September 18, 2025 / by Brian Hortz
With football season on the horizon, it’s essential for athletic trainers and sports medicine clinicians to refresh emergency action plans and align care practices with the latest evidence. Two recent publications represent crucial updates in concussion care: the 6th International Conference on Concussion in Sport (Amsterdam, October 2022) and the NATA Bridge Statement on sport‑related concussion management. The following is a concise summary of their key insights, along with guidance for applying them in high‑contact sports.
Major Updates in Concussion Understanding & Management
1. A more nuanced definition
The Amsterdam consensus expands the view of concussion as a dynamic injury with heterogeneous presentations. It acknowledges that symptoms may evolve over minutes to hours and that standard structural imaging (CT, T1/T2 MRI) will typically be normal, even though abnormalities might appear in adva
nced functional or metabolic studies.
In short: concussion is not a single snapshot but a process, and its diagnosis rests largely on clinical observation rather than imaging.
2. Emphasis on individualized care
Rather than applying blanket protocols, the new guidance encourages tailoring concussion plans to each athlete’s context—factoring in age, sex, medical history, concussion mechanism, and symptom trajectory. This shift supports more precise, patient-centered decision making.
3. Flexible Return‑to‑Play (RTP) progression
The updated consensus reinforces a graduated RTP framework, urging clinicians to adapt step progression based on recovery rather than rigid timeframes. The approach is less about “wait X days” and more about “advance when tolerated,” with frequent symptom monitoring and clinician oversight.
4. Early, controlled reintroduction of physical and cognitive tasks
Instead of prolonged strict rest, the documents now support initiating light aerobic and cognitive activity after a brief rest period (typically 1–2 days). Emerging evidence indicates that this early, monitored stimulation may actually encourage recovery and reduce symptom burden.
5. Multidisciplinary, integrative care models
Both Amsterdam and the Bridge Statement highlight that concussion management benefits from a team approach—integrating physicians, athletic trainers, neuropsychologists, physical/vestibular therapists, and other specialists. Concussions often impact multiple systems, so siloed care is no longer adequate.
6. Enhanced diagnostics and prognostic tools
New and updated clinical tools include:
- CRT6 (Concussion Recognition Tool-6)
- SCAT6 (Sport Concussion Assessment Tool-6)
- SCOAT6 (Sport Concussion Office Assessment Tool-6)
These tools are designed to support (not replace) clinical judgment—particularly for recovery monitoring, rehabilitation planning, and risk stratification.
The Bridge Statement also updates recommended domains such as prognostic factors, mental health screening, and return to academics, aligning with emerging research.
Suggested Best Practices for Football Programs
- Ongoing education and symptom awareness: Encourage open reporting. Equip athletes, coaches, and staff with symptom checklists and eliminate stigma around reporting.
- Policy alignment and enforcement: Ensure concussion protocols are up-to-date and enforced consistently. Give on-site clinicians autonomy in decision making.
- Baseline and serial testing: Use preseason baselines (neurocognitive, balance, symptoms) and repeat post-injury to guide recovery.
- On-field removal and evaluation: At first suspicion, remove the athlete and use tools like SCAT6 or CRT6. Always err on the side of caution.
- Initiate gentle rehab early: After 24–48 hours, start light aerobic activity and graded cognitive tasks—within symptom tolerance.
- Use protective gear wisely: No equipment eliminates concussion risk, but quality helmets, mouthguards, and rule changes can reduce impact severity.
- Symptom tracking and psychological support: Watch for mood changes, sleep issues, or emotional symptoms. Mental health support may be needed during recovery.
- Structured rehabilitation and targeted treatment: Implement multi-domain rehab (physical, cognitive, vestibular). For trained clinicians, dry needling may support symptom-specific recovery such as cervicogenic headache or neck pain.
Dry Needling in Post-Concussion Care
If you are credentialed to perform dry needling, it may serve as a complementary tool—especially for headache, neck pain, and dysfunction secondary to concussion mechanisms.
Rationale includes:
- Local effects on trigger points in suboccipital, cervical paraspinal, or craniofacial muscles
- Segmental and systemic effects influencing autonomic balance and nociceptive processing
- Management of secondary conditions like TMJ pain, occipital neuralgia, or cervicogenic headache
Clinical prudence is essential: Dry needling should be adjunctive, symptom-monitored, and part of a broader, multimodal treatment plan.
If you’re seeking formal training, consider our Foundations in Dry Needling or Comprehensive Craniofacial & Upper Quarter Dysfunction courses.
Final Thoughts
The 6th International Consensus and the NATA Bridge Statement reflect a major evolution in concussion care—moving from rigid, one-size-fits-all rules toward flexible, individualized, evidence-based protocols.
For those working with football and high-contact athletes, staying current isn’t optional. It’s our responsibility to ensure care evolves with the science—to protect athlete health, support safe recovery, and advance our profession.
