Review Article Air Travel after Sport-Related Concussion: A Systematic Review
by Islam A. Sherif1*, Ahmed Mostafa1, Mohamed Abouelela2, Jim Moxon3
1Department of Health, University of Bath, Bath, United Kingdom 2Egyptian Football Association, Cairo, Egypt 3Brighton and Hove Albion Football Club, Brighton, United Kingdom
*Corresponding author: Islam A. Sherif. MSc Sports and Exercise Medicine, University of Bath, Bath, United Kingdom
Received Date: 17 September 2026
Accepted Date: 23 September 2026
Published Date: 26 September 2026
Citation: Sherif IA, Mostafa A, Abouelela M, Moxon J (2026) Air Travel after Sport-Related Concussion: A Systematic Review. Sports Injr Med 10: 211. DOI: 10.29011/2576-9596.100211
Abstract
Background: Sport-related concussion (SRC) is common in athletic populations and is followed by a period of neurometabolic vulnerability during which physiological stressors may influence recovery. Air travel produces mild hypobaric hypoxaemia and is common among athletes in the days following injury, yet no current consensus statement provides guidance on post-injury flight. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, and Scopus were searched from inception to March 2026. Eligible studies included comparative observational studies in athletic populations reporting the effect of air travel on concussion recovery outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Findings were synthesised narratively. Results: Two cohort studies were included. A large prospective cohort (NCAA–DoD CARE Consortium; n = 1,475–1,677) found no significant association between air travel within 72 hours of concussion and symptom severity, headache severity, return-to-learn, or return-to-play outcomes. A retrospective cohort of professional NHL athletes (n = 325), reported exclusively as a conference abstract, found that air travel within six hours of injury was associated with approximately one additional game missed (6.54 vs 5.54; P = 0.031). Risk of bias was low for the CARE study (NOS 8/9) and moderate for the NHL study (NOS 6/9), which is available only as a conference abstract. Conclusion: Current evidence is limited and inconsistent. Air travel beyond the immediate post-injury period does not consistently worsen recovery. Very early post-injury flight may modestly delay return to play in some cohorts, but this derives from a single moderate-quality study. Post-concussion air travel decisions should be individualized until prospective, adequately powered studies are available.
Keywords: Concussion; Sport-Related Concussion; Mild Traumatic Brain Injury; Air Travel; Aviation; Flight; Return To Play
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