Establishing a New Baseline After Concussion: When Your Old 'Normal' No Longer Applies

After full recovery from a concussion, should the athlete get a new baseline? The answer, supported by clinical practice guidelines and common sense, is yes — and here’s why.

What a pre-injury baseline captures

A pre-injury baseline captures the athlete’s cognitive, balance, and vestibular-ocular function at a specific point in time, before that specific injury. After the injury and recovery process, several things may have changed. The athlete may have fully returned to their pre-injury cognitive level — in which case the new baseline will simply confirm this. Or their cognitive function may have settled at a slightly different level — perhaps marginally lower on one composite but unchanged or improved on others. This new level is their actual current “normal,” and it is the only appropriate comparison point for any future injury.

The risk of using the old baseline

Using an old pre-injury baseline as the comparison for a future concussion introduces two problems. If the athlete’s current function is lower than the old baseline (due to cumulative effects of the previous injury), the old baseline sets an unrealistically high recovery target — potentially keeping a recovered athlete out of activity indefinitely because they can never reach a threshold that no longer represents their brain. Conversely, if the athlete’s function has improved since the old baseline (due to normal development in young athletes, or improved testing familiarity), the old baseline sets a bar that’s too easy to clear — potentially missing genuine post-injury deficits.

What the consensus supports

Research on this topic is limited but the clinical logic is strong, and the practice is supported by the principle of individualized concussion management emphasized in the 6th International Consensus Statement. Serial baselines over time also provide the longitudinal data needed to detect progressive changes that might indicate cumulative effects of repeated injuries.

Our protocol

At Headquarters, re-baselining after concussion recovery is a standard part of our protocol. Once an athlete is fully cleared — symptom-free, back to baseline across all domains, and completed the graduated return-to-play protocol — we schedule a new comprehensive baseline within 2–4 weeks. This updated data becomes their reference point going forward. See also prior concussion history and baselines.

Frequently asked questions