiveness of exercise for improving cognition, memory and executive function: a systematic umbrella review and meta-meta-analysis. British Journal of Sports Medicine.

5. Proactive Brain Health Screening for Serious Falls

Proactive brain health surveillance is gaining traction as a practical way to identify risk early and intervene before significant decline occurs.

Simple, measurable markers such as gait speed, grip strength, and mental health indicators are proving to be powerful predictors of outcomes. Research shows that combining gait speed and grip strength can effectively identify individuals at higher risk of serious falls, while monitoring depression and anxiety is increasingly recognised as essential to comprehensive assessment.

A useful way to conceptualise this approach is to think of brain health like a high-performance vehicle. Rather than waiting for a major failure, proactive screening acts as a dashboard of warning lights, allowing early adjustments and maintenance to support long-term performance and resilience.

Digital platforms such as ScreenIT support this multimodal approach, enabling longitudinal health profiling and earlier identification of risk patterns and one of the key reasons why we have developed it.

Key paper:
Raru, T. B., et al. (2025). Contribution of gait speed, grip strength, and depression on the risk of serious falls among older adults. Archives of Gerontology and Geriatrics Plus.

Over the past decade, research has linked traumatic brain injury (TBI) and repetitive head impacts with neurodegenerative disease. Links with Dementia and Chronic Traumatic Encephalography (CTE) in particular ha dominated headlines, but links between head impacts and MND (also known as ALS) remains less clearly understood.

In October 2025, a major UK population study published in JAMA Network Open in October 2025 attempted to clarify this relationship using national electronic health records.

What the Research Found

Zhu et al. (2025) analysed health records from 342,760 adults, including over 85,000 individuals with documented traumatic brain injury.

Three findings stand out.

1) A higher observed risk of MND after TBI

Individuals with a history of TBI showed approximately a 2.6-fold higher risk of later receiving an MND diagnosis compared with matched members of the general population. In absolute terms, 69 of 85,690 people with TBI developed ALS (about 0.08%), while 81 of 257,070 matched controls developed ALS (about 0.03%).

At face value, this appears alarming, and it is easy to interpret this as evidence that brain injury causes MND, but the story is more nuanced.

2) No difference in disease timing or survival

The researchers found no difference in age at diagnosis or age at death between people with and without prior TBI.

If traumatic brain injury were directly accelerating disease progression, we might expect earlier onset or shorter survival. That was not observed.

3) The risk was confined to the first two years

The finding that deserves the most attention, is that increased risk existed only within two years after the injury. After that period, risk returned to baseline levels.

This led researchers to propose a concept many outside academia rarely hear discussed: reverse causality.

What is Reverse Causality?

MND often develops silently before diagnosis. Early symptoms can include subtle weakness, coordination changes, or balance issues long before disease is recognised.

Zhu et al. (2025) suggests that, in some individuals:

• early, undiagnosed MND may increase falls or accidents
• those events result in a recorded traumatic brain injury
• the neurological disease is diagnosed months or years later

In other words, the injury may not be causing the disease; the disease may be contributing to the injury. This distinction matters enormously for athletes, governing bodies, and public perception.

What This Means Sport

The current evidence does not prove that traumatic brain injury causes MND.

What it does show is an observable association, a strong possibility of reverse causality and significant gaps in long-term data.

The journeys of Rob Burrow and Doddie Weir increased awareness of MND in the public eye and Lewis Moody’s diagnosis reminds us that this is not a historical conversation, but an ongoing one. Rugby has already implemented meaningful change; increasing concussion awareness, introducing stricter protocols, appointing independent match-day doctors, enforcing graduated return-to-play pathways, and adapting laws to reduce head contact. Each represents a step forward.

Yet we are only at the beginning of understanding brain health across an athlete’s lifetime. The next breakthroughs may not come from looking harder at the brain in isolation, but from understanding the wider system around it, how forces move through the body and brain in different sports, how athletes adapt over time, and how subtle changes accumulate long before symptoms appear, and monitoring all known risk factors that influence brain health  both during and well beyond an athletes sporting career.

