A neck strength training protocol in high school football players for concussion risk reduction

Background: Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic. Purpose: To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes. Methods: This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer. Results: Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (p<0.001, figure 3). The team suffered 4 concussions in the 2018 season, 2 of which were sustained by athletes who did not participate in preseason neck training, compared to 12 concussions in 2017 and 7 concussions in 2016 (figure 3). Conclusion This study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program [Figure: see text][Figure: see text][Figure: see text]