Who Should Get Baseline Concussion Testing Before the Season?

Every preseason, the same question comes up for coaches, athletic trainers, and parents: who should get baseline concussion testing before the season starts? It is a fair question. Baseline testing takes time and money, and the honest answer is that not every athlete needs the same plan. Some athletes get real value from a baseline test before the season. For others, a generic comparison may work almost as well. This article walks through what the evidence actually shows, so your team or your family can make a smart choice instead of a guess.

A quick definition first. A concussion is a brain injury caused by a hit to the head or body that makes the head move fast. Baseline testing means measuring how an athlete’s brain works when it is healthy, before any injury happens. After a concussion, that healthy score becomes a personal reference point. The goal is simple: know what “normal” looks like for that person, so you can tell when they are truly back to normal.

What Is Baseline Testing Actually For?

Baseline testing is mainly about safe return to play, not about diagnosing the concussion itself. “Return to play” means the point when an athlete is cleared to go back to full sport. Symptoms, like headache or dizziness, are still the main tool for spotting a concussion in the first minutes and days. A baseline test is not needed to know someone got hurt.

Here is the key thing to understand. Symptoms often go away before the brain has fully healed. An athlete can feel fine, pass a basic symptom check, and still have small drops in memory, balance, reaction time, or focus. During this gap, the brain may sit in a window of vulnerability, a stretch of time when a second hit can cause more harm than usual. After a concussion, brain cells go through an energy crisis and blood flow to the brain becomes dysregulated, meaning it is poorly controlled rather than simply lower. That recovery process takes longer than most symptoms last.

So what does that mean practically? If you clear an athlete on symptoms alone, you may send some of them back too early. A good baseline gives you objective data, which means measured numbers instead of opinions, to check whether the athlete has really returned to their own pre-injury level. That is the real job of athletes baseline testing.

Who Should Get Baseline Concussion Testing?

The athletes who benefit most from a baseline test before the season share one thing in common: a generic average does not describe them well. Below are the groups where individual baseline testing earns its place.

Contact and Collision Sport Athletes

Athletes in contact and collision sports are the clearest case for contact sport baseline testing. These are sports with frequent, hard body and head contact, such as football, rugby, hockey, and lacrosse. Their concussion risk is higher, so the payoff from good data is higher too.

There is also a measurement reason. A large preseason study of more than 9,000 balance tests found that collision-sport athletes had worse balance scores at baseline than athletes in lower-contact sports, and that age and sex changed the scores as well [1]. In plain terms, a hockey player’s “normal” balance is not the same as a tennis player’s “normal.” Comparing a collision athlete to a blended average can hide a real problem or invent a fake one. Their own baseline is the cleaner yardstick.

Youth and High School Athletes

Youth sport baseline test programs deserve special attention, and high school baseline concussion screening is where this matters most. The reason is growth. A young brain changes a lot from one year to the next, so last year’s average for “a 15-year-old” may not fit this year’s 16-year-old.

The evidence backs this up. A study of high school football players found that younger athletes improved their scores more across a single year, likely because they were still developing, while older teens were more stable [2]. A separate reliability study in middle and high school athletes found that scores on a mobile thinking test were not very stable over a year, and that normal growth in reaction time could actually hide a real post-concussion drop [3]. Researchers have also shown that baseline scores in young athletes shift with age, sex, race, learning history, and family income, which means one fixed average can mislead [4][5].

For families, this is the practical point. If your child plays a contact sport, a baseline test is one of the few ways to get a personal, evidence-based picture of their healthy brain before anything goes wrong. For parents navigating this, the difference between good and poor concussion management is real, and a Complete Concussions certified provider can give you a proactive, evidence-based plan instead of a wait-and-see approach.

Athletes With Health or History Factors

Some athletes carry health or history factors that make generic norms a poor fit. For these athletes, athlete baseline screening on their own personal numbers is the most useful approach. The research shows why.

• Past concussions. A preseason study of youth athletes found that athletes with two or more prior concussions had the slowest repeated reaction times and gained the least from practice, a difference a single first-pass test would miss [6].
• Migraine or frequent headaches. In more than 7,000 student-athletes, those with a headache or migraine history reported more symptoms and had lower visual memory scores at baseline, before any new injury [7].
• Anxiety. In a study of nearly 38,000 adolescent athletes, anxiety had a small effect on thinking scores but a much larger effect on baseline symptom reports, and many anxious athletes already met symptom cutoffs while healthy [8].
• Diabetes and other medical conditions. Collegiate athletes with diabetes reported more baseline medical issues and averaged about one extra balance error compared to athletes without it [9].
• Sex and personal history together. A cohort of college soccer and lacrosse athletes showed that female athletes and those with prior concussion or migraine reported more baseline symptoms, so a flat threshold treats people unequally [10][11].

