Your Brain Health is thrilled to welcome the renowned Professor Mike Loosemore MBE to its expanding network, forging a partnership that puts cutting-edge concussion care right in the heart of London. With decades of expertise in concussion management, musculoskeletal injuries, and exercise as medicine, Prof. Loosemore’s collaboration marks a pivotal moment in our mission to deliver world-class care around the globe.

This partnership is a double win for anyone passionate about their brain and body health. Here’s what’s happening:

The ISEH Concussion Clinic Joins the Your Brain Health Network

Located on Tottenham Court Road, the Concussion Clinic at the Institute of Sport and Exercise Health (ISEH), led by Prof. Loosemore, has officially joined the growing Your Brain Health network. This international network already includes Prof. Jon Patricios’s clinic in Johannesburg, South Africa. Both Loosemore and Patricios were co-authors of the most recent Concussion in Sport Group Consensus Statement and played instrumental roles in the development of the groundbreaking SCOAT6 (Sports Concussion Office Assessment Tool 6). Their shared expertise ensures that patients have access to care informed by the latest global standards.

The ISEH Concussion Clinic is one of the leading centres in the country for concussion diagnosis and management, offering pioneering technology and treatments that set it apart. What makes this clinic exceptional is its unique ability to treat children as well as adults with concussions—a vital service. From young athletes to professionals recovering from injuries, the clinic combines advanced diagnostic tools with personalized care plans to ensure optimal recovery.

Prof. Loosemore’s expertise in the pathophysiology of brain injuries, backed by decades of research, means patients receive care rooted in science and tailored to their individual needs. Whether it’s the result of a sports injury, an accident, or a fall, this clinic is redefining what’s possible when it comes to managing concussions.

Don’t Miss the Concussion Workshop on 22nd March

In addition to running one of the country’s most innovative concussion clinics, Prof. Loosemore is passionate about sharing his expertise. That’s why he’s teaming up with physiotherapist Nicola Hunt to deliver a Concussion Workshop at ISEH on 22nd March.

This workshop promises to be an eye-opening event for healthcare professionals, sports coaches, and anyone looking to understand the science behind concussion recovery. Expect practical tools, insights from cutting-edge research, and real-world strategies for optimising recovery and long-term brain health.

Prof. Loosemore is not just a leader in concussion care—he’s also a passionate advocate for exercise as medicine, believing in its power to prevent and treat chronic diseases. Combined with Nicola Hunt’s hands-on expertise in rehabilitation, this workshop is set to be an unmissable opportunity to learn from the best.

Reserve your spot!

Meet Professor Mike Loosemore MBE

If you’re wondering what makes Prof. Loosemore such a trailblazer in his field, here’s the lowdown:

Areas of Expertise: Diagnosis and treatment of concussion, musculoskeletal injuries, and sports injuries; exercise as a tool for disease prevention and management.

NHS Base: University College London Hospitals.

Private Practice: ISEH and The Portland Hospital.

Prof. Loosemore’s groundbreaking work has earned him an MBE for services to Sports Medicine, alongside numerous awards like the Sir Robert Atkins Award and the David Hemery Award. With a PhD in the Pathophysiology of Boxing Injuries, he’s at the forefront of concussion research and has dedicated his career to improving care for athletes, children, and anyone dealing with injury.

Beyond the clinic, Prof. Loosemore’s influence extends globally. He’s traveled with national squads to the Olympics, Commonwealth Games, and World Championships, using his expertise to help athletes perform—and recover—at their best.

The Future of Brain Health in London

The collaboration between Your Brain Health and Prof. Mike Loosemore marks a new era of accessible, expert-led brain health care in London. Whether it’s through the world-class care provided at the ISEH Concussion Clinic or the upcoming workshop designed to empower others with knowledge, this partnership is set to change lives.

So, if you or someone you know is navigating the challenges of a concussion, don’t wait—explore the possibilities at the ISEH Concussion Clinic today. And for those eager to dive deeper, make sure to reserve your spot at the Concussion Workshop on 22nd March.

Your brain health deserves the very best—and now, it’s right here in London.

By Sam Peters, founder Concussed Media

Your Brain Health today launches a global campaign calling on all sports clubs, schools and other sporting organisations to appoint a Concussion Officer responsible for overseeing head injury protocols.

The initiative, which already has the backing of sports stars, coaches, medics, charities, concussion campaigners and grassroots organisations, including Datchworth RFC, calls on governing bodies to embrace an open conversation about concussion and facilitate the push for increased safeguards.

Become a Concussion Officer Today

Similar in principle to a club Fire Warden or Safeguarding Officer, which have been widely adopted by sports clubs and associations in recent years, a concussion officer would be nominated by each organisation and take responsibility for ensuring protocols and best practice are followed.

