# Development of a Biomechanically-Based Post-Concussion Return to Play Protocol for Gymnasts

> **NIH NIH R03** · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2022 · $73,675

## Abstract

Project Summary/Abstract
Gymnastics is a leading cause of head injury among sports- and recreation-related activities and is the second
most common cause of emergency room visits for non-fatal traumatic brain injury among non-contact sports.
Despite this, return to play protocols in gymnastics have scarcely been researched. As a sport, gymnastics is
composed of six disciplines: men’s artistic, women’s artistic, rhythmic, acrobatic, trampoline and tumbling, and
aerobic gymnastics that utilize various skills showcasing balance, power, and artistry. Women’s artistic
gymnastics is the most popular discipline of gymnastics and has been recommended for developing strength
and coordination in female youth athletes. However, the physical demands of the sport often lead to a variety of
injuries, including concussion, and females disproportionately represent a higher percentage of gymnastics-
related injuries treated in hospitals. Athletes recovering from concussion are reintegrated back into sport using
a guided return to play protocol. Existing post-concussion return to play protocols developed for contact sports,
such as football, may not be relevant to acrobatic sports and are not grounded in biomechanical evidence
informing the unique exposure profile of gymnasts. With ~ 5 million Americans participating in gymnastics-related
activities, there is a critical need to understand the complex loading environment of the head in gymnastics to
inform return to play protocols in the sport. The objective of this study is to characterize kinematics of the head
across women’s artistic gymnastics skills for the development of a biomechanically-informed post-concussion
return to play protocol in the sport. In Aim 1, 11 beginner-level (age 11-13) and 11 advanced-level (age 13-15)
gymnasts will be fitted with mouthpiece-based head motion sensors. Biomechanical data will be collected and
quantified during all practices to determine the frequency and magnitude of head accelerations experienced
during normal participation of the sport. A sub-sample of athletes will complete a series of skills with two
progressive safety modifications, to evaluate the effect of safety modifications on reducing head acceleration. In
Aim 2, mixed methods will be used to integrate return to play guidelines identified from literature and data from
Aim 1. Stakeholders will be engaged to develop and refine a biomechanically-informed post-concussion return
to play protocol in women’s artistic gymnastics. Outcomes will include characteristics of the protocol and
dissemination materials for national organizations to consider for adoption. This R03 small pilot study seeks to
change the paradigm in which concussions are managed in gymnastics and will result in methods and key data
to support a large-scale study evaluating the effectiveness of the return to play protocol on reducing symptomatic
episodes and recovery time following concussion while assessing optimal implementation strategies in this
...

## Key facts

- **NIH application ID:** 10456187
- **Project number:** 5R03HD104894-02
- **Recipient organization:** WAKE FOREST UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Jillian Elizabeth Urban
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $73,675
- **Award type:** 5
- **Project period:** 2021-08-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10456187

## Citation

> US National Institutes of Health, RePORTER application 10456187, Development of a Biomechanically-Based Post-Concussion Return to Play Protocol for Gymnasts (5R03HD104894-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10456187. Licensed CC0.

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