What evidence supports primary prevention strategies for sport-related concussion? An umbrella review
Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia
Department of Movement Sciences and Sports Training, School of Sport Science, The University of Jordan, Amman, Jordan
Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
SIESTA Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
Department of Humanities, COMSATS University Islamabad, Islamabad Campus, Park Road, Islamabad, Pakistan
Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax 3000, Tunisia
Nutrition and Food Technology Department, School of Agriculture, the University of Jordan, Amman, Jordan
Section Sports Medicine, University of Pretoria, South Africa
Department of Exercise and Sport Sciences, University of the Free State, South Africa
High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
Research Unit Physical Activity, Sport and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
Naufar Center, Doha, Qatar
Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Tunis, Tunisia
Department of Psychiatry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
Government Hospitals, Manama, Bahrain
Biol Sport. 2026;43:1589–1614
This umbrella review aimed to systematically evaluate and synthesize evidence from published systematic reviews on the effectiveness of primary prevention strategies for sport-related concussion (SRC) in athletes, and to identify areas of uncertainty relevant to policy and practice. A comprehensive search of the Cochrane Database of Systematic Reviews, Epistemonikos, ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science was conducted from 2001 to April 2025, with an updated search in November 2025. Peer reviewed systematic reviews, with or without meta-analyses, assessing primary prevention strategies to reduce SRC incidence in competitive athletes of any age or sex were eligible. Interventions included rule or policy changes, protective equipment, educational programs and training-based strategies. Twenty-five systematic reviews were included, eight of which contained meta-analyses; all were rated as critically low quality using the AMSTAR-2 tool. Rule and policy changes, particularly the disallowance of body checking in youth ice hockey, demonstrated the most consistent evidence for reducing SRC incidence. Meta-analyses evaluating mouthguards and headgear showed substantial overlap of primary studies and inconsistent effects. Educational interventions and training-based programs, including structured warm-up programs such as FIFA 11+ Kids, produced inconclusive findings. Evidence specific to female athletes was limited and insufficient to support any particular prevention strategy. Overall, rule and policy changes that reduce exposure to high-risk contact currently have the strongest supporting evidence for SRC prevention, whereas evidence for equipment, education and training remains mixed. Given the critically low methodological quality of existing reviews, higher-quality evidence syntheses and robust primary studies are urgently needed.
Keywords
Contact sport, Head protective devices, Muscle strength, Risk reduction, Traumatic brain injury, Overview of systematic reviews
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