Neck Strengthening: A Key to Reducing Concussion Risk in Contact Sports

As clinicians working with athletes in contact sports, we're all too familiar with the devastating impact of concussions. For years, we've focused on helmet technology and rule changes, but what if a key piece of the puzzle lies in the athlete's own body? We're talking about the neck. A growing body of evidence suggests that a stronger neck may be a critical factor in reducing concussion risk. In this brief, we'll delve into the latest research on neck strengthening for concussion prevention and provide practical takeaways for your clinical practice. So, what's the connection between neck strength and concussions? When an athlete sustains a blow to the head, the head accelerates and decelerates rapidly, causing the brain to move within the skull. This is the mechanism of a concussion. A stronger neck can help to absorb and dissipate the forces of an impact, reducing the amount of head acceleration and, theoretically, the risk of concussion. Think of the neck as a shock absorber for the head. The stronger the shock absorber, the less force is transmitted to the brain. Recent research has started to quantify this relationship. A 2024 literature review in the *American Journal of Physical Medicine & Rehabilitation* found that isometric neck strength, but not neck size, is a predictor for sport-related concussion prevention. This is a key distinction. It's not about having a bulky neck, but about having a strong, functional neck. The review also found that formal neck strengthening programs are feasible and can lead to a decreased risk of sport-related concussions. This is great news for us as clinicians, as it suggests that we can make a real difference with targeted interventions. While the evidence is promising, it's important to note that the optimal parameters for neck strengthening programs are still being investigated. The 2024 review by Silverman et al. concluded that the optimal duration, intensity, and frequency of these programs have yet to be determined. This is where our clinical judgment comes in. We need to tailor our programs to the individual athlete, considering their sport, position, and baseline neck strength. A 'one-size-fits-all' approach is unlikely to be effective. So what does a neck strengthening program look like in practice? The research points towards a focus on isometric exercises. These are exercises where the muscle contracts without any visible movement. For the neck, this could involve pushing the head against an immovable object, such as a wall or the clinician's hand, in different directions (flexion, extension, and lateral flexion). The goal is to build strength and endurance in the cervical muscles. It's also important to include dynamic exercises that mimic the movements of the athlete's sport. For example, a rugby player might benefit from exercises that involve resisting a force while moving their head and neck. It's also crucial to consider patient selection. Not every athlete needs a comprehensive neck strengthening program. We should focus our efforts on athletes in high-risk sports, such as football, rugby, and ice hockey. We should also consider athletes with a history of concussion, as they may be at an increased risk of future injuries. A thorough assessment of the athlete's neck strength and function should be the first step in determining if a neck strengthening program is appropriate. In conclusion, neck strengthening is an emerging and promising strategy for concussion prevention in contact sports. While more research is needed to determine the optimal training parameters, the current evidence suggests that a focus on isometric neck strength can be beneficial. As clinicians, we have a unique opportunity to be at the forefront of this evolving field. By incorporating evidence-based neck strengthening programs into our practice, we can help to protect our athletes from the devastating consequences of concussions.