Speaking about the initiative, Your Brain Health (YBH) Chief Operating Officer and current Welsh Fire Lead Physiotherapist David Bartlett, said:

‘Sport is an incredible force for good—it builds physical fitness, mental resilience, and lifelong friendships. But to keep sport safe and accessible for everyone, we need to take concussions seriously. Appointing a Concussion Officer ensures that when head injuries happen, they’re managed properly, and allows participants to recover fully and return to enjoying the sports they love.’

Originally promoted by the Australian Institute of Sport, the Concussion Officer campaign is also fully supported by influential medical figures in the UK, including Mike Loosemore, Professor of Sport and Exercise medicine at the Institute of Sport, Exercise and Health (ISEH).

Professor Loosemore said: ‘I fully support this initiative being run by Your Brain Health. The concept of having a Concussion Officer in place is just simple common sense and I hope to see many clubs and schools embrace it over the coming months’

The campaign, which is being launched by Your Brain Health to coincide with the Six Nations Rugby tournament in Europe and the start of the Australian Football League (AFL) season in Australia, is aimed at all sports.

‘The Australian Institute of Sport has recommended in their 2024 Brain Health statement that every club and school should have a Concussion Officer. We already have safeguarding officers for child protection and fire wardens for emergencies. A concussion officer should be seen in the same way: a key role dedicated to ensuring safety and best practice in concussion management.

‘Early intervention is critical when managing concussions. Properly recognising and responding to a concussion can significantly reduce the risk of long-term complications, including persisting symptoms that in some instances can include mental health concerns. Having a Concussion Officer in place ensures that individuals get the right care from the start, improving recovery and protecting their future well-being.’

While the sports field would seem the most likely place for a child to sustain a concussion, or mild traumatic brain injury as it is also referred, school playgrounds see an estimated 27,000 diagnosed cases in Australia alone each year.

‘Schools have a duty of care to ensure these injuries are managed appropriately. Without clear protocols, concussions can be missed, leading to long-term health consequences. A Concussion Officer ensures that no child falls through the cracks and that brain health is treated with the seriousness it deserves.’

YBH, with the backing of Concussed Media and other concussion awareness groups, believe the campaign will help clubs and sports organisations achieve:

  • Better protection for clubs / schools
  • Better health outcomes
  • Better performance
  • Peace of mind of players / parents
  • Increase participation
  • Improve reputation of organisation

Datchworth Rugby Football Club, who play in Herts/Middlesex League One, this week became the first UK rugby club to embrace the campaign.

Sports Club Chairman Andrew ‘Woody’ Wood, believes the onset of professional rugby, which sees some aspiring amateurs players training five or six times a week while others can only manage one or two training sessions between work commitments, has created a serious disconnect at grassroots level.

He would also welcome the introduction of weight banded categories, similar to those used by the New Zealand Rugby Football Union, to avoid potentially dangerous mismatches between youngsters at different developmental stages.

He said: ‘I’ve taken my eldest son and youngest son through all the age groups as a coach, and sometimes you get it where it’s effectively a man against somebody who hasn’t even been through puberty. And there’s a massive size difference there.’

The RFU was criticised for attempting to reduce the tackle height in the amateur game in 2023, but former Datchworth First XV captain Stu Young believes the reluctance of referees to penalise head high tackles, which have always been illegal under the game’s laws, is the biggest stumbling block to progress.

‘Massive hits to the head are either just given as a penalty or 10 minutes in the sin bin and then they come back on,’ Young said. ‘It’s not really achieving what I assume the RFU want to do which is to lower the height of tackles and therefore lower the amount of head knocks.

‘If the referees were a bit more on it (prepared to give red cards) that might have more of an impact than just saying ‘we’re going to lower the contact area from shoulder height to sternum’.’

Another Datchworth stalwart, Warren Sullivan, who coaches the junior section and is current Chairman, is concerned the mounting threat of legal action has caused some parents to become overcautious. He wants a renewed focus on coaching the tackle, where most concussions occur.

‘People have got scared,’ Sullivan said. ‘they’re more or less throwing the baby out of the bathwater.  A lot of parents don’t want their kids to play rugby anymore but I think a lot of it’s unfounded.

‘We need to improve tackle technique across the game. It doesn’t help seeing the professionals tackling so upright.’

Six Nations Concussion – let’s cut straight to the chase!

Yes, having one concussion can increase the risk of getting another. But why does this happen? And more importantly, what can we do about it?

At Your Brain Health, we believe answering this question is pivotal to improving the future of concussion management. Understanding why the risk increases gives athletes, clinicians, and researchers the tools they need to develop smarter, safer strategies for prevention and recovery. The ultimate goal? Safeguarding the long-term health of the brain, especially for those who put it on the line every time they play.

The evidence tells us some of the story—but not all of it. So, let’s unpack what we know and what might be contributing to this increased risk.

