Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis.

Concussions in sport are common enough that researchers have spent years testing whether equipment, rule changes, or training approaches might reduce them, but the evidence has been scattered across many small and differently designed studies. This systematic review and meta-analysis pulled together 192 studies covering protective gear, policy changes, training strategies, management approaches, and modifiable risk factors like neck strength or tackling technique. The pooled results pointed in a protective direction for a few specific strategies: mouthguards in collision sports, bans on bodychecking in youth ice hockey, and limits on contact during American football practices were each associated with meaningfully lower concussion rates, with no sign of bodychecking bans causing other injuries to rise. Neuromuscular training warm-ups in rugby also showed promising but less certain reductions.

The authors note that many potentially important risk factors, such as neck strength and tackle technique, still need more research before they can meaningfully inform prevention, and the included studies varied widely in design and sport context.

If you or someone you care about plays a contact or collision sport, you may wonder whether anything actually lowers concussion risk. This large review gathered findings from 192 studies looking at things like mouthguards, rule changes, training programs, and physical traits that might raise or lower concussion risk. The review found that mouthguards were linked to fewer concussions in collision sports, and that youth ice hockey leagues banning bodychecking saw notably fewer concussions than leagues that allowed it, without evidence of other injuries increasing instead.

In American football, limiting contact during practices (rather than games) was tied to fewer practice-related concussions. A specific warm-up program with balance and strength exercises showed encouraging but less certain results in rugby. It's worth knowing that these are associations drawn from many different studies, not one large controlled experiment, so they show patterns rather than proof that any single change will prevent concussion for an individual athlete.

Research on things like neck strength is still too limited to draw firm conclusions.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review speaks to a question physiotherapists working in sport often face: which concussion prevention strategies actually have supporting evidence, versus those that are plausible but unproven. Synthesizing 192 studies across protective equipment, policy and rule changes, training strategies, and modifiable risk factors, the authors found the clearest supportive evidence for three approaches: mouthguards in collision sports (pooled incidence rate ratio 0.74, 95% CI 0.64 to 0.89), policies disallowing bodychecking in youth ice hockey (incidence rate ratio 0.42, 95% CI 0.33 to 0.53, with no unintended rise in other injuries reported), and limiting contact in American football practices (incidence rate ratio 0.36, 95% CI 0.16 to 0.80 for practice-related concussions). A neuromuscular training warm-up in rugby showed up to 60% lower concussion rates, though this evidence is described as preliminary and rests on fewer studies than the other findings.

Sixty-four studies examined modifiable risk factors such as neck strength and tackle technique, but the authors conclude more research is needed before these can meaningfully inform prevention strategies. As a review of observational and intervention studies across many different sports, settings, and study designs, this work cannot establish causation with the certainty of a single controlled trial, and heterogeneity across studies limits how confidently findings generalize to any one athlete population or level of play.