Standing at the top of the skeleton run at the 2018 Winter Olympics in PyeongChang, the cold was aggressive. It was -27 °C. Cold enough that icicles had formed in my beard as I watched athletes prepare to hurl themselves head-first down an ice chute at motorway speeds – a perfectly normal way to spend a Tuesday morning, obviously.

PyeongChang was my 4th Olympic Games, but my first as Chief Medical Officer for Team GB. You might think three decades in Sports and Exercise Medicine would dull your curiosity, but if anything, experience just refines the questions. As I looked down the run that morning, two things occupied my mind.

First: would Lizzy Yarnold retain her Olympic gold? (Spoiler: She did, magnificently).

Second, and the one that has nagged at me far longer: what truly causes the symptoms skeleton athletes call “Skelly Head” (or “Sled Head” to our North American colleagues)?

The first question was answered on the podium. The second remains one of the more interesting, unresolved puzzles in our field.

A career defined by head injuries

Skelly Head has always fascinated me, and not by accident. My academic background is in concussion. I’ve spent over thirty years as Chief Medical Officer for GB Boxing; a sport where rapid, precise symptom recognition and knowing the difference between structural injury and functional disturbance is critical.

Here is the challenge: Skeleton athletes often present with symptoms that look, on the surface, suspiciously like concussion; headache, dizziness, disorientation, visual disturbance, neck discomfort.

Yet, in most cases, they haven’t hit their head. There is no big impact, no rotational acceleration, and no consistent post-traumatic cognitive profile.

My position is clear: Skelly Head is not concussion, despite the superficial similarities. Conflating the two is like treating a migraine with a neck brace, it risks misunderstanding both conditions.

When the physics hits the physiology

Skeleton is one of those brilliant sports that captures global attention for two weeks every four years, then largely vanishes from view.

But the physiological demands don’t disappear when the TV cameras leave. These athletes are repeatedly exposed to one of the most extreme mechanical environments in sport. Over multiple Olympic cycles, I’ve seen a recognisable pattern emerge: athletes reporting dizziness, visual strain, and stiff necks following runs. Sometimes transient, sometimes cumulative, and often without any identifiable “crash.”

So, what is happening?

It has become increasingly clear that the culprit is repeated, high-frequency vibration transmitted through the sled, the ice, the helmet and right into the cervical spine.

We need to stop viewing this vibration as just an incidental nuisance of the sport. It is an active sensory stressor. It occurs within specific frequency ranges known to bother vestibular organs (our balance system) and the sensors in our neck responsible for spatial orientation.

The “Snow Globe” Effect: A Mechanistic Framework

Rather than a single pathology, I believe Skelly Head is best understood as a transient disturbance of how the brain integrates multiple senses under load.

1. The Vestibular Shake-Up Imagine your inner ear getting shaken like a snow globe. Repeated vibration seems to transiently scramble vestibular signalling-specifically the inputs that sense linear acceleration and head position. The result is subtle reductions in reflex stability and a “visual–vestibular mismatch.” The eyes and ears are telling the brain different things. Crucially, this happens without permanent damage, which explains why standard vestibular tests usually come back looking normal.
2. The Cervical Response The neck is not a passive passenger. Vibration transmitted through the sled–helmet interface modifies signals from the neck to the brain. The body responds with protective stiffness-increasing muscle tone. This stiffness is both adaptive (trying to stabilise the head) and contributory to the problem, leading to secondary headaches and discomfort.
3. Central Processing Overload At a central level, the poor brain has to reconcile noisy signals from the ears, altered input from a stiff neck, and heavily relied-upon visual information, all while moving at 80mph. It’s a massive increase in processing demand.

Symptoms arise not because tissue is broken, but because the integration system becomes inefficient under extreme, repeated load.

Why this matters (beyond the ice track)

Why fuss over a niche condition in a niche sport? Because precision in diagnosis is everything.

Misclassifying Skelly Head as concussion is unhelpful. It risks inappropriate management, unnecessary restriction, and misplaced anxiety about brain injury, while failing to address the true underlying mechanisms.

Athletes deserve explanations grounded in physiology, not just convenient labels. Clinicians need frameworks that recognise functional, load-dependent disturbances rather than forcing symptoms into diagnostic categories that don’t quite fit.

