An 8-Week Neuromuscular Training Program After Concussion Reduces 1-Year Subsequent Injury Risk: A Randomized Clinical Trial

Howell DR, Seehusen CN, Carry PM, Walker GA, Reinking SE, Wilson JC. The American Journal of Sports Medicine. January 2022. doi:10.1177/03635465211069372

Take-Home Message

An 8-week neuromuscular training program delivered only twice per week can dramatically reduce the likelihood of injury in athletes who sustained a concussion.


An athlete who recently sustained a concussion has a 2-4 times higher risk of injury than someone without a concussion. Their elevated injury risk may be because the brain’s movement control fails to regulate movement properly. Thus the authors hypothesized that a neuromuscular training program could reduce the likelihood of injury after a person sustained a concussion.

Study Goals

The authors performed a randomized clinical trial among youth athletes with a concussion to examine if a neuromuscular training program compared to standard care decreased sports-related time-loss injuries.


The authors enrolled patients aged 12-18 years old who were less than 14 days from their concussive injury and were symptomatic from their concussion at enrollment. The athletes were randomized into the training program or standard of care group. The training program lasted for 8-weeks and consisted of two 20-minute supervised training sessions/week. The training program focused on balance, strength, technique, plyometric, and dual-task exercises adapted from previously published programs. Each group reported monthly injuries and athletic participation for one year. The primary outcome was a self-reported sports-related time-loss injury during the year after return-to-play clearance.


One year after returning to play, 75% of the standard of care group participants sustained a time-loss injury compared to only 36% in the training group. The authors found the standard of care group had a 3.5 times higher injury likelihood than the training group.


These findings suggest that after an athlete returns to play following a concussion, a neuromuscular training program may help prevent injury. The most significant disparity in injury rate between the two groups is in the first two months after a concussion, where it appears almost 50% of the standard of care sample sustained an injury. However, because of the small sample size (26 participants), it is unclear if these results will apply to all patients who sustain a concussion. Furthermore, if teams implemented injury prevention warm-up programs similar to this intervention, it is unclear if we would still need this type of one-on-one intervention. Unfortunately, the implementation of team-based injury prevention warm-up programs remains poor.  

Clinical Implications

Clinicians should consider adding a neuromuscular training program for two months after return to play to prevent injury in patients with a recent concussion.

Questions for Discussion

What other prevention strategies can providers use to prevent injury after a concussion? How could providers incorporate primary prevention efforts into daily practices to not need specific rehabilitation plans for patients who have returned from a concussive injury?

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Written by Mitchell Barnhart
Reviewed by Jeffrey Driban

Evidence-Based Assessment of Concussion Course - 5 EBP CEUs