Holistic Performance Programming for mTBI Recovery in U.S. Military Tactical Athletes: A Narrative Review

Tactical athletes, including military service members, are exposed to occupational demands that increase their risk of mild traumatic brain injury (mTBI), particularly through blast exposure, falls, collisions, and repeated sub-concussive events. Although clinical tools and progressive return-to-activity protocols support acute management, recovery may remain fragmented when physical, cognitive, psychological, and performance domains are not integrated. Military personnel require recovery models which extend beyond symptom resolution and return-to-duty clearance. Holistic performance programming offers a multidimensional framework which incorporates subject matter experts across strength and conditioning, rehabilitation, nutrition, behavioural health, cognitive performance, and human performance optimisation. This narrative review examines the role of holistic performance programming in optimising recovery from mTBI among tactical athletes, with emphasis on interdisciplinary care, structured assessment, recovery periodisation, monitoring technologies, and return-to-duty readiness. The role of embedded subject matter experts in identifying and monitoring mTBI; interdisciplinary care models which integrate clinical and performance expertise; structured recovery pathways from assessment to reintegration; and the importance of flexibility, communication, and service member engagement are examined. In addition, the review assesses the potential use of biomarkers, wearable technologies, and multi-domain assessment tools to guide individualised recovery. Holistic performance programming may bridge the gap between clinical recovery and operational readiness following mTBI. By integrating physical, cognitive, psychological, nutritional, and sleep-related strategies, this approach may reduce fragmented care and better address the complex nature of mTBI recovery. Interdisciplinary performance teams may improve early recognition, individualised rehabilitation, safer return-to-duty decisions, and long-term readiness. Future practice should prioritise standardised assessment, real-time monitoring, education, and stigma reduction.