Concussion Recovery for Tactical Athletes

By Dr. Savannah Snead - O2X On-Site Specialist

Tactical athletes operate in high-risk environments where concussions are a real and frequent threat. Returning to duty after a concussion isn’t just about feeling better; it’s about being fully mission-ready. Rehabilitation following a concussion is highly individualized, depending on the severity of the brain injury, specific job demands, and the individual’s medical history. However, a supervised rehabilitation plan generally follows stages of progressive physical activity to allow the athlete to heal and return to their job safely, while minimizing the risk of long-term issues.

A concussion is defined as a traumatic brain injury caused by a blow (direct contact) or jolt (sudden impact without direct contact) to the head that can result in impaired brain function. The severity of a concussion can range from mild to very severe, with symptoms that vary widely from person to person. 

Symptoms may include (but are not limited to): 

• Headaches
• Dizziness
• Difficulty concentrating 
• Visual disturbances
• Nausea and/or vomiting
• Loss of consciousness 
• Sensitivity to light or noise
• Balance problems 
• Memory loss

Tactical athletes are routinely placed in situations that could result in concussions, including military training, close contact combat, and blast exposure. Assessment by a medical professional trained in concussion management is imperative following a potential concussion. 

After medical clearance to begin rehabilitation, several objective measures can be used to guide treatment and monitor progress. The Buffalo Concussion Treadmill Test (BCTT) is commonly used to determine the heart rate at which symptoms begin to worsen by gradually increasing exercise intensity and tracking symptom changes. Once this threshold is identified, training is kept at or below 90% of that heart rate to avoid symptom provocation, with periodic reassessment as recovery progresses. Postural stability and balance can be evaluated using the Balance Error Scoring System (BESS) and/or the Functional Gait Assessment (FGA), which help track changes over time. Dual-task training is also incorporated to combine cognitive and physical demands, as mild concussion symptoms often become more apparent when attention control is required. Additionally, Vestibular and Ocular Motor Screening (VOMS) may be used to assess visual tracking, convergence, and symptom provocation during head movement which are critical functions for tactical readiness.

Once the athlete is stable, return to duty typically follows six progressive stages:

Phase 1: Complete Rest

• Requires full physical and mental rest for a minimum of 24 hours
• Duration may be extended based on medical evaluation
• Mental rest may be adjusted if the athlete is asymptomatic

Phase 2: Light Aerobic Exercise (No Resistance)

• Begins only once the athlete is symptom-free at rest
• Activities include light cardio such as walking or stationary biking
• The Buffalo Concussion Treadmill Test (BCTT) may be used to determine safe heart rate thresholds to allow the athlete to exercise without triggering symptoms

Phase 3: Light Strength Training and Job-Specific Drills

• Introduces movements that may provoke symptoms (e.g., walking with head turns, visual tracking)
• Reintroduces gear wear (helmet, vest) combined with head movement
• Focuses on tactical movements relevant to the athlete’s role
• Begins incorporating dual-task training to create a cognitive demand during physical tasks 
• Examples of training in this phase:
  
  • Walking drills with head turns while wearing gear
  • Visual target tracking while performing light squats or lunges
  • Simulated radio communication while navigating a short obstacle course
  • Light gear transitions (e.g., donning/doffing helmet and vest) with balance challenges

Phase 4: Non-Contact Training with Progressive Resistance

• Aerobic intensity increases based on BCTT heart rate thresholds
• Resistance training ramps up to meet physical fitness standards
• Training remains non-contact but simulates job-specific physical demands 
• Examples of training in this phase:
  
  • Weighted step-ups or stair climbs with gear
  • Circuit training with sandbags, kettlebells, or resistance bands
  • Simulated casualty drags or equipment carries over short distances
  • Tactical movement drills (e.g., bounding, low crawls) without external contact

Phase 5: Full-Contact Training

• Athlete resumes unrestricted training involving physical contact
• Includes tactical simulations and operational drills 
• Examples of training in this phase:
  
  • Close-quarters combat simulations with partners
  • Full gear obstacle course with timed transitions
  • Team-based tactical scenarios involving dynamic movement and communication
  • Live-fire or force-on-force drills (as appropriate and cleared by command/medical)

Phase 6: Return to Duty

• Full clearance from a medical doctor is required
• Athlete resumes all job responsibilities without restrictions

Progression through these phases can range from a few days for very mild concussions to several months for more complex cases. Tactical athletes face unique job demands that must be considered when designing and implementing a return-to-duty regimen. Wearing heavy gear, navigating confined spaces, visual tracking, and attentional control are just a few of the challenges that place additional strain on someone recovering from a concussion.

Physical therapists and athletic trainers are ideally positioned to take a holistic view of the athlete and develop a rehabilitation plan tailored to their specific needs. Concussion recovery requires time and consistency, but with the right approach and careful progression, athletes can heal, avoid reinjury, and return to peak performance.

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References: 

1. Centers for Disease Control and Prevention. Returning to Sports After a Concussion. CDC, https://www.cdc.gov/heads-up/guidelines/returning-to-sports.html. . Accessed 21 Oct. 2025.

2. Wake Forest University Athletics. Concussion Management Policy. GoDeacs.com, 2 Aug. 2018, https://godeacs.com/sports/2018/8/2/concussion-management-policy. . Accessed 21 Oct. 2025.

3. Shirley Ryan AbilityLab. Home. https://www.sralab.org/. . Accessed 21 Oct. 2025.

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About O2X On-Site Specialist Dr. Savannah Snead:

Dr. Savannah Snead is an O2X On-Site Human Performance Specialist specializing in Injury Prevention as a Doctoral Physical Therapist (DPT) with HSCWL-Norfolk. In this role, she provides expert physical therapy support, focusing on injury management and prevention to help individuals optimize their performance and maintain operational readiness. With a strong background in holistic care, Savannah is dedicated to helping clients achieve their physical potential and sustain long-term wellness.Savannah’s professional experience includes rehabilitating athletes and service members recovering from conditions such as traumatic brain injuries and post-operative orthopedic issues. During her doctoral studies at Campbell University, she completed a rotation at Fort Belvoir Community Hospital, where she collaborated with an interdisciplinary team to care for military members affected by traumatic brain injuries. This transformative experience ignited her passion for serving those in uniform, leading her to begin her career at Naval Medical Center Portsmouth, where she treated service members across all branches of the military in an outpatient orthopedic setting.Originally from a farm in Virginia, Savannah earned her bachelor’s degree in Human Biology from North Carolina State University in 2016 before completing her Doctor of Physical Therapy at Campbell University in 2019. Certified in Level I and II dry needling, she brings a comprehensive approach to injury prevention and recovery.