Skelly Head isn’t mystical. It is a predictable physiological response to high-frequency vibration acting on tightly coupled body systems. Standing in that -27 °C freezer in PyeongChang, it was clear to me that getting this right mattered.

In the work we do at the clinic today-applying that same rigorous curiosity to all head symptoms, whether from an Olympic sled or a fall at home, it matters even more.

At Your Brain Health, staying ahead of the evidence is core to our mission. It is essential that we incorporate this knowledge into our educational courses and resources, and use it to evolve and improve ScreenIT.

There was a plethora of concussion research in 2025. Here are our nominations for the five biggest themes in concussion research in 2025 based on our own biases and interests!

1. Mental Health & Fear Avoidance

Mental health is finally (and rightly) recognised as a central component of concussion recovery and persisting symptoms. Two major studies this year emphasise that catastrophising thoughts, fear-avoidance behaviours, and perceptions about symptoms strongly influence long-term outcomes—sometimes more than the injury itself.

Key insights:

• Mental health concerns are common but often overlooked in concussion care.
• People may avoid seeking help due to fear or misunderstanding of their symptoms.
• Education and early support remain essential.
• Including mental health in routine brain health surveillance helps normalise monitoring and encourages early intervention.

Key papers:

Hecker, L., King, S., Wijenberg, M., Geusgens, C., Stapert, S., Verbunt, J., & Van Heugten, C. (2025). Catastrophizing thoughts and fear-avoidance behavior are related to persistent post-concussion symptoms after mild traumatic brain injury. Neurotrauma Reports, 6(1), 148–157.

Otamendi, T., Sanghera, S. K., Mortenson, W. B., Li, L. C., & Silverberg, N. D. (2025). Patient perceptions of persistent symptoms after mild traumatic brain injury and their influence on mental health treatment-seeking: A grounded theory study. Disability and Rehabilitation, 1–9.

2. Functional Neurological Disorder & Functional Overlay After Concussion

FND has historically fallen between neurology and psychiatry, but 2025 marks a shift. There is a stronger recognition of functional overlay following concussion: best-practice now promotes positive “rule-in” diagnostics and targeted rehabilitation, providing new clarity for clinicians.

Key insights:

• Functional overlay after concussion is common, including functional cognitive symptoms.
• FND and Persisting Symptoms Post Concussion share both risk factors and clinical presentations, which clinicians should be aware of. I recently met Dr Ioannis Mavroudis in Leeds UK, who has a wealth of knowledge and experience in both concussions, TBI and FND. Ioannis was lead author in an excellent discussion that I recommend everyone read!
• Understanding these mechanisms can prevent misdiagnosis and ineffective management.
• Oculomotor data—such as saccades, anti-saccades and smooth pursuit—already collected across the YBH network may prove particularly informative.
• Longitudinal brain-health surveillance can help distinguish functional recovery patterns.

Key insights:

Mavroudis, I., Petridis, F., Karantali, E., Ciobica, A., Papagiannopoulos, S., & Kazis, D. (2025). Post-concussion syndrome and Functional Neurological Disorder: Diagnostic interfaces, risk mechanisms, and the Functional Overlay Model. Brain Sciences, 15(7), 755. 

Sangare, A., de Liège, A., Gaymard, B., Rivaud-Péchoux, S., Bonnet, C., Růžička, E., May, J., Serranová, T., Mesrati, F., Roze, E., Vidailhet, M., Louapre, C., Naccache, L., & Garcin, B. (2025). Ocular motor abnormalities in functional neurological disorder: A video-oculography study. Movement Disorders Clinical Practice. https://doi.org/10.1002/mdc3.70394

3. Football Headers: Technique, Demands & The Future of Prevention

One of the defining questions in sport science today is: How can we reduce head-impact exposure in football without changing the game itself?

