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Researchers, doctors and athletic trainers are always searching for ways to prevent concussions. Part of that requires having a better idea of the risks athletes face.

But parents can put athletes at greater risk for other health problems by taking drastic actions to protect their children.

“My biggest worry with concussions right now is the fact that we are terrifying parents about playing sports, whether it be soccer, football, rugby, lacrosse, hockey, basketball, you name it. We’re terrifying our parents and they’re making decisions about activities, and that’s the worst thing we can do,” said Dr. Paul Berkner, director of the Maine Concussion Management Initiative at Colby College.

“We have a population of young adults who don’t do anything near as much. Our obesity rate in children in Maine is terrible. If we start having people not participating, I think the long-term risks from obesity are probably higher than the long-term risks from concussions,” Berkner said.

Athletes can take steps to reduce their risk of concussions, experts say. Some are quite basic.

“Being in good overall physical condition is very, very important,” said Dr. Chris Lutrzykowski, a specialist with Maine General Health.

Much like tackling in football, experts are still debating banning or placing age restrictions on heading in soccer. Some suggest simply enforcing the rules will reduce aggressive body contact and reduce concussions, while others believe that even repetitive head-to-ball contact in younger children can cause brain trauma.

More and more soccer players are now wearing headgear for protection. The equipment, which can cost anywhere between $20-$80, can prevent external head injuries such as cuts and bruises, but experts say they don’t have a clinical link to reducing concussions.

“There is no data that supports the use of headgear makes a difference whatsoever,” Berkner said. “In football, helmets are designed to reduce skull fractures, not to reduce concussions.”

Lutrzykowski said some studies have shown improved neck strength can reduce the risk of soccer concussions. Stronger necks can reduce the whiplash effect that can cause or exacerbate a concussion.

With that in mind, Colby College head athletic trainer Tim Weston said his athletes are incorporating more exercises to strengthen their necks and trapezius muscles into their conditioning programs.

Contact from heading the ball is the biggest risk factor, although head-to-head or head-to-body contact poses a far greater risk than head-to-ball contact.

“I think it’s critical to have that neck and upper-body strength, particularly in soccer,” he said.

Neck strength and myoelectric fatigue in fighter and helicopter pilots with a history of neck pain.
Neck strength and myoelectric fatigue in fighter and helicopter pilots with a history of neck pain.


Flight-induced neck pain at high Gz loads or during sustained rotary-wing missions may be caused by limitations in neck muscle function. A better understanding of the contributing factors of excessive external load and internal neck-stabilizing mechanisms would improve the ability to prevent and treat such pain. The aim of this single-blinded cross-sectional study was to evaluate neck neuromuscular function in fighter and helicopter pilots who suffered from frequent neck pain.


Subjects with pain were 16 fighter pilots (FP-P) and 15 helicopter pilots (HP-P) with frequent neck pain episodes who were compared with pain-free controls (FP-C and HP-C). In all groups, neck extensor and flexor muscles were studied by measuring 1) the strength of maximum voluntary contraction (MVC), and 2) fatigue due to a submaximal isometric contraction. The decline (slope) of the electromyogram (EMG) median frequency power spectra was used as an index of fatigue, while initial median frequency (fi) was taken from the intercept of the regression line.


Two-way analysis of variance (ANOVA) revealed interaction effects for extensor MVC. Post hoc testing showed that FP-P had significantly lower extensor MVC (p = 0.03) than FP-C, while there was no such difference for the HP-P vs. HP-C or between the two control groups. There were no significant effects for MVC-balance (flexors/extensors); nor were there any fi or extensor EMG-slope effects. However, there were interaction effects for flexor EMG-slopes: HP-P showed lower slopes than did HP-C (p = 0.02).


To protect and stabilize the head and neck in high Gz environments, higher neck muscle strength is needed; less muscle strength in FP-P may cause further pain and perhaps reduced mission effectiveness. Less localized steep slopes for HP-P might reflect impaired muscle functioning. Specific preventive and clinical attention may be warranted for different types of pilot.

