SPORTS MEDICINE
One of the few good things about summer turning into fall is the return of fall sports. Recently however, there has been great concern over concussions and their long term effects. According to the CDC, “a concussion is a type of traumatic brain injury (TBI) caused by a bump or blow to the head or body that causes the head and brain to move rapidly back and forth.” A multimodal approach must be taken to limit the incidence of concussions in all athletes, but especially the younger ones, as they are more susceptible to concussions and post concussion syndrome. By wearing protective equipment, changing rules, limiting exposure and teaching proper technique, we can begin to protect athletes. The focus of this blog will be on preparing athletes physically to absorb blows that can potentially cause concussions. I will discuss why, when and how neck strengthening should be completed.
Recently, studies have been completed which confirm that concussions, especially multiple concussions are implicated in long term progressive damage. Even non-symptomatic non concussive hits have been implicated in long term brain damage. The long term damage seen is called Chronic Traumatic Encephalopathy or CTE. The symptoms of CTE are wide ranging, but include headaches, decreased cognition and depression. This makes prevention of concussions critical for the coach, athlete, parent and medical professional.
Research suggests that strengthening the neck can reduce the odds of getting a concussion. Increasing neck strength by 1 psi as measured by a hand held dynamometer can help decrease the odds of getting a concussion by 5%. (Collins et al)
Low level neck strengthening is simple and requires no equipment. It can be done in the gym after practice, or even on the field with a partner. It is important to note that neck strengthening should NOT begin when an athlete is recovering from a concussion. Neck strengthening should only be initiated when the athlete is completely healthy!
Strengthening the neck has some risk. Some athletes can develop feelings of stiffness and in some cases even pain. A thorough history, and a consultation by a physician must be completed prior to initiating the strengthening program. Research suggests that strengthening weak muscles decreases the odds of a concussion. However, the returns begin to diminish as the neck becomes stronger. Therefore, I think the best approach to neck strengthening is sub maximal isometrics. The specificity of isometrics also dictates that it may also be beneficial to perform them at multiple angles. Utilize three sets of 8-12 repetitions with a 5 second isometric hold. This is a good general strength protocol that will develop adequate strength. You can apply the resistance manually or do it as a partner drill. For a quick video on how to perform this basic drill click here.
Another method that can be used is lying prone, supine, and side lying on a bench or treatment table and performing various arm movements with your head unsupported off of a bench/treatment table. Improving specificity by adding dynamic arm movements while simultaneously contracting the neck musculature to maintain your head and spine in a neutral position can be beneficial.
As with all strength training, the athlete must learn how to apply the newly developed strength during competition. This can be accomplished by having the athlete clench down on their mouthpiece before hitting a sled or going up for a header. During this phase of training I would also spend ample time teaching the athlete proper technique and postures that allow them to both give and receive forces.
Although this may only prevent a few of the millions of concussions that happen annually, it should be part of the multimodal approach to decrease the incidence of concussions. Neck strengthening is both simple and quick. It is worth performing to both protect young athletes and allow them to continue to play the sports that they love.
References:
Beardsley, C. (n.d.). Could strength training help prevent concussions? Retrieved August 22, 2017, from www.strengthandconditioningresearch.com
Collins, C. L., Fletcher, E. N., Fields, S. K., Kluchurosky, L., Rohrkemper, M. K., Comstock, R. D., & Cantu, R. C. (2014). Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports [Abstract]. The Journal of Primary Prevention, 35(5), 309-319. doi:10.1007/s10935-014-0355-2
Ryan Correia, PT-A
