Brain trauma accumulates, and can become CTE Diagnosed concussions are not the whole story. Accumulated hits carry the neurodegenerative risk. That is why I need the whole story they will only tell when athletes learn to trust me. Head impact history includes playing style and the hidden injuries they never reported. @OrthoColumbia @drcharliepopkin @ChrisNowinski1

Sleep is an important part of the recovery process after a concussion. Getting consistent, quality sleep may help support the brain as it recovers and can be an important part of an athlete’s overall recovery plan. In this video, Dr. Thomas S. Bottiglieri, DO, explains the critical role of sleep during concussion recovery and what athletes should understand before returning to activity. Watch the video to learn more about concussion recovery and the importance of healthy sleep habits. #ConcussionRecovery #ConcussionAwareness #SportsMedicine #AthleteHealth #BrainHealth #SleepHealth #ReturnToSport youtube.com/shorts/h6OUJWOOU…

Athletes do not want to say the C-word. The only way to protect your brain is to not keep getting hit after it is already traumatized. Get evaluated.

If you have neurologic symptoms while you are playing a contact or collision sport, you have a concussion. Make it that simple. Get evaluated.

Rest is not the treatment. Cocoon, quiet room, no stimulation is not it. After the first day or two, start exercise. I do not clear on rest.

Cognitive load matters during concussion recovery. Thinking, studying, working, screen time, multitasking, and emotional stress can all add to the demands placed on the brain. Dr. Thomas Bottiglieri, DO, explains why monitoring symptoms and taking regular breaks can be helpful when returning to school, work, and daily activities. He also discusses why managing mental workload can be relevant to recovery from other injuries. Watch the video to learn more about cognitive load and practical ways to manage mental stress during recovery. #Concussion #ConcussionRecovery #SportsMedicine #BrainHealth #ConcussionAwareness #MentalFatigue #InjuryRecovery youtube.com/shorts/19UQbBplG…

We perform orthostatic VS in our complete concussion evaluation. But it doesn’t change much in our approach clinically. We have known ANS dysfunction exists for a long time (I started studying HRV in 2008 in fellowship) But this reinforces the idea that we need to consider ANS dysfunction in our approach to care and find more reliable diagnostics of ANS function. Post exertion testing fits that paradigm but is equally lacking in precision. 1) Orthostatic Vital Signs After Sport-Related Concussion: A Cohort Study. Am J Sports Med. 2024;52(11):2902-2910. PMID:39190299. pubmed.ncbi.nlm.nih.gov/3919… 2) Evidence Rating: 🚦 AJSM, PubMed-indexed Level 3 cohort/cross-sectional evidence; clinically actionable but not a standalone diagnostic or RTP rule. 3) What’s New? - Acute SRC athletes had larger delayed standing HR rise than controls: 18.4 vs 13.2 bpm. - Positive orthostatic HR response was more common after SRC: 18% vs 7%, OR 2.79. - Signal was strongest in child and adolescent athletes. 4) What’s Actually True? Autonomic/exertional-readiness pattern: concussion recovery is not fully captured at rest or by symptoms alone. Orthostatic vitals are a cheap way to expose an autonomic domain, but the paper does not prove they diagnose concussion or predict safe RTP by themselves. 5) Clinical Takeaway: - Add 2-minute orthostatic HR/BP response to acute SRC assessment, especially in youth athletes. - Treat abnormal orthostatic HR as a flag for autonomic/exertional intolerance, not as a one-test clearance decision. - Pair findings with exertional testing, vestibular/ocular/cervical measures, symptoms, and sport demands. 6) Why This Matters: It turns the HRV/autonomic thread into something clinics can measure quickly without specialized equipment. 7) What you can do today: Measure, but more importantly, treat ANS dysfunction as well with stepwise exertion, HRV Biofeedback, and box breathing during rest intervals.

