Concussion management in artistic gymnastics with a discipline-specific return-to-sport framework aligned with FIG guidelines

Sport-related concussion (SRC) represents a clinically relevant injury concern in artistic gymnastics (AG) due to the sport’s distinctive biomechanical and neuromotor demands, including frequent inversion, aerial rotation, and high-impact landings. Although international concussion consensus statements provide overarching principles for concussion management and return-to-sport (RTS) decision making, their sport-agnostic nature limits direct applicability to AG. The purpose of this paper was to propose a discipline-specific RTS framework to assist clinical decision making following concussion in AG, aligned with the Federation Internationale de Gymnastique (FIG) Concussion Guidelines and informed by contemporary international consensus recommendations. A narrative, guideline-based framework development approach was employed, synthesizing peer-reviewed literature published between 2000 and 2025 that addressed SRC, RTS principles, and gymnastics-specific biomechanical and neuromotor demands. The resulting framework outlines a structured, symptom-limited progression for return to AG following concussion, integrating general concussion recovery principles with gymnastics-specific training elements to provide clinically actionable guidance while maintaining alignment with established international standards. Emphasis is placed on individualized progression, ongoing medical oversight, and functional readiness rather than time-based clearance alone. This discipline-specific RTS framework offers a practical and policy-aligned approach to concussion management in AG by operationalizing the FIG Concussion Guidelines within the context of gymnastics-specific demands, thereby supporting safer RTS decision making and bridging the gap between consensus-level recommendations and real-world gymnastics practice. Further empirical research is warranted to evaluate clinical outcomes associated with implementation of this framework.