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!

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.

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

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

Functional Gaze Stability = Everyday Brain Performance 

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

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

• Identify direction and speed specific subtle deficits 

• Track rehab progress 

• Assessing cervical-vestibular coordination and compensatory strategies 

• Tailor VOR retraining 

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

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

Recalibrating Our Focus 

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

• Smooth pursuit and VOR cancellation 

• DVA at varied speeds 

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

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

• Functional movement with gaze tasks 

Final Thought 

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

Step 1: Confirming the Concussion

Think of this as saying, “Yep, you’ve had a knock.” It’s an important first step — but it’s only the beginning.

Imagine a car that’s been in a minor crash. The first thing you do is check for visible damage. Confirming a concussion is similar. The brain — along with the neck and brainstem — has taken a hit, and there’s been a temporary change in function.

In the immediate aftermath, the top priority is determining whether emergency medical care is needed. We look for red flags that require an immediate medical response. Following this we monitor physical, cognitive, and emotional symptoms over the next few days. This process should be overseen by a responsible adult — not your mates while out at the pub.

To help guide decision making in this acute phase, the Concussion Recognition Tool 6 (CRT6) is the go-to resource. It’s simple, safe, and designed for use by coaches, trainers, parents, and anyone involved in player care. It helps recognise red flags and core symptoms and provides helpful advice for what to do next.

Yes, emerging technologies like blood biomarkers, saliva tests, and wearable sensors are exciting — but they need to add value. That means improving decisions and guiding actions. These tools must be co-designed with those on the front lines: players, physios, coaches, and carers. Plenty of apps and other portable measures of specific brain functions are now hitting the market. However, if it doesn’t support and enhance decision-making, it’s not helping.

Why It Matters

When we know which systems are affected, we can deliver targeted support — whether it’s neck physiotherapy, balance training, vision rehab, heart rate-guided aerobic exercise, or structured rest strategies.

We’re not just managing the concussion — we’re tuning the whole system. That includes identifying pre-existing conditions (e.g. migraine, anxiety, ADHD) that might influence how we approach rehabilitation and recovery.

This leads to:

• Faster, safer return to activity
• Reduced risk of prolonged symptoms
• Better outcomes across the board

So, the next time you hear about a “new tool” to diagnose concussion, ask: Does it help improve care? Does it inform recovery planning?

Diagnosis is step one. But multimodal brain health profiling continues to evolve — and it’s here to stay!

We were delighted that Simon Shepard was joined by Associate Professor James McLoughlin alongside Liz Jemson-Ledger as the latest guests in the final of our 2024 concussion webinar series.

Watch back as we discussed:

* How patients with persistent concussion symptoms often present

* What interventions can have a positive impact on outcomes, including real life case studies

* The importance of early intervention in preventing persistent symptoms

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

You’re at the top of your game, both mentally and physically, tackling life head-on. Then, bam! You suffer a concussion, and suddenly, everything feels off.

Headaches, dizziness, memory loss – the usual suspects.

But what about those silent saboteurs lurking at the bottom of the SCAT score sheet?

Anxiety, irritability, sadness – the uninvited guests crashing the post-concussion party.

The link between concussions and mental health struggles isn’t a mere coincidence; it’s a well-established fact. Studies reveal that over 65% of concussion survivors battle with depression and anxiety post-injury. And if you’re among the unlucky 20-30% stuck with lingering symptoms for more than two weeks, those odds skyrocket to a staggering 76%.

Now, let’s put things into perspective. The World Health Organization defines mental health as ‘a state of mental well-being, that enables individuals to cope with difficulties in life, understanding their abilities, and working towards the betterment of themselves as well as for the community.’  But what happens when a concussion disrupts this delicate balance?

In adolescents, a history of concussion in the past year increases the risk of suicidal thoughts and actions. Considering that suicide ranks as the second leading cause of death among U.S. teens, and an estimated mind-boggling 33 million children worldwide suffer concussions yearly, the gravity of mental health post-concussion becomes painfully clear.

Mental health matters. And post-concussion, it really matters.

