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Stronger Necks May Reduce Concussion Risk: Study

A growing number of concussion experts (1), strength and conditioning trainers (2), and physical therapists, believe that one important way to reduce the risk of sport-related concussion is by strengthening the neck, the theory being that stronger neck muscles will help cushion against and lessen the linear and rotational forces that cause concussion. 

Now, for the first time, there is research to back up the theory.

The preliminary results of a pilot study (3) suggest that overall neck strength is a statistically significant predictor of concussion, with the odds of concussion falling by 5% for every one pound increase in aggregate neck strength. The data also showed that the quarter of the subject group of more than six thousand high school athletes playing boys' and girls' soccer, basketball, and lacrosse with the weakest necks suffered the greatest number of concussions, while the quartile with the strongest necks suffered the fewest.

"The evidence [suggests] that neck strengthening programs may be an effective primary concussion prevention mechanism that is inexpensive, easy to adopt, widely available, and fully within the athlete's control," says R. Dawn Comstock, PhD. associate professor in the Department of Epidemiology at the Colorado School of Public Health and principal investigator for the High School RIO TM  (an internet-based data collection tool used in the National High School Sports-Related Injury Surveillance Study) from which the study results were drawn.  Comstock presented her preliminary findings at the 4th Annual National Youth Sports Safety Summit in Washington, D.C.

"We focus so much on how to properly diagnose concussions," Comstock told Time's Sean Gregory. (3)  "That's obviously important, but preventing concussions is a much better outcome.  We're not saying you won't get a concussion if your neck is stronger.  But the data shows that neck strengthening has strong potential as a key concussion prevention tool." 

"The results are promising and support what those of us caring for athletes believed to be true, based on our observations, who see strengthening the neck musculature as a means of reducing the risk of sport-related concussion," said William P. Meehan, III, M.D.,  Director of the Sports Concussion Clinic and the  Micheli Center for Sports Injury Prevention in the Division of Sports Medicine at Children's Hospital Boston, and a MomsTEAM concussion expert.     

Neck strengthening exercises

Fortunately, neck strengthening exercises are easy to do and don't require a huge investment in equipment.

Here are some simple strengthening exercises Dr. Meehan says athletes can add to their current resistance training:

  1. Shrugs: A common resistance exercise which can be performed either with a barbell or dumbbells.  The easiest way may be for the athlete to hold a dumbbell of appropriate weight in each hand, with the arms extended at the side, and then raise their shoulders, lifting the weight of the dumbbell, and then slowly relaxing to the starting position.
  2. Dumbbell press: For the dumbbell press, the athlete raises their arms so that the elbows are even with the shoulders and flexed at approximately 90 degrees.  From this starting position, the athlete then raises the dumbbell toward the ceiling whileTeenage boy with hand weights straightening the elbow.  Then, the dumbbell is returned to the starting position.
  3. Lateral, forward, backward, and rotational resistance exercises of the neck.  Athletes playing for teams with significant resources will often have a machine that is specifically designed to help them strengthen the neck muscles.  There are, however, some very simple resistance exercises athletes without such resources can still do which are perhaps the easiest and most effective ways to strengthen the neck muscles.

In order to perform lateral resistance exercises, an athlete places their right hand on the right side of their head.  The muscles of the neck are flexed so that the right ear attempts to move downward towards the right shoulder, but, because the athlete is resisting that action, the head doesn't actually move.  The athlete should hold this position in active resistance for about 5 to 10 seconds. The exercise can then be performed on the left side of the head, front of the head, and back of the head.

The rotational resistance exercises are similar: the athlete places their hand against the side of the forehead and then attempts to rotate the head towards the right or the left while nodding "no."  This motion is resisted by the hand so there is no actual movement of the head.  Again, the athlete should hold the position in active resistance for about 5 to 10 second and then repeat in the opposite direction.

Proper supervision on technique 

As with all resistance training, particularly in younger athletes, the emphasis should be on proper and safe technique.  Younger athletes who are unfamiliar with resistance training should be coached and supervised by an adult with expertise in resistance training of the pediatric athlete. The descriptions outlined above are for descriptive purposes only; anyone planning on engaging in them should consult a proper manual or seek professional assistance.

For more on neck strengthening advice from MomsTEAM's expert physical therapist, Keith Cronin, DPT, click here

Editor's Note: Both Doctors Meehan and Cronin will be featured in MomsTEAM's soon-to-be-released football concussion documentary,"The Smartest Team", discussing neck strengthening as a way to reduce the risk of concussion 

1. Meehan WP, Kids, Sports, and Concussion (Praeger 2011)  

2.  Cohen M. "Neck strengthening exercises could help lessen risk of concussions." Sports Illustrated (September 28, 2012)(http://sportsillustrated.cnn.com/2012/football/ncaa/09/28/concussions-neck-strength-syracuse-eastern-michigan/index.html)(accesssed February 22, 2013).

3.  Gregory S. "Neck Strength Predicts Concussion Risk, Study Says" (http://keepingscore.blogs.time.com/2013/02/21/study-neck-strength-predic...)(accessed February 22, 2013), citing Comstock R.D. High School Sports-Related Injury: Recent Trends and Research Findings. Presented at the National Youth Sports Safety Summit, Washington, D.C., February 5, 2013. 

Posted February 22, 2013; updated February 25, 2013 to include Dr. Meehan's comments.