Keep an eye on this year’s Six Nations concussion cases – how big is the collision and are they sustained by players with a history? You can find all the men’s, women’s and U20s fixtures HERE

Risk Factors: The Inside and Outside Story

When it comes to concussion, there are external factors—like the rules of the game, training schedules, or protective gear—and internal factors, which are more about what’s happening inside the brain and body.

Both matter, but internal factors seem to be the bigger piece of the puzzle when it comes to why one concussion can make future ones more likely.

Let’s take a look at the breakdown of some of the key internal factors that might contribute to the Six Nations concussions this season.

Internal Risk Factors

1. Motor Control and Coordination: The Body’s Foundation

Ever feel like your body just isn’t moving the way it should? After a concussion, changes in coordination, reaction time, and spatial awareness can throw athletes off their game. This can lead to awkward movements or reduced neck and head stability, making another hit more likely.

The good news? Targeted rehab focusing on neck strength, stability, and dynamic movement can help restore confidence and reduce risk. Think of it as rewiring the body’s GPS.

2. Cognitive Function: Fast Brains Make Smart Plays

Split-second decisions are the bread and butter of most sports. But concussions can slow processing speed, mess with attention, and cloud memory. The result? Poor decisions on the field, unexpected collisions, and even higher odds of another injury.

Solution? Incorporate sport-specific cognitive training into recovery plans. Faster thinking equals smarter, safer gameplay.

3. Vision: More Than Meets the Eye

Your brain and eyes work as a team. After a concussion, that teamwork can falter, impacting things like depth perception, eye movement control, and spatial awareness. This leaves athletes vulnerable to missing critical visual cues during play.

The emerging field of vision training holds promise for retraining the brain’s eye control systems. It’s early days, but the potential is exciting.

4. Vestibular System: Balance and Beyond

Concussions don’t just make you dizzy—they can also mess with how your brain processes movement, balance, and spatial orientation. Even small disruptions in these areas can make athletes more prone to falls or poorly executed plays.

Vestibular rehab is a key part of recovery, addressing those subtle balance issues that might otherwise fly under the radar.

5. The Threshold Effect: When Resilience Takes a Hit

Ever notice that some athletes, after multiple concussions, seem to get injured more easily—and from less severe impacts? This is what’s known as the “threshold effect,” where the brain’s ability to recover diminishes with each injury.

Several factors play into this:

Metabolic Imbalance: The brain struggles to regulate energy after repeated hits.

Cumulative Damage: Neurons take a beating, making cognitive and neurological issues worse.

Neuroinflammation: Chronic inflammation makes the brain more vulnerable.

Blood-Brain Barrier Breakdown: This critical protective layer weakens, leaving the brain exposed.

Synaptic Dysfunction: Communication between neurons slows, impacting overall brain performance.

The solution lies in understanding these risks early and tailoring recovery programs to build resilience instead of rushing back to play.

6. The Autonomic Nervous System: A Hidden Player

This system controls vital functions like heart rate, blood pressure, and breathing. Concussions can throw it out of whack, which might explain why some athletes struggle with performance or symptoms only during high-pressure gameplay. That’s why mimicking real-game conditions during return-to-play protocols is so crucial.

7. Rest: Finding the Sweet Spot

Believe it or not, too much rest can backfire. While rest is essential in the early days of recovery, prolonged inactivity can lead to deconditioning, loss of confidence, and even higher injury risk.

A balanced recovery plan gradually reintroduces physical and cognitive activity, rebuilding resilience in a way that’s specific to the athlete’s sport.

What’s Next?

Every concussion tells a story—and every recovery is a chance to learn. The more we understand the factors behind increased concussion risk, the better we can protect athletes. At Your Brain Health, we’re committed to being part of the solution.

By contributing to global research and refining clinical practices, we’re helping clinicians and athletes make smarter, evidence-based decisions. Whether it’s through new insights into brain health, targeted rehab, or innovative training approaches, we’re working toward a future where athletes can thrive without sacrificing their long-term brain health.

For those looking to stay ahead of the curve, our courses dive deep into the latest research, offering actionable strategies for managing concussions at all levels of sport.

The bottom line? Knowledge is power. And with the right tools, we can give athletes the support they need to play smarter, recover better, and protect their most valuable asset: their brain.

By Sam Peters, author of Concussed.

It is often purported that the growing band of brothers and sisters championing the need for improved athlete welfare through a more caring culture in professional sport are blind to its number one imperative: winning.

Those of us in rugby who have spent decades calling for greater protections for players as the sport’s risk profile has sky-rocketed have been labelled ‘soft’ or ‘not rugby people’ while the mere mention of ‘player welfare’ is snarled at in certain quarters as evidence of an invidious woke culture creeping into the game.

It is, of course, utter tosh. But that does not stop those whose interests are best served by ignoring the long-term health and wellbeing of those we cheer on from the stands parroting the same old tired lines.