The pattern is clear. When an athlete’s healthy starting point is already different from the average, comparing them to that average is risky. Their own baseline removes the guesswork.

Does Every Athlete Need a Fresh Baseline Every Year?

This is where the answer gets honest: no, not every athlete needs the same testing schedule. The value of a personal baseline depends on whether good comparison data already exists.

Recent high-quality work makes this point. A large analysis from the NCAA and Department of Defense CARE Consortium, a major research network, compared personal baselines against normative data, which means scores from a big reference group. Overall the two approaches performed about the same for diagnosis, and some groups were actually classified more accurately using norms [12]. A separate study found that whether a clinician used a one-year-old baseline, a two-year-old baseline, or norms, the diagnostic decision rarely changed in college athletes [13]. Another consortium study reported that adding a preseason baseline did not meaningfully improve how well the tools spotted an acute concussion [14].

So what does that mean? In settings with older athletes and strong reference data, a fresh baseline every single year may add little. The flip side is that single tests are also unstable. One study found that year-to-year baseline scores in varsity athletes were stable as a group but jumped around a lot within individuals [15]. That instability is exactly why a single baseline is weak and why repeated, individualized testing over time is stronger than one snapshot.

Put together, the takeaway is balance, not dogma. Target your testing. Prioritize the athletes above. Repeat it sensibly rather than treating one annual test as sacred.

What Makes a Baseline Test Worth Doing?

A baseline only helps if it is done well. A weak or invalid baseline can be worse than none, because it gives false confidence. Three things separate a useful preseason brain testing program from a box-ticking exercise.

First, use more than one test. Concussion can affect memory, focus, eye movement, balance, and reaction time, so a real baseline samples several of these. The order matters too: one study of nearly 2,900 athletes and cadets found that memory and reaction-time tasks scored best when done early in the session, while symptom checklists ran lower at the end [16]. A team concussion protocol baseline built on a single test is not a true baseline.

Second, make sure the test is valid. “Valid” means the athlete gave honest, full effort under fair conditions. This is not only about effort, though. A study of nearly 6,500 young athletes found that poverty and neighborhood hardship were linked to lower odds of a valid baseline, so an invalid result is not always poor effort [17]. Baseline symptom checklists can also carry useful mental health signal, with one rugby study finding that preseason screening flagged athletes who warranted follow-up [18]. For clinics and programs running this at scale, NeuroLogic consolidates baseline, post-injury, and remote monitoring into one workflow, so testing is reliable, interpretation is built in, and the documentation happens without the overhead.

Third, interpret scores in context. Norms still help when a personal baseline is missing, but they must fit the athlete. Researchers building tandem-gait norms, a heel-to-toe walking test, found that sex and contact level mattered enough that one blended number was not good enough [19]. The same logic runs through every test in the battery.

The Bottom Line

So, who should get a baseline test before the season? Prioritize contact and collision sport athletes, youth and high school players whose scores shift as they grow, and any athlete whose health or history makes a generic average a poor fit. For lower-risk athletes, and in programs with strong reference data, a personal baseline adds less, and that is a reasonable place to spend fewer resources. The goal is smarter, safer return-to-play decisions, not testing for its own sake.

If you run a school, team, or club and want a baseline test before season that is sideline-ready, scalable, and defensible, NeuroLogic gives you baseline testing, post-injury screening, and built-in documentation on one platform, with predictable cost and decisions you can stand behind.

Common Questions

Who should get baseline concussion testing?

Athletes in contact and collision sports get the most value, especially youth and high school players and anyone with a history of concussions, migraine, anxiety, or other conditions that make a generic average a poor match. These athletes benefit most because their healthy starting point is often different from the population average, so a personal reference point is more accurate.

Is a baseline test used to diagnose a concussion?

No. A concussion is diagnosed mainly from symptoms and a clinical exam right after the injury. A baseline test is used later, to help decide when an athlete has truly returned to their own pre-injury level before going back to sport.

How often should an athlete get a baseline test before the season?

It depends on age and sport. Younger athletes change quickly as they grow, so they generally benefit from more frequent baselines. Older athletes with stable, strong reference data may need them less often. Targeted, repeated testing is usually better than one yearly test treated as the final word.

Do youth athletes really need their own baseline?

Often yes, because a young brain develops year to year and generic averages may not fit a growing child. Several studies show youth baseline scores shift with age, growth, and personal background, which can hide or fake a post-injury change if no personal baseline exists.

What makes a baseline test reliable?

Three things: testing several brain functions instead of one, making sure the test is valid and done under fair conditions, and comparing scores to the right reference for that athlete’s age, sex, and sport. A single test taken in poor conditions can give false confidence.