September 18, 2012 • Sports Medicine & Nutrition

Strengthening the neck protects your athletes

New research offers evidence-based protocol, which may be a step in reducing concussions

By Ralph Cornwell, Ph.D. and Mark Asanovich, MS, Virginia Tech University, Blacksburg, Va.

As strength and conditioning professionals, you are charged with the duty of first and foremost protecting the health of your athletes. Protection first and performance second is the priority. The well being of the individuals who have entrusted their health to our care hangs in the balance and to do this, training the head, neck and surrounding muscular structures of the cervical spine, whether athlete or non-athlete, must be your top priority.

By training the head, neck and trapezius muscles, strength coaches enhance both the protection and performance of their athletes. A stronger neck increases the strength of an athlete, who then functions at a higher level of work. For example, consider that the trapezius muscles run from the base of the posterior skull to the thoracic vertebrae twelve. By neglecting the head, neck and upper back muscles in training regimens, it predisposes the athletes to injury. While orthopedic surgeons can repair many soft-tissue and bone-related injuries, which then allows athletes to compete again, the head and cervical spine, however, are not areas of the body where successful surgical outcomes are likely, even with the advances in modern medicine.

Proactive Method Needed To Stop Concussions

There are many concussion-management programs emerging across the United States. Sadly, most programs only address what to do after the athlete has concussed, rather than implement preventive sports medicine measures prior to the episode.

The rate of concussion has increased steadily over the past two decades. This trend likely is caused by improvement in the detection of concussion, but also may reflect an increase in the true number of concussive impacts occurring. As athletes get bigger, stronger and faster, it is logical to figure forces associated with their collisions also increase in magnitude. It is important to realize there is currently no effective headgear to prevent concussions; therefore, as the number of forceful collisions increases, the number of concussions would be expected to increase.

Concussions have become a national epidemic. Millions of dollars have been spent to fund studies over the last 15 years. The research continues but the number of concussions in athletics increases each year. Something proactive needs to be done.

Project Neck

My research, combined with input from some of the greatest minds in strength and conditioning, has resulted in Project Neck, which produced an evidence-based protocol to protect your athletes.

Project Neck is the first and only research study to conclusively demonstrate through mathematical models that as strength increases in the head and neck muscles, kinetic energy from concussive and sub-concussive impacts can be better dissipated.

Female Study Results

+45 LB Increase in Head and Neck Extension
+35 LB Increase in Extension
+45 LB Increase in Head and Neck Flexion +35 LB Increase in Flexion
+185 LB Increase in Parallel Grip Row +140 LB Increase in Parallel Row
+150 LB Increase in Bilateral Shrug +80 LB Increase in Bilateral Shrug
+140 LB Increase in Levator Scapula +80 LB Increase in Levator Scapula

The most improved results are listed immediately next to the least improved for comparison and to make a very important point. As unbelievable as the most improved results are…the least improved results are quite remarkable as well. If the outcomes attained by the least improved subjects are achieved in most training venues, the preventative influence this could have on cervical spine injury and concussive pathologies is highly significant and could make a prolific impact on the incidence and severity of cervical spine and concussion pathologies.
NOTE: All female subjects were measured for upper and lower neck circumferences. There were no increases with the exception of one who increased lower neck circumference 1/32 of an inch. Proper head and neck strengthening does not result in the development of masculine physical features in females.

The mathematical equivalent to the structure of the neck is a cylinder. As such, if there is an increase in circumference (as is the case with hypertrophy in most males) or stiffness (as is the case with strength increase without a compensatory increase in hypertrophy, as is the case with most females), the cylinder better dissipates kinetic forces, which results in less deformation (or movement) of the neck. Consequently, if there is less movement of the neck, there is less movement of the head, which ultimately results in less movement of the brain.

The focus here is to break down the research data of Project Neck–The Female Study. The research study was conducted at The Elon University Neurosciences Laboratory located in North Carolina. Healthy females ranging in age from 18 to 24 were selected as tests participants. The study lasted eight weeks in duration. The subjects came from various fitness and activity levels. The females trained twice a week compared to their male counterparts in the Male Study (still being measured) and had similar statistical outcomes.

A dynamic progressive resistance training protocol was designed to specifically target the muscles reducing forces to the head. These include the anterior and posterior capital muscles of the head and upper cervical spine, and the muscles that surround the cervical spine and the surrounding musculature of the upper and mid-back.

