Concussions remain one of the most complex and challenging injuries for athletic trainers to manage, despite significant advances in concussion science and care over the past decade. The National Athletic Trainers' Association (NATA) recently published a "bridge statement" that updates key recommendations from their 2014 position statement on concussion management. These new guidelines synthesize the latest research and best clinical evidence to provide critical guidance for athletic trainers on the frontlines of concussion care.

A Biopsychosocial Approach 

The new recommendations emphasize the need to adopt a biopsychosocial model when managing concussions. This holistic approach considers not just the biological aspects of the injury, but also psychological factors and social determinants of health that can significantly impact patient outcomes and quality of care.Athletic trainers are advised to be aware of how a patient's personal history, family circumstances, cultural background, and access to resources may influence their concussion recovery. Building strong interprofessional care teams that include experts in mental health, academic support, and targeted rehabilitation can help address the multi-faceted challenges concussion patients often face.

Earlier Return to Activity 

One of the most notable changes in the updated guidelines is the shift away from recommending strict cognitive and physical rest after a concussion. Converging evidence from several randomized controlled trials now indicates that after an initial 24-48 hour period of relative rest, symptom-limited activity is not only safe, but beneficial.Studies show that steadily increasing subsymptom threshold aerobic exercise (in other words, as much exercise as you can without provoking symptoms) in the first 10 days after injury can speed recovery in adolescents and reduce the incidence of prolonged symptoms. Mild symptom exacerbation during controlled physical activity does not appear to be detrimental. The key is to avoid repeatedly pushing patients into symptom-worsening territory.This means the latest return-to-sport protocols now integrate clinician-supervised exercise in the very early stages. Aerobic conditioning that doesn't trigger more than a mild, temporary increase in symptoms is progressively increased in duration and intensity. This active rehabilitation approach continues until the athlete can resume normal training activities without restrictions.

Targeted Treatment Strategies 

For patients struggling with persistent symptoms beyond the first 1-2 weeks, the updated recommendations also highlight the importance of deficit-targeted treatments. Depending on the specific problems identified during assessment, this could include:

• Vestibular and cervical rehabilitation for dizziness, imbalance, or neck pain
• Vision therapy for oculomotor issues
• Cognitive behavioral therapy for psychological distress
• Graduated academic adjustments to manage cognitive fatigue

Several studies have shown that such focused, active interventions yield better outcomes than a prolonged "rest is best" approach for patients with lingering impairments.

The Road Ahead 

While many questions remain, this bridge document provides an important step forward in aligning best practices for concussion management with the current state of the evidence. Athletic trainers play a vital role in translating these evolving guidelines into tangible improvements in patient care.Moving forward, concussion research must continue striving to identify clinical profiles that can predict recovery trajectories, evaluate novel diagnostic tools and biomarkers, and further optimize evidence-based treatment strategies. Athletic trainers can support these efforts by participating in research and meticulously documenting patient outcomes.Most importantly, athletic trainers must compassionately guide concussion patients through an individualized path to recovery ― modifying management strategies as needed based on the latest science, the patient's unique biopsychosocial context, and their own expert clinical judgment. Although concussions remain challenging injuries, this new blueprint for whole-person, active care marks a significant leap in the right direction.