Call for change and be prepared to be shot down by some uneducated but very loud voices. Such is life today, I suppose.

Professional sport is a tough world. Anyone who has been within a cricket ball’s throw of a sports dressing room or training ground knows that. No quarter is ever asked, let alone given.

In the wrong hands, it can be a world where machismo reigns, bullying can fester and being honest about emotions or personal health can be sacrificed on the altar of protecting a contract or your place in the starting line up. Short-termism reigns. The future? It can wait.

Meanwhile, in schools sports, players and parents themselves can be their own worst enemies when pushing for faster return to play times.

Medics can also be pressured into burying their morals by coaches and owners more interested in today than tomorrow while those calling for improved workplace culture are dismissed as romantics who don’t understand the cold, hard reality.

Brain health inevitably suffers as concussions are denied and mental-health problems hidden.

 

And there are few sports where the participants have traditionally been expected to ‘suck it up’, ‘grin and bear it’ or ‘take one on the chin’ more than in professional horseracing where the owner is king and young, vulnerable jockeys compete for rides.

In a sport where concussion is an everyday risk for jockeys and stable staff tasked with moving the horses around their yard and the country, the temptation to hide symptoms of concussion or mental health concerns is ever present.

“There’s times in my career and I think every jockey has had times where they know and you go into the instant mode where you’ve always got to beat the doctor,” explains Max Kendrick, a seasoned jump jockey with almost 500 rides in the past five years.

“Yeah I think you have to break it down and understand the sport if you think about like every single lad in that change well most lads in that change room are self-employed so I mean if you’re stood down, it’s not like you’re playing for Arsenal or Chelsea if you’re injured.

“There is insurance so you’re getting paid for but you know you miss rides you might not get back on the horse the next day. So automatically the mentality is straight away no matter what the injury is not just head – whatever it is – can I get away with riding. Yeah, so in that sense like I think the power has got to be kind of taken out of the jockey’s hands because like I don’t think I can see a world where you’re ever gonna shift that mentality.”

Kendrick is speaking with me on a crisp December day outside the office of the Grade One National Hunt trainer Fergal O’Brien’s yard in the stunning surrounds of his Ravenswell Farm in the heart of the Cotswolds.

We are in racing country, where tradition and hierarchy are prized. But here, at one of the most successful and well-known yards in the land, there is a real sense of change in the air. Progress even.

I’m here at the invitation of Your Brain Health, an Australian owned company on a mission to improve the education of medics and physiotherapists around the world about the importance of better concussion management,  brain health awareness and improved brain function.

Critically, they are seeking to take the guesswork out of return to play protocols following a concussion, where historically decisions have been made either by the subsistence of demonstrable symptoms, or even worse, on the athletes word.

“When we’re treating an athlete with a hamstring injury there are tests we perform so we know precisely when it has returned to full function,’ YBH’s chief operations officer and current Welsh Fire physio David Bartlett tells me.

“Just because the patient is symptom free does not necessarily mean that hamstring has recovered. The same is true of brain injuries but historically we haven’t treated them with the same levels of objectivity and reasoning as other parts of the body.”

Bartlett and his YBH team, include experienced physiotherapists Simon Shepard and Emma Edwards, a chartered physiotherapist and member of the jockey injury management team which looks after professional jockeys on the racecourse, have been invited to the yard by Dr Simon Gillson, a close confident of O’Brien’s founded Concierge Medical and has worked at the yard for nine and a half years.

Gillson describes the concussion risk in racing as ‘an occupational hazard’.

“It would basically be impossible for a jockey to go through their career without sustaining a concussion,” Dr Gillson explains.

“I think the stats on fallers have changed over the years. It used to be one in 10 races you expected to fall off as a race rider. I think that might be down to one in 20. They’ve (authorities) have improved jumps safety and other things which is great and there’s improved equipment but you are still having rotational injuries, you’re falling at speed, horses are rolling on top of you, being kicked in the head, the neck, the chest.

“So your chances of getting through any lengthy career without having a significant head injury and concussion are, I would say, a zero. I mean, absolutely zero.”

Edwards nods in agreement.

“When it comes to testing for concussion so much has been based on some fairly basic orientation questions. As a physiotherapist something I’ve looked at is eye movements, as being something that even when someone’s denying having a concussion, you can pick up on eye movements. It provides an objective measure to tell a jockey, ‘this is what I’ve seen, do you think you’d be safe, seeing the stride to the fence, and making the right decision in that split second?

“More often than not they’ll put their hand up and go, ‘actually, now you’ve said that, I’m not really feeling 100%’.

“They’re not stupid. They know their every move is being scrutinised. They just want to perform well.”

The plan, with O’Brien’s blessing, is for all 37 of his yard staff to undergo a ‘multimodal’ baseline screening of their brains by the Your Brain Health team, with tests ranging from balance, and reaction times to a digital evaluation of the vestibular ocular motor system.