The head and neck are two separate segments working together as one and should be trained as such. This study is the first research to examine what occurs if the deep capital muscles of the head are trained separately from the superficial muscles of the neck. The research also includes exercises for the upper back and the highest and lowest fibers of the trapezius.

The purpose of the research study is two-fold–increase neck cylinder size of the human neck and increase muscle strength and stiffness in the muscles of the head, neck and upper back.

There were four specific scientific questions posed.

1. Will the increase in surface area due to neck cylinder size gain (hypertrophy) lower concussive and subconcussive forces?

2. Will strength increases affectively alter muscle stiffness, thus lowing deformation of head and neck cylinder segment during impact?

3. Will anatomical and morphological changes produced in the test subjects result in a more effective kinetic energy dissipater?

4. With statistical data collected, can a mathematical model demonstrate that forces (concussive and subconcussive) be significantly lowered as a result of the research protocol?

Exercise Protocol

All exercise protocols were conducted and supervised at Elon University Sports Performance Laboratory. A starting weight was determined by the amount of weight a participant safety could use while performing the protocol for 12 repetitions in good form.

The test subjects performed six head and neck movements on a four-way neck and shrug machine: front flexion, extension, lateral flexion (both right and left), the “nod” (10 degrees of head flexion, which is the movement resembling a person nodding “yes”) and the “tilt” (25 degrees of flexion with the jaw is jutted outward and head is gently tilted back).

The 35-degree range of motion represents the movement of the head not involving the neck with the exception of the atlas and axis vertbrea. By isolating the muscles of the head, this allows for the strengthening of the capital muscles of the head.

This is followed by a seated bilateral shrug, also performed on the neck machine to intervate the lower trapezius muscles. A unilateral shrug is then performed on the same machine to intervate the upper trapezius. The Levator Scapula Shoulder Elevaton Shrug (LSSES) is a movement to innervate the upper trapezius and the muscles surrounding and involved in scapular retraction. The LSSES is accomplished by placing a standard olympic bar on the posterior of the neck, at the nape or appoximately at cervical vertebrae seven. The subject then performs scapular retraction. The retraction of the scapula allows the bar to rise vertically at that point as the trapezius shrugs vertically. This allows the subject to train upper trapezius and other muscles without the limiting the factor of grip strength.

Next, seated rows are performed on the iso-lateral row using a parallel grip. This movement allows for the innervation of the large muscles of the back (i.e. latissimus dorsi, rhomboids major and minor with contribution of the posterior deltoid). A scapular shrug is performed on the iso-lateral row to involve the muscles of the upper back, posterior deltoid and the rhomboids involved in scapular retraction. The scapular shrug movement requires the particpant to keep the arms straight as they use a parallel grip, so the scapula is retracted. It is the retraction and contraction of the upper-back muscles that successfully moves the weight loaded onto the row.

The retraction and pull is accomplished by using a supinated grip on the other horizontial handles. With straight arms and retraction of the scapula, the lifter then flexes elbows 90 degrees appoximately eight to 12 inches allowing for maximum intervation of the middle trapezius and fibers to the lowest fibers terminateing at thoracic vertebrea 12 musculature. The repetition range is 12 repetitions or until a repetition cannot be performed with good form. Neck circumference measurements are taken at the beginning of each training session. There was a 15-second rest period between sets.

Conclusion & Discussion

The results of this study demonstrate that females can increase head and neck strength safely and with significant gains. The female neck during this study showed a very minimal increase in circumference while strength level increases were substantial (the control group showed zero change in strength and neck circumference size).

The females did not exhibit the hypertrophy of their male counterparts, in comparison with a previous study by this author (the men’s study); the strength gains obtained will add stiffness to the muscle trained both passively and actively.

This researcher hypothesizes that the strength/stiffness increase will lower both concussive and sub-concussive forces. It is intuitive that a stronger athlete will be a better-protected athlete and less susceptible to injury. If the body is to be prepared for competition, strengthening and protection of the head and neck should certainly be of the highest priority. The results of force reduction and stiffness increases are computed using mathematical probabilities based on the large strength gains of the test participants.

On another note, the University of Memphis football strength staff initiated a simple neck strengthening program and reduced concussions by 50 percent. The leading neurologist and concussion researcher in the United Sates, Dr. Robert Cantu, now believes making the neck stronger may be the only proactive means to lowering concussion rates in competitive athletics. This research currently provides the only evidence-based, sports medicine approach to training the capital muscles of the head and the cervical muscles of the neck.

If you have questions on this research, Dr. Cornwell encourages you to email him at [email protected]

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