Women are at greater risk than men of concussions in both high school and college athletics, yet the attention and research is focused on male athletes. Scientists don’t know why girls and women report more concussions than their male counterparts, especially given that most female sports have fewer collisions than male sports. Theories include differences in neck muscles, hormones or willingness to acknowledge symptoms.

Tori Bellucci steadied her balance, dizzied by climbing a flight of stairs at Huntingtown High in 2012. She couldn’t remember the next class on her schedule — one she'd had for two months — so she ducked into the bathroom to take a look at her schedule.

Both [Comstock and Crutchfield Studies] suggested weaker muscles and tighter ligaments in female necks relative to boys’ as another potential cause [of concussion]

Pro players speak out about the ‘absurdity’ of the concussion protocol in women’s soccer...

EVERY FOUR YEARS or so, some of the world's most prominent scientists gather to synthesize and summarize the latest in brain-injury research. Since first meeting in 2001, the assemblage, called the Concussion in Sport Group, has grown in size and influence. Doctors, athletic trainers and media types around the world take their cues from the recommendations it publishes and from the Sport Concussion Assessment Tool (SCAT) it has developed. When members gathered in Berlin last October, Jiri Dvorak, then FIFA's chief medical officer, said they worked on behalf of some 1 billion professional and amateur athletes. For that 2016 symposium, around 400 medical and sports professionals met in the Grand Ballroom of the Ritz-Carlton hotel, with art nouveau stylings that hark back to the days before the world wars and trappings so posh that guests enjoy breakfast honey harvested from a rooftop beehive. Over two days, a stone's throw from where the Berlin Wall used to stand, the leading lights of the sports neuro-establishment made clear their role as gatekeepers of concussion research. Organizers closed the conclave to the media and swatted audience members off social media.

There was another group almost entirely shut out of the 5th International Consensus Conference on Concussion in Sport: female athletes.

Seifert came to the conference to speak about how neck strengthening may help prevent concussions. Women athletes get concussions at a higher rate than males. One theory which may explain why has to do with neck strength. Originally Published by USA Today

The weaker your neck, the more likely your head will bob around on impact. And concussions are caused by the brain shaking inside the skull.

“Teams that weren’t doing these isometric neck exercises were five times more likely to suffer a concussion than teams that were which is absolutely huge,” Benson says. “It’s very significant.”

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"I assure you there are very few programs training the neck," Gittleson said. "It's unbelievable. In high schools, it's probably worse. We have these magnificent bodies, and we're not attending to the cylinder that protects the skull. We need to build to deflect and dissipate force."

American soccer star Brian McBride played 17 professional seasons and suffered only one documented concussion. He also played a pretty mean air guitar. Is there a correlation? “People ask me, ’How did you get your neck so strong?’” the former Columbus Crew SC striker said. “I used listen to heavy metal music and I would head bang. I’m not kidding. My answer is a bit silly, but I think it helped with my neck strength.”

In a study of 14- to 18-year-olds in 40 schools, those completing the exercises three times a week saw 59% fewer concussions than other schools. The exercises focus on increasing neck muscle strength, balance and movement.

"I thought clearly we would find a correlation between bigger, fatter necks and lesser concussions, but we didn't find it," Cantu said. " ... Some individuals with taller, slender necks surprisingly had greater strength than other individuals with shorter, fatter necks."

What Cantu and Comstock have found to be the crucial measurement is the actual strength of the neck, which they documented using scales that measured the pounds a neck could move. Their data shows that the quartile of athletes with the weakest necks suffered the greatest number of concussions, while the quartile with the strongest necks suffered the fewest.

Teams purchase helmets more frequently, wear Guardian Helmets (with added padding) at practice, preach hydration, and building up kids’ neck muscles in hopes of better absorbing any impact to the head. Riddell offers an InSite helmet with a impact-response system that is designed to measure the severity of the impact a player sustained.

