An Accessible, 16-Week Neck Strength Training Program Improves Head Kinematics Following Chest Perturbation in Young Soccer Athletes

in Journal of Sport Rehabilitation
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Context: Neck size and strength may be associated with head kinematics and concussion risks. However, there is a paucity of research examining neck strengthening and head kinematics in youths. In addition, neck training is likely lacking in youth sport due to a perceived inadequacy of equipment or time. Objective: Examine neck training effects with minimal equipment on neck strength and head kinematics following chest perturbations in youth athletes. Design: Single-group, pretest–posttest case series. Setting: Athlete training center. Participants: Twenty-five (14 men and 11 women) youth soccer athletes (9.8 [1.5] y). Intervention: Sixteen weeks of twice-weekly neck-focused resistance training utilizing bands, body weight, and manual resistance. Main Outcome Measures: Head kinematics (angular range of motion, peak anterior–posterior linear acceleration, and peak resultant linear acceleration) were measured by an inertial motion unit fixed to the apex of the head during torso perturbations. Neck-flexion and extension strength were assessed using weights placed on the forehead and a plate-loaded neck harness, respectively. Neck length and circumference were measured via measuring tape. Results: Neck extension (increase in median values for all: +4.5 kg, +100%, P < .001; females: +4.5 kg, +100%, P = .002; males: +2.2 kg, +36%, P = .003) and flexion (all: +3.6 kg, +114%, P < .001; females: +3.6 kg, +114%, P = .004; males: +3.6 kg, +114%, P = .001) strength increased following the intervention. Men and women both experienced reduced perturbation-induced head pitch (all: −84%, P < .001). However, peak resultant linear acceleration decreased in the female (−53%, P = .004), but not male (−31%, P = 1.0) subgroup. Preintervention peak resultant linear acceleration and extension strength (R2 = .21, P = .033) were the closest-to-significance associations between head kinematics and strength. Conclusions: Young athletes can improve neck strength and reduce perturbation-induced head kinematics following a 16-week neck strengthening program. However, further research is needed to determine the effect of improved strength and head stabilization on concussion injury rates.

Le Flao, Pichardo, and Oranchuk are with the Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand. Ganpatt is with the Concussion Active Prevention Corporation, Calgary, AB, Canada.

Oranchuk (dustinoranchuk@gmail.com) is corresponding author.
  • 1.

    Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375378. PubMed ID: 16983222 doi:10.1097/00001199-200609000-00001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F. Sports- and recreation-related concussions in US youth. Pediatrics. 2016;138(1):e20154635. PubMed ID: 27325635 doi:10.1542/peds.2015-4635

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths-United States, 2007 and 2013. MMWR CDC Surveill Summ. 2006;66(9):116. doi:10.15585/mmwr.ss6609a1

    • Search Google Scholar
    • Export Citation
  • 4.

    Sim A, Terryberry-Spohr L, Wilson KR. Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes. J Neurosurg. 2008;108(3):511516. PubMed ID: 18312098 doi:10.3171/JNS/2008/108/3/0511

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Soccer UY. US youth soccer policy on players and playing rules. 2021. http://www.usyouthsoccer.org/assets/56/6/us_youth_soccer_policy_on_players_and_playing_rules.pdf2019.

    • Search Google Scholar
    • Export Citation
  • 6.

    Peak K, Elliott JM, Gardner A. Purposeful heading in youth soccer: time to use our heads. J Orthop Sports Phys Ther. 2020;50(8):415417. doi:10.2519/jospt.2020.0608

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Debison-Larabie C. Examining the Relationship Between Cervical Anthropometrics, Head Kinematics and Cervical Muscle Responses to Sudden Head Perturbations in Competitive Ice Hockey Players. Ontario, Canada: Health Sciences in Kinesiology, University of Ontario Institute of Technology; 2016.

    • Search Google Scholar
    • Export Citation
  • 8.

    Fukushima M, Kaneoka K, Ono K, Sakane M, Ujihashi S, Ochiai N. Neck injury mechanisms during direct face impact. Spine. 2006;31(8):903908. PubMed ID: 16622379 doi:10.1097/01.brs.0000209257.47140.fc

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Schmidt JD, Guskiewicz KM, Blackburn JT, Mihalik JP, Siegmund GP, Marshall SW. The influence of cervical muscle characteristics on head impact biomechanics in football. Am J Sports Med. 2014;42(9):20562066. PubMed ID: 24928761 doi:10.1177/0363546514536685

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Collins CL, Fletcher EN, Fields SK, et al. Neck strength: a protective factor reducing risk for concussion in high school sports. Prim Prev Insights. 2014;35(5):309319. doi:10.1007/s10935-014-0355-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Le Flao E, Brughelli M, Hume PA, King D. Assessing head/neck dynamic response to head perturbation: a systematic review. Sports Med. 2018;48(11):26412658. PubMed ID: 30242627 doi:10.1007/s40279-018-0984-3

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Tierney RT, Sitler MR, Swanik CB, Swanik KA, Higgins M, Torg J. Gender differences in head-neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc. 2005;37(2):272279. PubMed ID: 15692324 doi:10.1249/01.MSS.0000152734.47516.AA

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Müller C, Zentgraf K. Neck and trunk strength training to mitigate head acceleration in youth soccer players. J Strength Cond Res. 2020. (Ahead of print). PubMed ID: 33065700 doi:10.1519/JSC.0000000000003822

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Wahlquist VE, Kaminsky TW. Purposeful heading in youth soccer: a review. Sports Med. 2021;51(1):5164. PubMed ID: 33141286 doi:10.1007/s40279-020-01376-8

  • 15.