In 2025, several landmark papers have begun to answer this

Key insights:

• Townsend et al. produced the first high-resolution dataset of heading demands for elite men and women, establishing an important foundation for accurate load monitoring. Impressive work!
• Peek and colleagues at FIFA argue that prevention will be most effective when focused not only on neck strength, but also whole-body technique and tactical decision-making. This is a shift that places coaches at the centre of injury-prevention strategy. A smart approach, so keep coaches involved as we progress this knowledge together!
• Multimodal cervical training in women shows promising early results. A you may have already gathered, we (at YBH) think the neck is a crucial part of concussion rehabilitation in many cases!
• At YBH, these findings reinforce our view that performance data, biomechanics, and applied coaching must sit alongside medical care in concussion-prevention frameworks.

Key papers:

Peek, K., Georgieva, J., Wilson, B., Massey, A., & Serner, A. (2025). Re-thinking head injury prevention in football: The role of tactics and technique. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2025.07.009

Thompson, B. J., & Lattimer, L. J. (2025). A pilot study on the effects of multimodal cervical exercise training on clinical concussion risk factors in female athletes. Physical Therapy in Sport, 72, 39–45.

Townsend, D. C., Jones, C., Patel, S., Green, M., Riley, P., Brownlow, M., Gillett, M., & Belli, A. (2025). Heading to guidance: Understanding in-training heading demands for elite men’s and women’s football. British Journal of Sports Medicine. bjsports-2024-109525.

4. Sport-Specific Considerations: From Circus to Cricket

Best-practice guidelines are essential—but athletes rarely fit into one generic model. This year, we’ve seen excellent work applying concussion evidence to very specific performance environments.

Highlights:

• Circus artists face complex inverted positions, spinning, aerial rotations and extreme physical demands. I had the pleasure of meeting David Munro this year, an experienced concussion physiotherapist from Melbourne. David and colleagues have produced a much-needed extension of the CISG guidelines tailored to circus performance—something I deeply appreciate after meeting with the Cirque du Soleil medical team ealier this year.
• Cricket, currently in the spotlight with the Ashes, requires nuanced return-to-play (RTP) considerations: batting reaction timing, fast-bowling workloads, fielding exposure, travel fatigue, and more. Golding et al. provide an excellent framework for cricket-specific concussion care.

Key papers:

Munro, D., Greenspan, S., Nicholas, J., & Stuckey, M. I. (2025). Circus-specific extension of the 6th international consensus statement on concussion in sport. BMJ Open Sport & Exercise Medicine, 11(2), e002524.

Golding, L., Orchard, J. W., & Swan, M. (2025). Concussion in cricket: Risk, mechanism, identification and return to play. In Cricket Sports Medicine (pp. 333–339). Springer Nature Singapore.

5. Concussion in Older Adults: A Critical Knowledge Gap

While most assume concussion is primarily a youth-sport issue, the truth is stark: most concussions occur due to falls in older adults. Yet research in this population is decades behind.

Key insights:

• Concussion symptoms in older adults often overlap with dementia, depression, delirium or medication effects.
• Little is known about their recovery trajectories.
• Falls risk itself is rising with ageing populations.
• Without structured monitoring, concussion may remain undetected—or misattributed—for months.
• Many of our cognitive, balance and vestibular outcome measures used in concussion care, overlap with measures that relate to falls risk. ScreenIT will hold some valuable data soon that will give interesting insights!

Key papers:

Joghataie, G., Hundal, S., Mushtaque, A., Tator, C. H., & Tartaglia, M. C. (2025). Critical gap in practice—Lack of attention to falls and possible fall-related post-concussion symptoms in older adults and individuals with neurodegenerative disease. GeroScience, 47(1), 1269–1276.

Okrah, A. K., Tharrington, S., Shin, I., Wagoner, A., Woodsmall, K. S., & Jehu, D. A. (2025). Risk factors for fall-related mild traumatic brain injuries among older adults: A systematic review highlighting research gaps. International Journal of Environmental Research and Public Health, 22(2). https://doi.org/10.3390/ijerph22020255

We think these research papers in 2025 were worth sharing. But plenty of great research was not included. We are happy for anyone in our growing Your Brain Health community to share other research in 2025 that we missed.

Also, keep an eye out for our Top 5 Topics Brain Health Research next!

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 — such as vestibular-ocular assessment tools within ScreenIT — 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.

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.