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Coach and Athletic Director

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


MOST IMPROVEMENT
+45 LB Increase in Head and Neck Extension

LEAST IMPROVEMENT
+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 intelligentexerciserx@gmail.com.

COMMENTS: 10
Concussions
Posted from: Lawrence Bullock, 7/2/13 at 12:55 AM CDT
The neck is the easiest muscle to develop with resistance, it is important to teach tension of neck during tackling form with shoulder it is important to tense arms back slightly to activate neck and shoulder ligaments, not swing neck left or right .any neck strength exercises is active to help prevent head and neck injury, I do not believe we had that many concussions in College Football when we were doing neck exercises during before and after practice daily plus weight training
The Battle of the Concussion Experts
Posted from: Rey Hernandez, 6/29/13 at 1:25 PM CDT
Unfortunately coaches are stuck right in the middle when it comes to research and concussions. Dr. Cromwell's credentials are posted but not Dr. Cam's but I would like to see what his credential's are and a bit more about his scientific research before I summarily dismiss his position. Neck strenghting has always been an important part of the equation but unfortunately not all coaches place a high priority on it on the high school level. What is happening now is what I feared was going to happen as the concussion debate started to spin out of control fueled primarily by the NFL's litigation troubles. The issue is a serious one but I'm having to ask myself who am I to believe. A University of Pittsburgh study was just published that concluded that not enough contact may be detrimental on the Pop Warner level. The response to this study by a neurosurgeon on Pop Warners's youth football advisory board was that the study was erroneous in its conclussion and not sending the right message. I'm certain that more of this type of disagreement is sure to surface as the concussion debate intensifies. If limiting contact time advocates are correct we are moving in the right direction, but if they are not we are placing the players in a more dangerous practice setting. The limitations on contact time I believe have serious implications on all levels and needs to be investigated further. For now my plan is to look at all studies closely and not dismiss any of them, especially when they do not agree with the mainstream point of view. I will rely on my personal experience as a football coach and take everything into account. I will look closely for any financial implications. Look at the health care industry. How many drug studies are funded by companies that want to get a drug on the market ot sell a product or device? It is no differnt in the concussion context.
Clueless Cam
Posted from: Dr Ralph Cornwell Jr, 6/28/13 at 4:23 PM CDT
If Cam believes you are better prepared with a small, weak neck while playing sports, Cam is a fool. Do nothing but talk about what we should do are fueling concussion ignorance. Game awareness alone increases passive stiffness. The body awareness of an athlete during competition is very high. The Viano 2007study does suggest neck strength as a protective mechanism. Cam would have you do nothing, just let it happen. I would like to speak with cam because the lack of knowledge and the recommendation can be dangerous. I have produced a zero concussion rate at the university and high school level. Cam do nothing, but stay out of the way of people who are proactive. Cam is wrong about athletes not seeing the blow coming. But once again if you follow Cam logic you do nothing. If there were a 1 percent chance that this protocol would lower the possibilty that athletes would fare better on the field of competition, would you not atleast do something proactive. Cam has little to no athletic experience and no knowledge of resistance training because Cam failed to realize what made this protocol different.
Misleading
Posted from: Dr. Cam, 6/27/13 at 9:32 AM CDT
This study simply shows that athletes can increase the strength of their necks with exercise. We should already know this... This does not translate into a reduction in concussions. It's actually already been studied and found that neck strength had no correlation with concussion incidence. It is not neck strength but rather neck stiffness (according to Viano et al, 2007) that can reduce the Head Injury Criterion by a substantial amount. The problem is that peak head acceleration happens within the first 6 to 20 milliseconds of head impact and it takes between 100 to 200ms to activate your cervical musculature and another 90ms to reach even half of your MVC.
So basically, it all comes down to awareness. If you are aware of the impending hit and you can tense up your body and neck muscles, then the strength of your neck may be able to protect you from a concussion. If you are unaware of the impending hit, then it doesn't matter how strong your neck is, because by the time you try to contract and brace it, it's already too late, the damage is done.
While great in theory, neck strength may only have a minor bearing on reducing head injuries because it is still limited to those athletes that are aware the hit is coming and can brace in time. Most concussions however are delivered to the unsuspecting victim cutting through the middle and looking back for the pass.
Thanks!
Posted from: Dave Barr, 5/12/13 at 5:38 PM CDT
I have been wondering about the best way to train athletes for reduction of concussions. This is part of the answer I have been looking for. Great info! I would really like to learn more specifics about what this training looks like.
Posted from: Bill Wilson, 1/14/13 at 1:12 PM CST
Great post! Thank you for the information.
I will be sharing this with all my hockey contacts.
Bill Wilson
Owner
Your College Hockey
Bravo Dr. Cornwell!
Posted from: Ted Seay, 9/26/12 at 5:57 PM CDT
This is NEEDED to help inform the public debate...
Posted from: wendy lynne, 9/24/12 at 9:33 PM CDT
Really appreciate how you clearly spelled out the issues and gave solutions - great article!
At Last - Proof!
Posted from: Mike Jolly, 9/20/12 at 6:06 PM CDT
It is so important to finally have proof positive that a strong neck will dissipate concussive forces and help if not prevent concussions. As a manufacturer of a neck strengthening device (www.halostrong.com) it has been very frustrating trying to convince strength coaches that it is a strong neck not a better helmet or mouth piece that will protect our athletes brains. Thank you Dr. Cornwell!
Great Post
Posted from: Dwayne Wimmer, 9/19/12 at 1:25 PM CDT
Thanks for the post! This is GREAT information that needs to get out. Keep up the good work.
Dwayne Wimmer
Owner
Vertex Fitness Personal Training studio

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