Prompted by a rash of on-field concussions, the NFL, NCAA and other sports organizations are now spearheading efforts to keep their athletes safer. Updated regulations regarding protective equipment are being enacted, as are new rules to protect players. Although protective equipment technology has improved dramatically over the years, athletes—particularly those engaging in contact sports—are still falling victim to concussions.

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In self-report data that we will explore further in a future column, college female ice hockey players have the highest odds ratio of developing concussion, even when considering football, a male-only event. Thus, female athletes seem uniquely predisposed to suffering with more concussion and worsened concussion symptomatology relative to males. What is startling is that even in lacrosse, female athletes seem to suffer concussion at a similar incidence to males, but female lacrosse is not a contact sport, whereas male lacrosse is a contact sport.

In a study of collegiate athletes, the highest rate of concussions was reported not by male football players, but by female ice hockey players.

Lutrzykowski said some studies have shown improved neck strength can reduce the risk of soccer concussions. Stronger necks can reduce the whiplash effect that can cause or exacerbate a concussion.

In today’s NFL, many strength coaches are expected to adapt their programs around what the players want or risk getting fired.

“If all our focus is on performance and not prevention, we throw the sport in crisis,” said Mark Asanovich, a 14-year NFL strength coach who spoke at the Legends of Strength symposium. “That’s why we have the epidemic of concussions and escalation in injuries.

Alex Marvez of attended a symposium in Cincinnati over the weekend that gathered 100 strength and conditioning coaches, with the focus being on preventing head trauma through neck exercises. The coaches believe neck strength makes all the difference.

“We’ve got all this information about kids and brain damage. But nobody is talking about any preventative measures,” said former Bengals strength coach Kim Wood, who help organize the weekend.

“We probably put more emphasis on the neck because of the concussion aspect that now is part of our daily life,” Ravens strength coach Bob Rogucki said. “We want to minimize [the chances] and hopefully prevent, but you may not ever prevent it. The chance is always going to be there.

Cantu's says a kid's head also sits on a less developed neck and torso than an adult's does — so the same blow might cause more shaking to a kid's head than it would to a grown up's.

Stronger helmets, teaching players to tackle differently, and changing the overall "let's kill 'em" culture are the points usually brought up when discussing how to solve the NFL's dangerous concussions issue.

But there's an easier way to improve the limit the number of potential concussions in football: greater neck strength.

The latest piece of research to emerge has pointed to neck strength being a catalyst to concussions, with players with stronger necks less likely to suffer according to the Otago-based study.

Dr Barry O’Driscoll, who was a medical advisor to World Rugby before he stepped down in 2012 due to their handling of concussion, believes that the latest theory is “definitely worth looking into and it wouldn’t surprise you” if it was validated.

"We found players with stronger necks had lower acceleration or whip-lash like movement.

"The stronger you can make the neck the less the head accelerates - it controls the brain's movement against the skull."

Salmon said coaches at all levels needed to put as much value on neck strengthening exercises as they did fitness and skills.

"As a strength coach, I've noticed the neck area is overlooked in the weight room. The neck is comprised of a small group of muscles that have a limited range of motion. Training your neck is not glamorous, but it is absolutely necessary for football players."

Football coaches are reminding players about good tackling techniques ever since the cervical spine injury of Kevin Everett, tight end for the NFL's Buffalo Bills. But one coach, who also runs a spine care clinic in in Portland, Ore., says neck strengthening at younger ages can also help.

“Recent studies show that improving cervical spine and neck strength helps to limit transitional forces that can cause concussion,” said Dr. Patrick Kersey, USA Football’s medical director of St.Vincent Sports Performance in Indianapolis. “Head injuries are caused by a sudden change in directional force. That additional strength gives the athlete the potential to protect them more.”


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