From force plates to measure balance, to a reaction mouse, to the use of a VR headset, the key thing seems to be the use of technology to provide better quality data.

“With multiple functions the brain is a complex organ and what we are doing is not going to cover everything.’ said Shepard. ‘However, put this data alongside other tests and clinical examination, and it may well lead to better understanding, better decision making and a personalised approach to care.”

The tests are carried out in a highly professional but light-hearted manner, which puts the jockeys and yard staff at ease and encourages them to take a full part in the testing. The participants seemed genuinely interested in both the testing and the reasons that sit behind it.

I undergo the tests myself and am pleasantly surprised to read the graph afterwards which shows my eye tracking to be in pretty decent order.

Much more importantly, the presence of the YBH team indicates a shift in mindset which is looking to place the brain health of staff far higher up the priority list than it has been historically in horse racing. It is forward thinking in every sense.

It also has the added benefit of potentially improving the performance of jockeys who after all, need great balance, great eyes and great decision making, if they are to optimise their performance and that of their prized equine assets.

“It’s been shown in cricket there is a correlation between certain helmet strikes and a drop in batting averages,” Bartlett explains.

“By generating more objective data, and adding a ‘gamification’ element, not only do we see better compliance than with historic testing, but we are also being able to identify individuals function, and as such ensure a return to performance, rather than trying to ‘beat’ the system and return before they are ready.”

Improved athlete welfare and improved performance. Now that really is something worth going the extra yard for.

Your Brain Health is proud to partner with CONCUSSED Media to bring the inaugural Ahead of the Game event, to be held at St Paul’s School in London on February 12, 2025.

This highly anticipated evening, created by award-winning author and concussion campaigner Sam Peters, promises a powerful discussion about the future of sports. Featuring a world-class lineup of speakers, the event will unite guests for panel discussions, networking, and debate centered on how to ensure sports remain both safe and accessible.

World-Leading Speaker Lineup

Ahead of the Game will bring together an extraordinary panel of experts, including:

  • Catherine Bishop, former World Champion rower, Olympic silver medalist, and author of The Long Win. Catherine will share her unique insights on the role of sport in fostering resilience and long-term success.
  • Professor Willie Stewart, one of the world’s leading authorities on concussion research, from Queen Elizabeth University Hospital.
  • Professor Mike Loosemore MBE, a pioneer in sports medicine from the English Institute of Sport.
  • Dr. Lisa Ryan, head of the Department of Sport, Exercise, and Nutrition at Atlantic Technological University and an expert in youth sports safety.

The event will be co-hosted by Sam Peters and former Mail on Sunday sports editor Alison Kervin OBE, who together spearheaded the paper’s Cudlipp Prize nominated concussion campaign. The pair will lead the evening’s discussions with their unparalleled expertise in sports journalism and safety advocacy.

Former professional rugby players Nick Greenhalgh and Sam Smith will join Kervin for the second panel of the evening, alongside current Welsh Fire Physiotherapist David Bartlett and professional cricketer Tom Kohler-Cadmore.

What to Expect

The event will feature two engaging panel discussions addressing the challenges and opportunities facing grassroots and school sports today. Topics will include:

  • Innovations to improve player safety and prevent injuries, including concussion.
  • Balancing competition, inclusion, and well-being in school sports programs.
  • The evolving role of administrators, medics, and educators in shaping the future of youth athletics.

Following the panels, attendees will have the chance to ask questions and contribute to the discussion during an extensive Q&A session.

Networking and Exclusive Access

Guests will also enjoy unique opportunities to network with the speakers and fellow attendees, fostering connections and collaboration. As a special highlight, attendees can purchase a signed copy of Sam Peters’ award-winning book, Concussed – Sport’s Uncomfortable Truth, which has been instrumental in raising awareness about concussion in sports.

Join Us to Shape the Future

Whether you’re a parent, coach, athlete, educator, or policymaker, this event is your chance to join a critical conversation about the role of sport in schools and the measures needed to make it safer for everyone who plays.

Event Details:
📍 Venue: St Paul’s School, London
📅 Date: February 12, 2025
🕒 Time: 1815-2200

Tickets are limited, so reserve your spot today to be part of this landmark event. Together, we can help shape a brighter, safer future for school sports.

Book your tickets here!

By Associate Professor James McLoughlin.

 

I have been asked recently my opinion about disappointing recent research with regard to the effectiveness of neurocognitive and VR eye-tracking tests in diagnosing concussion.

I could rant on about research methodology, types of tests, samples sizes and patient selection criteria. However, the answer to this complex question is simple – bad research questions!

Unidimensional Diagnostic Clinical Concussion Tests Are Doomed to Fail.