⚽ Does Heading a Soccer Ball Cause Concussions? Does heading a soccer ball increase the risk of concussion? In this video, Thomas S. Bottiglieri, DO explains what athletes, parents, and coaches should know about soccer heading, head impacts, concussion risks, and playing safely. Understanding the risks and recognizing concussion symptoms can help athletes make informed decisions and protect their brain health. 🎥 Watch the video to learn more. #Soccer #SoccerHeading #Concussion #SportsConcussion #BrainHealth #HeadInjury #SoccerSafety #AthleteSafety #SportsMedicine #ThomasBottiglieri #DrBottiglieri youtube.com/shorts/GcXxuw_Qk…

🏈 Should Kids Play Tackle Football? Is tackle football safe for young athletes? In this video, Thomas S. Bottiglieri, DO discusses the real risks of youth tackle football, including head injuries, concussions, and other common football injuries—and what parents should know before their child takes the field. The goal isn't to ignore the risks, but to understand them and take steps to make youth football safer through proper technique, rule enforcement, appropriate equipment, and responsible coaching. 🎥 Watch the video to learn more and make an informed decision about youth football. #YouthFootball #TackleFootball #FootballSafety #Concussion #SportsConcussion #HeadInjury #YouthSports #KidsSports #FootballInjuries #InjuryPrevention #YoungAthletes #ThomasBottiglieri youtube.com/shorts/YTfkuG6Vj…

n this video, Dr. Thomas S. Bottiglieri, DO, Sports Medicine and Regenerative Medicine Specialist, explains concussion in simple terms and why athletes need to recognize the warning signs early. ⚠️ Confusion, dizziness, headache, balance problems, or other neurologic symptoms after a contact or collision can be signs of a concussion. Recognize it. Report it. Get evaluated. Protect your brain and take symptoms seriously. 🧠🏃‍♂️ #Concussion #ConcussionAwareness #BrainInjury #SportsMedicine #AthleteSafety #HeadInjury #SportsInjury #ConcussionSymptoms #AthleteHealth #BrainHealth #ContactSports #CollisionSports #SportsSafety #DrThomasBottiglieri #ThomasBottiglieriDO youtube.com/watch?v=NMwXV-tI…

My team and I have been going further and further down the rabbit hole of understand the missing ingredients in evaluation and treatment of concussion. 🤕 Simply, rehabilitation programs must reintegrate neuromuscular control and cognitive efficiency After concussion injury. 1) Liao M et al. Risk of all-cause and site-specific injury following concussion: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil. 2025;17(1):85. PMID: 41402865. link.springer.com/content/pd… (already indexed in QMD; no new duplicate found in fresh search) 2) Evidence Rating: YELLOW — Large meta (19 cohorts, n=86k+), consistent signal for elevated post-RTP MSK injury risk, but high heterogeneity (I²>90%) and variable RTP standards limit precision. 3) What’s New? - OR 1.93 all-cause injury (strongest for recurrent SRC OR 3.06); persists >6 months. - Upper extremity risk (OR 1.76) > lower extremity; college athletes highest. - Neuromotor/cognitive deconditioning proposed as mechanistic driver beyond deconditioning alone. 4) What’s Actually True? concussion creates a prolonged neuromotor vulnerability window that standard RTP clearance does not fully close. Subconcussive RHI + single concussive events both feed the same downstream injury-risk elevation via gait/balance/proprioceptive disruption. 5) Clinical Takeaway: - Mandate standardized neuromotor + dual-task testing at RTP and 3–6 months post-clearance for collision-sport athletes. - Prioritize neck proprioception + reactive balance training in the first 8–12 weeks post-RTP.

