March 22, 2019 • Strength & Conditioning

Powerline: Why all athletes must strengthen the neck

I learned about the importance of training the head and neck musculature early in my career. As a high school coach in the mid-1970s, our staff attended several spring football clinics at Penn State University. Dan Riley, who was the head strength and conditioning coach, would always emphasize strengthening the neck region in his presentations. I came away with a better understanding of why Riley put a premium on neck training, as well as some practical information on the administration of properly performed, partner manual resistance techniques.

At the time, addressing catastrophic cervical injuries was the main impetus behind Riley’s focus, and rightfully so. Combined with proper head positioning when blocking and tackling, and not making the head (especially the crown) the primary point of contact, the message was that neck strengthening could add another layer of protection to the cervical region.

It was during my high school coaching tenure that the NCAA and the National Federation of State High School Athletic Associations (NFHS) adopted rules to discourage head-first tackling and blocking techniques. I can attest to the fact that these techniques were taught and encouraged prior to that time. “Stick him,” which referred to leading with the head, was a phrase that could be heard during every football practice and game, at every level.

Clockwise from top left: Bilateral shrugs, neck extensions, lateral flexion and forward flexion should be performed two to three days per week by athletes who are exposed to the possibility of cervical injury or concussion. Each photo shows the mid-range position of the exercise.

The consequences of this technique were catastrophic for some, including cervical spine injuries resulting in paraplegia and quadriplegia. These serious, life-threatening injuries are the result of axial loading (the chin is down to approximately 30 degrees) upon contact, placing the cervical spine in a relatively straight column. A high-velocity collision made with the crown of the head when it’s in this position is likely to buckle the cervical spine under the stress. Essentially, the kinetic energy produced by the contact is transferred to the cervical column resulting in excessive axial loading. The concurrent buckling is a mechanism of energy release that is produced when slender, segmented structures are subjected to this type of compressive loading. If the bony fragments encroach the spinal cord, the results can be devastating.

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Both the NCAA and NFL now have “targeting” rules, designed to discourage helmet-to-helmet hits and any blows above the shoulders on defenseless players. And while football is the sport that comes to mind when discussing this event, it can occur in a host of other sports where collisions are inevitable.

As Riley would teach, strengthening the interwoven muscular structures that support and protect the cervical spine is crucial to the prevention plan. Additionally, teaching athletes the following competitive rules of engagement are imperative:

• Keep the head up, but do not use it as the primary point of contact. This places the cervical spine in a more favorable, stabilized and braced position. In football, and any other sport where physical contact and collisions are commonplace, the initial points of contact should be the shoulders, chest area, arms and hands.

• See the target. Visualizing what’s about to happen allows the neuromuscular system to brace for the ensuing collision by sub-conscientiously initiating contraction of protective musculature.

The paramount take-home point here is this: A strong neck will not necessarily prevent a serious cervical spine injury if axial loading is its mechanism. Keep the head up and neck musculature braced, and do not use the head as the primary point of contact.

Neck strength and concussions

With regard to neck strength as a protective factor in the incidence of concussions, the implications transcend the sport of football.

A landmark study using a new, cost-effective, hand-held tension scale device to measure neck strength found that neck strength was a significant predictor of concussions. The odds of concussion dropped by 5 percent for every 1 pound increase in composite neck strength. Additionally, the data showed that high school athletes with the weakest necks participating in soccer, basketball and lacrosse suffered the greatest number of concussions, while those with the strongest necks suffered the fewest.

Dawn Comstock, one of the study’s authors, indicated during a presentation at the Fourth Annual Youth Sports Safety Summit in 2013 that weaker (smaller) necks lead to higher susceptibility of concussions. Concussed athletes had a smaller mean neck-circumference-to-head-circumference ratio
(i.e., a small neck paired with a large head) and less overall neck strength than athletes who did not suffer a concussion. After adjusting for gender and sport, overall neck strength remained a statistically significant predictor of concussion.

A concussion is a brain injury. It’s defined as a complex pathophysiological process induced by mechanical forces that impact the brain. Concussions may be caused by — but not restricted to — a direct blow to the head, face or neck. However, any blow to the body that results in impulsive
forces directed to head and neck region can be the culprit.

Blows to the head can cause a shearing (i.e., acting parallel to a surface) injury to nerve fibers and neurons in proportion to the degree the head is accelerated and as these forces are imparted to the brain. Hits to the side of the head tend to produce greater acceleration forces than those to the face. These shearing forces placed upon blood vessels can cause bleeding between the brain and skull.

It’s clear that anything that can be done to abate concussions and the trauma leading to them must be done with consistency.

The basics

Though head and neck training can take on a long list of approaches and recommended exercises, forward flexion, lateral flexion, extension and shrugs should be performed two to three days per week by all athletes who are exposed to the possibility of cervical injury or concussion. We normally assign two sets of eight to 10 reps for each movement. We also control increments based on the length of time at each prescribed weight, which can range from three to four weeks. Movements should be executed in a smooth, controlled fashion, with a slight pause at the mid-range point. For forward flexion, lateral flexion (both right and left), and extension, the starting and ending points should be at an approximate head-neutral position.

Ken Mannie is the head strength and conditioning coach Michigan State University. His column, Powerline, appears regularly in Coach & Athletic Director magazine. 

1. Collins, C.L., Fletcher, E.N., Fields, S.K., Kluchurosky, L., Rohrkemper, M.K., Comstock, R.D., Cantu, R.C., Neck Strength: A Protective Factor Reducing Risk for Concussions in High School Sports, Journal of Primary Prevention, 2014.

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