Jerome Bettis walked off the field for the final time as a football player with a big smile on his face and a Lombardi trophy in hand.
If that wasn’t good enough, he got to soak in that moment in his hometown of Detroit.
Talk about a fairy tale ending for “The Bus.”
If Bettis’ football send-off was akin to the Disney fairy tales like Cinderella & Snow White, my football send-off was closer to the original Brother’s Grimm nightmarish versions that include assassins and amputation (among some much darker themes).
I got hurdled, scored on, and knocked unconscious at the same time.
I don’t think you could actually script a worse play to end your football career on.
While we can save the details of the story for another time, the part that matters today is that concussions ended my playing career.
I love sports. I love football. I love what they represent and I love how they build so many foundational skills for kids to be successful later in life.
I don’t want head trauma to take that away from our athletes, so I’ve spent a lot of time researching the best ways to prevent concussions from occurring in the first place.
One of the most promising tactics each person has at their disposal is neck strengthening.
What is it?
It’s the process of getting a stronger neck in an attempt to have less concussions.
Why does it matter?
Concussions aren’t just a football issue.
The sports with the highest concussion rates are women’s soccer and men’s ice hockey. They also play a significant role in basketball, baseball/softball, wrestling, volleyball, lacrosse, and gymnastics.9
Concussions are not good.
There’s debate about a causal relationship between repetitive head trauma and no consensus among experts,9 but at the very least trying to avoid repetitive head trauma seems like a common sense tactic for longevity.
Most concussion prevention strategies are outside your control at the individual level (rule changes of the sport, equipment advances, etc).
I’m super supportive of the people who are out there pounding the table for legislative changes to make games safer, but I want our athletes to focus on things that they can control.
When it comes to concussion prevention, there are only a few things under our control theorized to reduce injury risk.5
Neck strengthening is one of them.1,2,3,6,7
How does it work?
Concussions occur due to the rapid acceleration and deceleration of the head.
This causes the brain to move within the skull.
This movement stretches the brain tissue.
The stretching of brain tissue is what’s currently thought to cause the brain injury that we know as a concussion.
Reverse engineering the concussive process illuminates that if we can control and reduce the acceleration and deceleration of the head, then we can reduce concussion risk.
We need to stabilize the head, and the neck is the best structure suited for the task.
A stronger neck has the capacity to resist the acceleration and deceleration forces.2 For every one pound of improvement in neck strength, concussion risk has been shown to decrease by 5%.7
However, concussions don’t happen slowly. You need to produce that strength quickly. You need a high rate of force development and situational awareness to react to the impact.
How can you use it?
Train the heck out of your neck.
Be strategic, though. The type of training matters.
We want to develop the big, powerful neck muscles, as the deep neck flexors don’t appear to make a meaningful difference in concussion prevention.1
Check out these videos for examples of neck strengthening methods to use.
1) Bodyweight strength
– Pros: No equipment required. Work well for strength endurance with higher set/rep schemes (start 3 with 3 x 15 each way and then progress up to 3 x 25 ea way as tolerated).
– Cons: Not able to truly load and improve maximal strength as efficiently.
2) Partner manual strengthening & Rhythmic stabilization
– Pros: Minimal equipment required (just competent partner). Can really load heavily. Rhythmic stabilization is great for improving head position awareness and RFD.
– Cons: Resistance is variable and hard to progress and track. You really need a partner you can trust.
3) Cable/band resisted strengthening
– Pros: Can load heavy & work at high speeds to improve RFD.
– Cons: More extensive equipment needed.
My thoughts.
It is mind boggling how little published research there is on this subject.
With the amount of national attention concussion has garnered and the astronomical amount of funding going toward concussion research, how has this not been thoroughly studied?
It’s low-cost, time-efficient, actionable, measurable, and theoretically sound.
There appears to be a correlation between neck strength and reduced concussion risk, but causality has yet to be fully established.
Practically speaking, though, there’s no reason not to include neck strengthening in your training.
As stated above, it’s low-cost, time-efficient, and theoretically sound.
The risk/reward ratio is heavily skewed toward the reward end of the spectrum.
The worst case scenario of employing strategic neck strengthening methods is that you end up with a strong neck that doesn’t help much.
The worst case scenario of not employing neck strengthening is having increased risk of head/neck injuries, including concussions.
Life is an odds game. Do what you can to stack the deck in your favor.
I do strongly believe that having a neck that is not only strong, but able to produce that strength nearly-instantaneously is paramount. Combining that with high visual/perceptual capabilities would allow your neck to stabilize your head and minimize the acceleration/deceleration forces that cause concussions.
Fun facts.
This isn’t just a dude’s issue.
Girls are more likely to be concussed than boys4 and their symptoms are usually more severe.2
We don’t know exactly why, but some current thoughts include girls having a weaker neck and having an increased likelihood of actually reporting symptoms when they are present (which is a good thing).
Big numbers
It’s estimated that there are between 1.6 million and 3.8 million concussions in sports and recreation in the United States each year.10
That’s a lot of concussions.
This brings me back to my point, with such a large effect on society (and a lot of healthcare dollars going toward managing these patients), how do we not have straightforward answers to such a simple possible solution?
That’s it!
Best,
Zach
Dr. Zach Guiser, PT, DPT, CSCS
References
1. Elliott J, Heron N, Versteegh T, et al. Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review. Sports Medicine. 2021;51(11):2373-2388. doi:10.1007/s40279-021-01501-1
2. Gutierrez GM, Conte C, Lightbourne K. The Relationship Between Impact Force, Neck Strength, and Neurocognitive Performance in Soccer Heading in Adolescent Females. Pediatric Exercise Science. 2014;26(1):33-40. doi:10.1123/pes.2013-0102
3. Garnett D, Patricios J, Cobbing S. Physical Conditioning Strategies for the Prevention of Concussion in Sport: a Scoping Review. Sports Medicine – Open. 2021;7(1):1-16. doi:10.1186/s40798-021-00312-y
4. Cheng J, Ammerman B, Santiago K, et al. Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis. Sports Health: A Multidisciplinary Approach. 2019;11(6):486-491. Accessed May 6, 2023. https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=139386082&site=eds-live
5. Honda J, Chang SH, Kim K. The effects of vision training, neck musculature strength, and reaction time on concussions in an athletic population. J Exerc Rehabil. 2018;14(5):706-712. Published 2018 Oct 31. doi:10.12965/jer.1836416.208
6. Eckner JT, Goshtasbi A, Curtis K, Kapshai A, Myyra E, Franco LM, Favre M, Jacobson JA, Ashton-Miller JA. Feasibility and Effect of Cervical Resistance Training on Head Kinematics in Youth Athletes: A Pilot Study. Am J Phys Med Rehabil. 2018 Apr;97(4):292-297. doi: 10.1097/PHM.0000000000000843. PMID: 29557889; PMCID: PMC6813830.
7. Collins CL, Fletcher EN, Fields SK, et al. Neck strength: a protective factor reducing risk for concussion in high school sports. The journal of primary prevention. 2014;35(5):309-319. doi:10.1007/s10935-014-0355-2
8. Chandran A, Boltz AJ, Morris SN, et al. Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19. American Journal of Sports Medicine. 2022;50(2):526-536. doi:10.1177/03635465211060340
9. https://www.nytimes.com/2022/11/08/sports/football/cte-brain-trauma-concussions.html
10. https://www.cdc.gov/media/pressrel/2007/r070607.htm