Do concussion prevention programs work? 1) Sport-related Concussion Can be Prevented by Injury Prevention Program: A Systematic Review and Meta-analysis of Prospective, Controlled Studies. Sports Med Open. 2025 Dec 28;11(1):156. doi:10.1186/s40798-025-00936-4. link.springer.com/article/10… 2) Evidence Rating: Meta-analysis of 8 prospective controlled studies (2571 athletes) showing consistent, statistically significant 34% reduction in SRC incidence. 3) What’s New? - Injury prevention programs (physical or educational) reduce SRC incidence rate ratio to 0.66 (34% reduction). - Efficacy identical across intervention type and exposure context (practice vs match). - Strong signal that current evidence base is male/collision-sport dominant; explicit call for female-athlete protocols. 4) What’s Actually True? Modifiable risk-factor interventions (neck strength, neuromuscular control, technique/education) produce a real, replicable drop in concussion incidence; the effect holds across delivery methods and contexts in the studied populations. 5) Clinical Takeaway: - Implement structured prevention programs (neck training + neuromuscular warm-ups + education) in rugby, football, and soccer to cut SRC rates by ~1/3. - Both physical and educational modalities work; select by logistics and athlete buy-in. 6) Why This Matters: This meta-analysis supplies the strongest causal-grade evidence to date that concussion incidence in collision sports is meaningfully modifiable through scalable prevention programs.

Growing trends 📈 Beyond the conventional: Artificial intelligence in identifying risk factors in sports injuries. A scoping review - PubMed pubmed.ncbi.nlm.nih.gov/4188…

Return to learn is not an all or none game. After concussion cognitive rest is imperative immediately following injury. But progressive, self regulated, symptom aware activity is useful; titrating increasing duration and cognitive load/challenge as tolerated. Frequent breaks and symptoms journals can help. 1) Return-to-learn following sport-related concussion: a systematic review.” J Neurosurg Pediatr. 2025;36(2):173-185. PMID: 40344757. pubmed.ncbi.nlm.nih.gov/4034… 2) Evidence Rating: 🚦 Systematic review in J Neurosurg Pediatr; clinically useful, but primary studies used heterogeneous RTL definitions. 3) What’s New? - 21 studies, 8475 athletes aged 5-27. - “Any return-to-learn” median: 5 days; “full RTL without accommodations” median: 17.5 days. - Female sex and initial symptom severity were the most consistent predictors of delayed RTL. 4) What’s Actually True? rRecovery timelines are only meaningful when the endpoint is defined. “Back in class” is not the same as fully tolerating cognitive load without accommodations. 5) Clinical Takeaway: - Track cognitive load progression like exertional progression. - Document whether RTL means partial attendance, accommodations, or full academic tolerance. - Higher initial symptom burden should trigger proactive school accommodations, not passive waiting. 6) Why This Matters It extends the RTP-readiness framework into school recovery: concussion clearance should not be binary when cognitive load is still unstable. 7) what can you do now? Initiate a return to learn that is individually guided and self regulated.

We have used exertion as part of the concussion eval for a long time. Pre and post exertion testing can help to uncover persisting injury in need of further rehab. 1) Forch et al, Use of physical exertion to enhance objective testing following mild traumatic brain injury: a systematic review.* BMJ Open Sport Exerc Med. 2025;11(2):e002385. doi:10.1136/bmjsem-2024-002385. PMID:40303382. PMCID:PMC12039017. pubmed.ncbi.nlm.nih.gov/4030… 2) Evidence Rating: 🚦 BMJ journal systematic review, highly pattern-aligned, but most included primary studies had serious/critical risk of bias. 3) What’s New? - Resting tests separated mTBI from controls in only 8/22 studies; exertion/post-exertion testing did so in 21/22. - HRV looked most useful as a stress-response marker, not a resting clearance biomarker. - The paper ties autonomic, respiratory, cerebral autoregulation, and sensorimotor domains into one RTP-readiness frame. 4) What’s Actually True: Concussion recovery v persistent injury is often invisible at rest. The clinically useful signal is whether physiology stays organized under load, but the evidence is not strong enough to declare a single exertional metric or HRV cutoff as a clearance rule. 5) Clinical Takeaway: - Do not treat “asymptomatic at rest” as equivalent to sport readiness. - Add standardized exertional challenge before final RTP decisions when feasible. - Track HRV/RPE/symptom response as a pattern across load, not as a standalone pass/fail number. 6) Why This Matters: It strengthens the case for moving concussion clearance from calendar-plus-symptoms toward objective stress testing that can expose residual vulnerability. 7) What do to today? Add a simple exertion test and repeat objective testing post exertion.

Our team had the opportunity to show our tech to @CBSNews @OrthoColumbia @nyphospital