Picture this: you’re on the sidelines of a soccer game, and your friend—who just got bonked on the head by an overzealous defender—is getting asked a series of questions by a medical professional. The questions go something like, “What is your name?”, “What venue are we at today?” and “Who did we play last week?” Your friend squints at you, thinks for a second, and says, “Adelaide?” The medic gives them a thumbs-up, and suddenly they’re cleared to play again. Hooray?

Yeah, nah. Unidimensional tests, the one-trick ponies of concussion diagnosis, are hilariously doomed to fail. Let’s dive into why these outdated methods are less effective than using a paper umbrella in a rainstorm.

Concussions Are Like Bad Roommates: Complex and Unpredictable

Here’s the thing about concussions: they don’t fit neatly into one little box. They’re like that roommate who leaves dishes in the sink, hogs the bathroom, and sometimes mysteriously vanishes for days. They mess with your mood, memory, motor skills, and just about everything in between. So, expecting a single question like, “Do you know where you are?” to capture the full scope of this chaos is a bit like trying to catch some spilled soup with a strainer

Concussions mess with multiple dimensions of your brain. They affect your ability to think straight, your sense of balance, your visual processing, and—let’s not forget—your mood. If you try to diagnose that whole symphony of confusion with one simple test, you’re just going to miss the tune. And probably most of the instruments too.

The One-Test Wonder: Not So Wonderful

Imagine trying to determine if someone is drunk based solely on how well they can say the word “pineapple.” Sure, it might work for the extreme cases, but most people are going to skate by with a “pineapplish” that sounds about right. Concussion tests that focus on just one aspect—like memory recall or a basic visual task—are like this “Say pineapple” trick. They’re simplistic, easy to beat, and maybe not reflect the types of brian injury. I think sometimes sports are more concerned with convenience than accuracy.

The brain is far too crafty for these kinds of “gotcha” questions. A concussed person might nail the “What’s the score?” question but still struggle to walk in a straight line or remember why they went into the kitchen five minutes ago (and okay, to be fair, the latter could just be normal).

Multidimensional Problems Need Multidimensional Solutions

Here’s a radical idea: if concussions affect your brain in multiple ways, maybe—just maybe—we should assess them in multiple ways. Crazy, right? A strong concussion evaluation should involve balance tests, cognitive tests, eye tracking, and even mood assessments. It’s like forming a crack team of experts to tackle a complicated heist. Each one has their specialty, and together, they might just figure out what’s going on.

Plus, let’s be real: the stakes are high. A misdiagnosed concussion isn’t just a “fail” on the medical professional’s part—it could mean a person goes back out into a contact sport, takes another hit, and ends up with serious long-term damage. Concussions aren’t something we can afford to get wrong.

Let’s Leave Unidimensional Tests in the Past

The unidimensional test is the medical equivalent of trying to solve a Rubik’s cube by just staring at one side. Spoiler: it’s not going to end well. Concussions need a more nuanced approach—something that acknowledges the fact that the brain is not a simple machine but a symphony of electrical chaos, prone to occasional weird, delayed or subtle signs and symptoms. And all our brains are different before a concussion, with our own individual levels of eye movement control, skill, processing speed, headache symptoms, anxiety, sleep and memory. This is why multidimensional concussion baselines can be so useful.

Blood and saliva tests that confirm some brain damage are almost upon us, and symptoms and symptom provocation remain the cornerstone of the most sensitive tests following injury, with a mixed bag of physical, cognitive and psychological signs of injury. Currently symptoms carry the most weight in current concussion diagnostic tests and symptom resolution defines recovery! However multidimensional objective signs guide better decision making and gives everyone greater confidence moving forward.

If we’re serious about keeping athletes, children, and anyone else who takes an unfortunate knock to the head safe, we need to start treating concussion assessment like the complex issue it is. Please, no more research of these one-dimensional tests to confirm diagnosis. To be honest, the brain deserves more respect.

The autonomic nervous system can be complicated, which sort of makes sense as it is often responding to the complex challenges of life!

From heart rate to hormone, blood pressure to breathing, this is the part of the nervous system that unconsciously recognizes, reacts and regulates so many systems in our body. A conductor of our physiological orchestra, where the sympathetic nerves are activated at times of stress and demand, and the parasympathetic branches are key drivers for recovery and restoration.

However, for all of its nuances, there is increasing evidence that highlights the importance of understanding the autonomic system and how it can be disrupted following an mTBI.  Whether it is due to stretching and shearing of axons, inflammation, a change in the levels of neurotransmitters such as adrenaline, noradrenaline and acetylcholine it is not uncommon for patients, who remain symptomatic at 3 weeks, to be experiencing an autonomic component.

So, what to look out for?

If we think of what the autonomic nervous system controls these are the things that can go out of kilter. And whilst the following symptoms may be triggered from other systems, it is worth considering

Cardiovascular: Changes and fluctuations in blood pressure or heart rate

Gastrointestinal: Nause, vomiting, bowel disturbances, loss of appetite

Sleep: Insomnia, excessive sleep, ineffective, non-restorative, sleep

Thermoregulation: Changes in body temperature and sweat response

Eyes: Unequal pupil size (anisocoria), sensitivity to light

How to assess?

