Strengthen the Neck to Reduce Incidences & Severity of Concussions

By: Chris Dellasega, MS, CSCS, PICP 2, BioSig 1
October 7, 2012 - 8:07 AM

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It wasn’t all that long ago that strength coaches had their football players perform neck-strengthening exercises, but now it’s a thing of the past. Today, it seems too much emphasis is placed on setting squat, bench and power clean records (often with horrendous technique) and not enough on making players more resistant to injury.

The primary concern when developing a strength-training program should be “injury proofing” athletes. A strength program should first identify the most vulnerable areas of athletes’ bodies, and implement exercises that will help to minimize the chances of injury to that area. The muscles of the neck are generally grossly underdeveloped in high school athletes.

 

The University of Pittsburgh’s Department of Neurological Surgery reports that, “The likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19% per year of play. More than 62,000 concussions are sustained each year in high-school contact sports.” The Center for Disease Control cites football as the most common sport for males in which a concussion is likely to occur.

Most concussions occur when there is an abrupt change in direction of the head. This is likely to occur when an athlete sustains a hit to the body resulting in whiplash or a sudden rotation of the head. A forceful and sudden change in direction that is strong enough to jar the head can cause damage to the brain causing a concussion.

A study published in the August 2007 issue of Neurosurgery found that stronger necks reduced the forces associated with a concussion. Researchers measured head translational and rotational accelerations, upper neck responses, head kinematics and biomechanics, head displacement, head rotation, and neck loads on 25 impacts to the head using dummies wearing helmets. The researchers noted that models with stronger "necks," had a decrease in head velocity, as well as head injury criterion when compared to models with weaker necks. Researchers concluded that athletes with weaker necks are more susceptible to concussions because they are not capable of creating the internal muscle forces required to reduce head acceleration caused by a forceful hit.

Dr. Robert Cantu, MD, the Co-Director of Boston University's Center for the Study of Traumatic Encephalopathy, told Fox Sports in 2010, "It's just straight physics. If you see the blow coming and you have a very strong neck and contract the neck muscles, you have a much greater chance to have significantly reduced the forces the brain will see."

Dr. Mickey Collins, MD, the Assistant Director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, agrees that strengthening the neck may help prevent concussions. Dr. Collins told Stack magazine in 2008, “We believe one of the best ways to prevent concussions is actually neck strength. Having a strong neck allows the forces of the blow taken from the head, down through the neck and into the torso and may certainly help with this issue.”

Dr. Kevin Guskiewicz, PhD, the Chair of the University of North Carolina's Department of Exercise and Sports Science program, agrees. “We think a lot of it has to do with neck strength.” Dr. Guskiewicz told the Robert Wood Johnson Foundation, a site devoted to information and discussions about public health. “We’re beginning to look at prevention methods that might allow us to strengthen the neck musculature, to try to teach kids how to prepare to take a hit if they get one because we know that to take an ill-prepared hit, where they can’t brace the head and tense the neck muscles, that the forces to the brain are worse than they are if they’re prepared for it.”

Mike Gittleson, the strength coach for the University of Michigan for over 30 years, is perhaps one of the most outspoken proponents of neck strengthening to prevent concussions. Gittleson has spoken at conferences and to coaches all over the country about concussions since his retirement in 2008. Gittleson says that many of the 300 plus schools that he has spoken at do not have any kind of neck strengthening program in place.Untitled 1:Applications:Microsoft Office 2011:Office:Media:Clipart:Photos.localized:j0289377.jpg

Greg Aiello, who heads the NFL’s head, neck and spine committee, says that while there’s not a league-wide neck strengthening program all teams’ strength training programs do include training the neck muscles.

Several strength coaches at the NFL level believe that if neck strength were tested at the NFL combine many coaches at the lower levels would begin instituting a neck-strengthening program.

Ryan Cidzik, the Director of Football Strength and Conditioning at the University of Memphis has written that, “We saw significantly fewer concussions--50 percent less--during the 2010 and 2011 seasons. Players who missed playing time due to a head or neck injury also decreased 50 percent over the past two years.”

Sports Illustrated reported in September 2012 that the University of Eastern Michigan Eagles had 55 “occurrences of neck trauma” in 2010. In 2011 the Eagles had only 35 incidences of neck trauma and the team suffered only three concussions after implementing a neck-strengthening program.

Neck Strengthening Program

For the programs that do incorporate neck training many times their regimen consists only of 2 sets of 10 on a 4-way neck machine. Considering the complex nature of the movements the neck is capable of performing and that research is suggesting incidences of concussions can be dramatically reduced with appropriate training, this is hardly adequate.

