Head Repositioning Accuracy After Concussion: What New Research Suggests

Return to sport after concussion is rarely decided by one measure. Symptoms, exertional tolerance, balance, vestibular and oculomotor function, cognition and sport-specific performance all matter. New research suggests that head repositioning accuracy may deserve a clearer place within that broader assessment.

A 2026 prospective cohort study by Smulligan and colleagues examined vestibular, oculomotor and head repositioning accuracy in 45 adolescent athletes following sport-related concussion. The researchers then followed the athletes to examine subsequent injury risk.

What did the study find?

Greater error during head repositioning was associated with a higher hazard of subsequent injury. The reported hazard ratio was 1.46, meaning that higher error was statistically associated with greater injury risk within this sample.

This is clinically interesting because an athlete can feel recovered while still showing a measurable deficit in the way the head is repositioned after movement. Cervical proprioception contributes information about head position relative to the trunk. That information is integrated with visual and vestibular input during balance, orientation and rapid sporting movement.

What the finding does not prove

This was a small observational study. It shows an association, not causation. It does not demonstrate that head repositioning error caused later injury, nor that one test can determine whether an athlete is safe to return to sport. The sample consisted of adolescents, so the result should not automatically be generalised to every age group or sporting population.

The hazard ratio also needs context. It should not be converted into a simple statement that a given error produces a fixed percentage increase in risk without understanding the study's model and measurement scale.

Why this matters in practice

The practical message is not to add another pass or fail hurdle. It is to consider whether cervical sensorimotor function has been examined when an athlete reports neck symptoms, dizziness, visual disturbance, impaired balance or difficulty during head movement.

A useful assessment may include:

• symptom behaviour during active head movement;
• cervical range of motion and movement quality;
• head repositioning accuracy across repeated trials;
• gaze stability and oculomotor screening;
• balance under progressively more demanding sensory conditions; and
• dual-task and sport-specific movement once clinically appropriate.

Repeated measurement may be more informative than a single score. Direction-specific error, variability between attempts and response to fatigue can all help the clinician build a more complete picture.

Where HeadX Duo may fit

HeadX Duo can support objective measurement of cervical range of motion and head repositioning performance. Its value is not in predicting injury or replacing clinical judgement. It is in making a component of cervical sensorimotor assessment easier to quantify, repeat and communicate.

For rehabilitation, the same measurement framework can help clinicians set a baseline, select direction-specific exercises and review change over time. Clinicians looking for structured task examples can review the HeadX exercise hub and adapt them to the individual assessment and symptom response. The study supports further investigation of head repositioning accuracy as one element of a multidomain concussion pathway, rather than as a standalone return-to-sport test.

Clinical takeaway

Residual cervical sensorimotor deficits may remain relevant after the most obvious concussion symptoms have improved. This study is an early signal that head repositioning accuracy deserves attention, but larger studies are needed before it can be used for individual injury-risk prediction.

Source: Smulligan et al. Vestibular, Oculomotor, and Head Repositioning Accuracy Deficits after Sport-Related Concussion: Implications for Subsequent Injury Risk. Clinical Journal of Sport Medicine, 2026.

This article is for professional education and does not replace individual clinical assessment.