Restoring Symmetry After Sport-Related Concussion: A Viewpoint on Biofeedback-Guided Rehabilitation

Sport-related concussion (SRC) rehabilitation has advanced toward active, multidomain management, yet recovery may still be judged largely through symptom resolution and broad clinical indicators that may not fully capture persistent functional deficits. Emerging evidence suggests subtle disturbances in postural control, gait, and sensorimotor coordination may persist beyond apparent clinical recovery, raising the possibility that unresolved asymmetries represent an underrecognized dimension of dysfunction. This Viewpoint proposes symmetry restoration as a potential rehabilitative construct in SRC management and explores how biofeedback-guided approaches may provide a conceptual framework for identifying, monitoring, and retraining symmetry-related deficits. Drawing from concussion research, motor control theory, rehabilitation science, and biofeedback applications, this article discusses postural and movement asymmetries as possible markers of incomplete recovery, examines visual, wearable, neuromuscular, and auditory biofeedback strategies as potential mechanisms for symmetry-informed rehabilitation, and outlines clinical implications and future research priorities. Rather than proposing symmetry as a stand-alone determinant of recovery, this Viewpoint advances the conceptual proposition that symmetry-oriented approach may complement existing multidomain models by serving as an additional layer of functional assessment alongside symptom reporting, neurocognitive evaluation, vestibular and oculomotor examination, exertional testing, and routine clinical assessment. Within this framework, symmetry-related measures are envisioned not as independent clearance criteria, but as potentially informative indicators of residual sensorimotor function that may help guide rehabilitation progression and contribute to more functionally informed return-to-sport decision making through adjunctive measures such as center-of-pressure behavior, center-of-mass displacement, gait symmetry, stance and swing time asymmetry, limb-loading patterns, interlimb coordination, and muscle activation symmetry.