    Geary K, Green BS, Delahunt E. Effects of neck strength training on isometric neck strength in rugby union players. Clin J Sport Med. 2014;24(6):502508. PubMed ID: 24561636 doi:10.1097/JSM.0000000000000071

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Hislop MD, Stokes KA, Williams S, et al. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med. 2017;51(15):11401146. PubMed ID: 28515056 doi:10.1136/bjsports-2016-097434

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Lisman P, Signorile JF, Del Rossi G, et al. Investigation of the effects of cervical strength training on neck strength, EMG, and head kinematics during a football tackle. Int J Sports Sci Coach. 2012;6(3):131140.

    • Search Google Scholar
    • Export Citation
  • 18.

    Mansell J, Tierney RT, Sitler MR, Swanik KA, Stearne D. Resistance training and head-neck segment dynamic stabilization in male and female collegiate soccer players. J Athl Train. 2005;40(4):310319. PubMed ID: 16404453

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Versteegh TH, Dickey JP, Emery CA, Fischer LK, MacDermid JC, Walton DM. Evaluating the effects of a novel neuromuscular neck training device on multiplanar static and dynamic neck strength: a pilot study. J Strength Cond Res. 2020;34(3):708716. PubMed ID: 30946260 doi:10.1519/JSC.0000000000003091

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Hrysomallis C. Neck muscular strength, training, performance and sport injury risk: a review. Sports Med. 2016;46(8):11111124. PubMed ID: 26861960 doi:10.1007/s40279-016-0490-4

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Lisman P, Signorile JF, Del Rossi G, et al. Investigation of the effects of cervical strength training on neck strength, EMG, and head kinematics during a football tackle. Int J Sport Sci Eng. 2012;6(3):131140.

    • Search Google Scholar
    • Export Citation
  • 22.

    Becker S, Berger J, Backfisch M, Ludwig O, Kelm J, Fröhlich M. Effects of a 6-week strengthening of the neck flexors and extensors on the head acceleration during headers in soccer. J Sports Sci Med. 2019;18(4):729737. PubMed ID: 31827358

    • Search Google Scholar
    • Export Citation
  • 23.

    Mihalik JP, Guskiewicz KM, Marshall SW, Greenwald RM, Blackburn JT, Cantu RC. Does cervical muscle strength in youth ice hockey players affect head impact biomechanics? Clin J Sport Med. 2011;21(5):416421. PubMed ID: 21892015 doi:10.1097/JSM.0B013E31822C8A5C

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Gilchrist I, Storr M, Chapman E, Pelland L. Neck muscle strength training in the risk management of concussion in contact sports: critical appraisal of application to practice. J Athl Enhanc. 2015;4(2):119.

    • Search Google Scholar
    • Export Citation
  • 25.

    Nazarahari M, Arthur J, Rouhani H. A novel testing device to assess the effects of neck strength on risk of concussion. Ann Biomed Eng. 2020;48(9):2310–2322. PubMed ID: 32253614 doi:10.1007/s10439-020-02504-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Han TS, Oh MK, Kim SM, et al. Relationship between neck length, sleep, and cardiovascular risk factors. Korean J Fam Med. 2015;36(1):1021. PubMed ID: 25780512 doi:10.4082/kjfm.2015.36.1.10

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5 th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838847. doi:10.1136/bjsports-2017-097699

    • Search Google Scholar
    • Export Citation
  • 28.

    Fisher JP, Asanovich M, Cornwell R, Steele J. A neck strengthening protocol in adolescent males and females for athletic injury prevention. J Trainol. 2016;5(1):1317. doi:10.17338/trainology.5.1_13

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Stoykov ME, Madhavan S. Motor priming in neurorehabilitation. J Neurol Phys Ther. 2015;39(1):3342. PubMed ID: 25415551 doi:10.1097/NPT.0000000000000065

  • 30.

    Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Norris JB, Hinton RY. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med. 2011;39(5):958963. PubMed ID: 21278427 doi:10.1177/0363546510392326

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495503. PubMed ID: 18174937

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Eckner JT, Oh YK, Joshi MS, Richardson JK, Ashton-Miller JA. Effect of neck muscle strength and anticipatory cervical muscle activation on the kinematic response of the head to impulsive loads. Am J Sports Med. 2014;42(3):566576. PubMed ID: 24488820 doi:10.1177/0363546513517869

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Gutierrez GM, Conte C, Lightbourne K. The relationship between impact force, neck strength, and neurocognitive performance in soccer heading in adolescent females. Pediatr Exerc Sci. 2014;26(1):3340. PubMed ID: 24091298 doi:10.1123/pes.2013-0102

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Eckner JT, Goshtasbi A, Curtis K, et al. Feasibility and effect of cervical resistance training on head kinematics in youth athletes: a pilot study. Am J Phys Med Rehabil. 2018;97(4):292. PubMed ID: 29557889 doi:10.1097/PHM.0000000000000843

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Mortensen JD, Vasavada AN, Merryweather AS. Sensitivity analysis of muscle properties and impact parameters on head injury risk in American football. J Biomech. 2020;100:109411. PubMed ID: 31982110 doi:10.1016/j.jbiomech.2019.109411

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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