So, what’s going on inside our heads after a knock to the noggin? Let’s explore four potential culprits:

First up, the physical aftermath of a concussion have been proposed to affect the neural mechanisms of mood regulation circuits. When your brain’s emotional control centre takes a hit, it’s no wonder your mental health takes a nosedive.

Secondly, concussions aren’t just about physical pain; they’re a psychological rollercoaster. Factors like social isolation, fear of re-injury, and decreased participation, compounded by concerns over selection or contracts, as well as the dread of letting teammates down, can create a downward spiral into mental health challenges. This combination can morph into a vortex of despair, leading to significant mental health consequences.

Thirdly, your family and personal mental health history might increase your susceptibility to poor mental health post-concussion. It’s like having a genetic predisposition to a double whammy of emotional turmoil.

And let’s not forget the sleep-depression connection. With persistent concussions throwing your sleep regulation out of whack, it’s no surprise that executive function, working memory and processing speed take a hit, dragging your mental health down with them.

Now, here’s the kicker: despite the glaring mental health implications, a whopping 50% of concussions reportedly go undiagnosed. With no definitive test in sight, concussion remains a clinical diagnosis. So, when a patient waltzes into your office with nothing but mental health symptoms, are you equipped to connect the dots?

Tools like GAD-7, PHQ-9, and the Pittsburgh Sleep Quality Index might just hold the key to unlocking the silent suffering of concussion survivors.

Because mental health matters, today and every day.

We were delighted that Millie Bishop was joined by Nicola Hunt alongside Head of Medical and Research at Neuroflex, Dr David Stevens as the latest guests in our 2024 concussion webinar series.

Watch back as we discussed:

* The development and research behind Vestibular-Ocular motor technology

* How the technology works

* How NeuroFlex can be used in practise to improve clinical care and patient outcomes.

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

We were delighted that James McLoughlin was joined by Co-Chair of the Concussion in Sport Group, Professor Jon Patricios as the latest guest in our 2024 concussion webinar series.

Watch this on demand video as we discussed:

* Why there has been advancement in Vestibular Oculor Motor Assessments in concussion care

* Why the CISG decided to vote on the VOMS being included in SCAT-6

* The importance of gaining objective baseline screening data on the Vestibular-Oculor motor system.

* What the future of concussion care might look like.

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

We were delighted that Professor James McLoughlin was joined by Nicola Hunt as the first guest in our 2024 concussion webinar series.

Watch this on demand video as we discussed:

* How a multimodal approach to baseline screening can facilitate better care.

* How multisystemic assessment of concussion results in better practice.

* How early targeted rehabilitation is likely to lead to better outcomes.

We explored all of this, and much more besides, in what was an interesting and lively update on the current research in concussion care, followed by a live Q&A.

And don’t forget that that James McLoughlin will be joined by Co-Chair of the Concussion in Sport Group, Professor Jon Patricios as the next guest in our 2024 concussion webinar series on March 27th at 8pm (GMT) to discuss:

Advancements in Vestibular-Oculor Assessments in Concussion Management

Register here now!

Dr James McLoughlin, Co-Director of Your Brain Health answers our 10 most common questions about concussion.

How common is concussion?

It’s more common than most people might think. In Australia we estimate that around 180,000 concussions occur each year. In the US that number could be well over 2 million!

Why do you think concussion is now a such a big issue?

It’s interesting to see the change in media and community messaging around concussion. It has improved awareness around brain injury and brain health which is great. But there is also plenty of misinformation out there too, which means we need to work extra hard around community education.

Research around the effects of concussion and brain injury has helped us understand the negative impact it can have on so many people’s lives. The most alarming is the effects of repeated head impacts on increasing risk of degenerative neurological conditions like Chronic Traumatic Encephalography (CTE). But the effects of concussion have also been termed the ‘silent epidemic’ where people live with persistent signs and symptoms of traumatic brain injury, where their quality of life is impacted by mental health, cognitive effects, and physical impairments, often without appropriate clinical care and support. These people still fall through the cracks unfortunately, but I see their stories are starting to come out through the media over the past few years.