Aside from clinical questioning there are a whole host of tests that can be used to help form judgement. Here are three that you may find useful.

Buffalo Concussion Treadmill Test: This test can also be done on a static bike and looks at how heart rate, perceived exertion and symptoms vary with a graduated increase in physical demand. The outcome is a modified heart rate threshold that is relevant to a patient at that moment in time and this allows for greater accuracy in exercise prescription.

NASA Lean Test: A useful way to evaluate excessive changes in heart rate that can be seen with patients who are experiencing postural orthostatic tachycardia syndrome (POTS). If POTS is detected interventions may include medication, nutritional (fluids), compression garments and graded exercise.

Firstbeat Lifestyle Assessment: This brings together physiology and context. A monitor is used to collect changes in heart rate variability and whilst the monitor is worn the patient will keep a diary of actions / feelings. A report is produced that details intra-individual changes in autonomic response and these are mapped, minute by minute, against a timeline. This data is useful in understanding the demands of daily life and lead to lifestyle interventions.

How to Treat?

I have already touched on some of the possible interventions that could be considered on the road to recovery.

Sometimes the symptoms can be obvious, sometimes subtle but consideration of the autonomic system has a role to play in a multisystemic approach to assessment. As for the treatment here are three things to consider:

Medical – Potentially medication can be used to influence blood pressure and heart rate.

Physical – Graded exercise that respects the current heart rate threshold and any symptom provocation is generally accepted as an appropriate intervention.

Lifestyle – There is often a focus on structuring the loads (physical, mental and emotional) that a patient is placed under. Fatigue management is important and so is recovery optimization.

Autonomic deregulation can be seen in concussion, in particular those with persistent symptoms.

Recognition and a proactive approach to the management of autonomic irregularity is something to be considered by all members of the multi-disciplinary team.

The balancing act between the demands of life and the way we cope and recover from these demands is a skill. A bit like a soufflé – undercook it and no progress is made; overcook and collapse occurs – balance is everything!

Novak Djokovic steps onto Centre Court today, aiming for his 8th Wimbledon title and 25th Grand Slam victory, adding another milestone to his illustrious career. However, the past few months have posed significant challenges for the Serbian star.

It’s important to note that the following is anecdotal and depends on accurate reporting, but research suggests that management of head impacts can be just as important for both brain and body.

Could this be a case of a predictable coincidence?

10th May 2024 – Novak Djokovic is accidently struck on the head whilst signing autographs when a metal water bottle falls out of a spectator’s bag.

Djokovic reports “That has really impacted me a lot. After that I got medical care, been through half an hour, an hour of nausea, dizziness and blood,” Djokovic said. “I managed to sleep OK. I had headaches. The next day, or yesterday, was pretty fine, so I thought it’s OK. Maybe it is OK, maybe it’s not.”

 

12th May 2024 – Djokovic is unexpectantly knocked out of the Italian Open 6-2, 6-3 by 29th seed Alejandro Tabilo.

Djokovic reported after the game “Today under high stress, it was quite bad – not in terms of pain, but in terms of this balance. Just no coordination. Completely different player from what it was two nights ago.”

 

24th May 2024 – Djokovic is knocked out of the Geneva Open by world no. 44 Thomas Machac, beating the world no.1 6-4, 0-6, 6-1.

So what are some of the challenges athletes might face post-concussion?

Balance, coordination, concentration, vision.

Research suggests that more than half of sports-related concussions result in vestibular-ocular motor dysfunction. In an arena where even the smallest advantages can be the difference between winning and losing, the restoration of these components is critical.

With improved oculomotor function facilitating fast and accurate motor movements, this approach to training can even enhance sensorimotor abilities and hand-eye coordination. Could this be one of the secret weapons that elite athletes possess?

Post-concussion rehabilitating oculomotor function needs to be considered.

In a fast-paced sport like tennis, where top players rely on exceptional hand-eye coordination, it is likely to performance-critical.

Ever wondered why you never made it to Wimbledon? Maybe it wasn’t just technique.

4th June 2024 – Djokovic withdraws at the Quarter-Final stage of Roland Garos following victory over  Francisco Cerundolo due to a meniscal injury in his knee.

Djokovic reported that he had felt the knee before the tournament, but a slip in the second set exacerbated the issue.

 

6th June 2024 – Djokovic announces on his social media that he has had surgery on his knee having sustained a meniscus tear during his last match.

With evidence showing that following a concussion there is a 2.5 times greater risk of sustaining a musculoskeletal injury, a doubling in the risk of lower limb injuries, and the likelihood of a further concussive event occurring, it becomes clearer that challenges can go far beyond the brain.