The primary motions of the neck include:

            • Flexion (as in tucking the chin to the chest)

            • Extension (as in lifting the chin from the chest and tilting the head back)

            • Lateral Flexion (left & right – as in touching the ear to the shoulder)

            • Rotation (left & right – as in looking over the shoulder)

The secondary motions of the neck include:

• Upward Diagonal Rotation
(left & right – as in rotating the chin from the left shoulder at an upward 45 degree angle to the right)

• Downward Diagonal Rotation 
(left & right – as in rotating the chin downward from a 45 degree angle to the left shoulder: the opposite of Upward Rotation)

 

Because the neck is capable of moving in many different directions and angles, a variety of exercises, methods, ranges of motion, and tempos should be utilized when developing a neck-strengthening program.

Most researchers agree that neck-training machines should be the primary method of strengthening the neck because they offer a quantifiable way to measure and appropriately progress the loads used. However, the draw back is that most neck machines work on a single-hinge pattern and the neck is a multi-hinge joint.

The alternative method is manual eccentric-based work. Manual resistance works well because the neck muscles have what is known as an “acceleration strength curve”, which means a muscle can exert more force as it becomes fully contracted. Manual work allows the resistance to be applied in a way that better matches the strength curve of the neck muscles, i.e. applying more resistance when the neck muscles are at their strongest (contracted) and less when they are weakest (stretched).

Besides preventing concussions, increasing the strength of the neck has another benefit. World-renowned strength coach Charles Poliquin, who has worked with professional athletes from a variety of different sports, states that, “At the Poliquin Strength Institute we have found that there is a very strong correlation between the initial untrained strength levels of the neck extensors and the ability to gain strength in the upper body.”

Poliquin also says that the exact physiological mechanism for this is not known, but when the strength levels of the neck increase, the strength levels of the upper extremities also increase.

Loading Parameters for Neck Strengthening

For the majority of athletes the muscles of the neck are comprised of slow-twitch muscle fibers. This means that they’re not very strong (when compared to other muscle groups of relatively the same size), but they are very resistant to fatigue. Therefore, 1-2 sets of 15-20 reps for each function of the neck is recommended when beginning a neck-strengthening program.

As an athlete’s neck becomes stronger the same loading parameters apply as they apply to other muscle groups. When beginning a neck-strengthening program the number of repetitions per set is high and the number of sets is low. As strength levels increase the number of reps per set decreases, but the number of sets increase and the number of reps programmed should dictate the level of resistance.


 

Neck-Strengthening Loading Parameters

Weeks

Sets

Reps

*Tempo

Rest Interval

1-6

1-2

18-20

2010

60-75sec

7-12

2-3

15-20

2010

60-75sec

13-18

2-3

12-15

2020

60-75sec

19-24

3-4

10-12

3020

60-75sec

25-30

3-4

8-10

3030

60-75sec

*Tempo: First digit - number of seconds for the eccentric (stretching) component of exercise. Second digit - number of seconds taken at the stretched position of exercise; Third digit - number of seconds taken in the concentric (contracting) component of exercise; Fourth digit, the number of seconds taken in the fully contracted position of exercise.

Splitting neck training into different training days makes it easier to devote the time needed to undertake a serious neck-strengthening program. For example, pairing flexion and extension exercises together on one day and lateral flexion and rotational exercises together on another day.

One Division 1 football strength coach has his athletes spend the first 20-25 minutes of their workouts training the neck. Personally, I find this to be the best option as it ensures neck training is being treated as a priority, it’s done when the athletes are fresh and it builds accountability because the major compound lifts cannot be performed until all sets and reps have been completed for the neck.

Neck exercises should always be done to a smooth tempo (see the table above): no jerky movements. Always perform the exercises using a slow to moderate tempo, for example taking 2-3 seconds to stretch the muscles and 1-3 seconds to contract the muscles. Also ensure that each athlete understands the proper technique for administering manual resistance to teammates in order to avoid applying too much pressure at the weakest points in the strength curve.

In conclusion, a strength program’s primary role is to decrease the chances of an athlete becoming injured. The muscles of the neck are generally grossly underdeveloped in high school athletes making them more susceptible to concussions. There is a growing body of evidence that suggests strengthening the muscles of the neck is a very effective way of reducing the incidences of concussions.

 

For more information on neck training contact me at cdellasega@darisports.com.

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