Regardless of gender, or even the level competition, the risks are relevant. And this increased risk can persist well beyond the typical period for symptom resolution.

While the exact reasons for the changes in risk aren’t definitively known, one theory suggests that deficits in neuromuscular control following a concussion contribute to this increased risk.

However, one thing that does seem apparent is that many lines of thinking are leading us back towards the importance of multimodal, targeted rehabilitation.

So, what to do?

Waiting for symptom resolution alone is no longer appropriate management.

Whether it be visual training, neuromuscular control, balance or coordination; we need to rehabilitate athletes in the quest to both optimise performance and reduce injury risk.

Unsure where to start?

Your Brain Health Level 2 – Comprehensive Concussion Management will delve into the vast array of multimodal assessment options for immediate an on-going evaluation. A 10 hour online course, it is split into easy to manage modules so you can go at your own pace.

Take a deep dive into concussion management today.

You might not like cricket, but as the song goes, at Your Brain Health we love it!

A game that requires considerable physical characteristics, is also one where the players need to consider balance, visual and cognitive capabilities.

With this in mind, we are delighted to announce a project with Middlesex Cricket that will look to enhance both player welfare and performance development across the Men’s and Women’s game.

The collaboration will incorporate two key components; education and technology.

 

The education will focus on a proactive approach to the management of concussion. Whilst not as big a challenge as seen in a number of sports, the development of scoop shots and the acrobatic feats that are seen in the field mean that there is a possibility. The days of rest and return are now past us, and the word rehabilitate now sits firmly at the centre of the pathway.

 

Pete Waxman, Head of Medical Services said of the partnership:

“Knowledge around concussion management has advanced significantly over the past few years and it is imperative that we are at the forefront of understanding and implementing a proactive approach’.

 

As part of the partnership, the club will also be introducing NeuroFlex; a technology that uses eye and head tracking VR technology to both evaluate and train the performance of the Vestibular Ocular Motor System – crucial for balance, visual acuity and co-ordination. The approach will be part of the club’s multimodal screening programme and, in addition to the enhanced concussion pathway, will be used to develop performance markers across both Middlesex and Sunrisers squads.

 

James Fleming, Head of Athletic Performance feels the technology could support performance gains:

“We have seen new research coming out of the US showing the visual differences in certain baseball players. Our role is to develop the physical skills of our players, and if visual training can be then it is something I am keen on to give us a competitive edge.”

 

David Bartlett of Your Brain Health commented:

“We are committed to developing a global network of clinicians who are dedicated to improving brain health. It is exciting to have formed a partnership with the Sports Science and Medical teams at Lord’s, the Home of Cricket, to be part of that community.”

View Video

Jon Patricios on our latest webinar

“Concussion has evolved into a complex evaluation that mirrors what we do with other sport injuries”

The words of Professor Jon Patricios on the recent Your Brain Health webinar discussing the advancements in concussion care.

But how much of this ‘complex evaluation’ has really dripped down into our day-to-day clinical practise?

As a profession, Physiotherapists pride ourselves on our clinical reasoning skills. Utilising evidenced based practise is fundamental, regardless of setting, to delivering best outcomes for patients.

But when it comes to concussion, are we really abreast with current research?

I certainly wasn’t.

And it seems like I am not the only one. In a recent survey that was completed by 92 people from around the world, it was clear that the lowest levels of confidence were ‘Re-evaluation’ just keeping ‘Rehabilitation’ off the bottom of the list with scores of 52% and 51% respectively,

 

So let’s take a hamstring. There would be subjective questioning, objective testing, and a range of imaging options. Clinical outcome markers would be considered and used as a basis for test and re-test throughout the rehab journey.

For those in the high-performance environment, utilising technologies like force plates and isokinetic testing would form part of our battery of tests. Ensuring a player has covered the appropriate number of metres at varying percentage bands of their max velocity would be a non-negotiable for return to performance.

At a less resourced setting, we wouldn’t feel comfortable unless there was minimal asymmetry on single leg bridging or manual muscle testing. We would conduct a gait analysis, whilst assessing the function of the full posterior chain has become second nature.

 

So how do we mirror that in concussion?

How many MSK clinicians would feel confident to conduct a modified VOMS?

When it comes to assessing the Autonomic system, are we doing a Pittsburgh Sleep Quality Index or Buffalo treadmill test to ensure a return to performance?

We know the effects concussion has on mental health. Are GAD-7 and PHQ-9 undertaken routinely post-injury to support player welfare?

Concussion has evolved into a complex evaluation, but in reality how competent are we in assessing the multiple domains that lead to better clinical reasoning?

 

A physiotherapy colleague recently said to me: “it feels like the world has to catch up with how to assess and manage a concussion. I am a convert”.

And it feels like the job now is to support and educate clinicians to feel more confident and competent in proactively managing a concussion.