Head Games: Training the Neck to Reduce Concussions

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Playing Football is Like Getting into 30-50 Car Accidents Within a 3-Hour Period

The subject of concussions in sports has become an increasingly hot topic as of late. As awareness increases and preventative measures improve, more coaches are jumping on board with training protocols. According to ImPACT Applications Inc., there is an estimated 300,000 cases of reported concussions per year. Experts believe that many concussions go unreported. The majority of media coverage is divided between awareness, detection, and lawsuit. Very little is discussed about prevention, or better yet, protection. Any proactive measures taken have been limited to the ImPACT testing and advances in protective equipment.  The ImPACT test has become a standard form for baseline management and as a neurocognitive assessment. In addition, the Balance Error Scoring System (BESS) is used. These tests have become a screening tool which identify if there is a problem and allow for a safer return-to-play procedure.

There is a group of coaches who have not only been aware of the growing problem of concussions, but have been implementing protective strategies for decades. Strength training for the head and neck has been an critical aspect of the overall physical development of professional and collegiate strength coaches. This specific protocol has trickled down to the high school level. As collaboration between coaches reinforces anecdotal research, training protocols become more efficient and more prevalent in strength and conditioning programs around the country.

Kim Wood, who was hired by Paul Brown as the Cincinnati Bengals strength coach, held that position for 30 years.  Coach Wood, along with his brothers John and Mike Gittelson, host the football strength clinic every summer in Cincinnati, Ohio. Gittleson, who may be the most passionate coach when it comes to protecting athletes from head injuries, was Bo Schembechler's first and only strength and conditioning coach at the University of Michigan. The clinic also boasts some of the top NFL, college, and high school strength coaches from around the US and Canada who are dedicated to "preparing football players for the rigors and physical stresses of a violent game."

The clinic is a virtual who's who of strength coaches including staff from just about every major university in the mid-west. Although most of the coaches develop college and professional football players, the clinic benefits coaches of all sports and all levels. Protocols for training the head and neck can often start as early as the middle school level. At the Pingry School in New Jersey, Doug Scott introduces lying chin tucks and lying chin ups (protrusion) to his young student-athletes. Gabe Harrington, who has coached athletes at Michigan State, The United States Military Academy, and most recently Colgate University has all of his contact teams train their necks. Training the neck is part of the culture that Harrington attempts to create among his teams.

One of the first steps in understanding the risks associated with head injuries with sports is classifying those sports into "contact categories." Below is a chart that was adapted from Dr. Brian Hortz, PhD for the North Coast Athletic Conference Athletic Training Policies and Procedures. This list is modified from a classification system used by the American Academy of Pediatrics. The terminology can be interchangeable with descriptors such as contact, impact, collision, and combat. This is the classification chart that I used in the past:

*Non-Contact = Contact can happen but not intentional.  No Contact = contact with another athlete or teammate is extremely rare

#Non-Contact sports with collisions with other players are possible

These classifications can have a correlation between risk of injury between the sports, but that is not the entire picture. There are non-collision sports like women's soccer who creep in to the top five of sports mostly likely to yield a concussion.

Most number of concussions per sport according to an NCAA study:

  1. Football
  2. Men's Lacrosse
  3. Women's Ice Hockey
  4. Men's Ice Hockey
  5. Women's Soccer

The rankings for some of these sports are fairly obvious. The speed at what these games are played and the shear force of the collisions, make athletes playing these sports susceptible to head injuries. Sports like lacrosse and soccer, which the latter is not synonymous with head injuries, may have alternative factors placing them that high on a list of all NCAA recognized sports. Concussions may be more common due to the fact that predicted success of the athlete in these sports is often not associated with the physical development.

Female athletes can be especially susceptible to head injuries especially when compared to their male counter-parts. This is seen in sports like ice hockey and soccer, in particular. Factors such as smaller heads and weaker necks for females in sports where helmet weight and ball size and weight are the same for both genders.

Strength and conditioning coaches have streamlined the anatomical movements of the head and neck in a more structured manner to elicit more efficient training programs (as shown in the chart below). Terminology may differ and the level of biomechanical breakdown may vary between coaches.

Types of Resistance

Machines

There are several different types of machines constructed for the sole purpose of strengthening the neck. One of the negatives of using a neck machine is the feasibility when it comes to space due to the footprint (the amount of space the machine takes up). The decision to incorporate machines in the overall weightroom design is usually based on the strength and conditioning coaches discretion. For someone like Blair Wagner, it was a no-brainer. Wagner being one of the youngest head sports performance coaches in the FBS, dedicated an entire side of their weight room just to neck machines. The Eagles spend upwards of twenty minutes per training session just on neck and trap development. The distinct advantage of using a neck machine is the quantitative quality of training. While most forms of resistance for the neck can be subjective, the resistance used on a neck machine is specific.

Greg Pysczynski, who coached with Wagner at EMU before becoming an assistant strength and conditioning coach at The University of Illinois, has given a few critical points to help training all movements and lateral flexion specifically. Strength training any movement of the neck should always start in the neutral position first, then proceed to a full range-of-motion. Pysczynski has established himself as one of the leaders in the field when it comes to training. Greg solidified this notion by giving one of the most detailed presentations at the Central Ohio Strength and Conditioning Clinic on neck and trap development in 2012. The positioning of the resistance for lateral flexion is another important point Greg harped on at the Football Strength Clinic.  This load should be placed above the ears, which makes correct adjustments of the seat height especially important. Even in the following video, lowering the seat height would allow for better posture and a more efficient placement of the resistance load.

 Lateral Flexion on the Elitefts™ Neck Machine

 Using a combination of movements for the head and neck can be beneficial and save time. This can be dependent on the setup and the variably of the equipment you are using. The elitefts™ neck attachment for the erect-a-rack allows some flexibility in adjusting heights for large groups. This is crucial, especially when using combination movements like protrusion, flexion, tilt, or extension.

Protrusion and Flexion using the Elitefts™ Erect-A-Rack Neck Attachment

Neck Harness 

Neck harnesses may not be the most ideal form of resistance for large groups from a logistical standpoint. They may, however, be the most versatile. One training implement that accentuates the effectiveness of using a harness is elitefts™ resistance bands. There are two distinct advantages of using bands in conjunction with the neck harness. Both of these were explained by Blair Wagner at the football strength clinic. Wagner utilizes as many tools as he can for neck development with his athletes. Using bands for resistance minimizes undue stress on the musculature of the head and neck when the cervical spine is in its most vulnerable position. This means there is more resistance past the neutral position for all movements of the head. Secondly, there is also more variety in the angle of resistance. Attaching plates to the chain of the harness limits the the lifter in where the resistance is in relation to the head due to gravity. Using mini-bands, micro mini-bands, or monster mini-bands can allow the lifter to attach those bands to a rack and change the angle of resistance.

 Neck Extension using the Elitefts™ Deluxe Neck Harness

Manual Resistance

Without a doubt the most commonly used form of resistance training is manual resistance. This method is prevalent in team settings. However, what makes it the easiest methodology to institute also makes it the most difficult to qualify. Coaching athletes on how to use the proper hand placement, control the rep speed, and administer the correct amount of resistance at certain ranges of motion requires a tremendous amount of instruction and coaching. Because of this, Shawn Griswold would have all of his assistants perform the manual resistance exercises for every player.  Griswold, head coach of Sports Performance at Arizona State University, happened to be my first exposure to a structured program of training the neck. While interning at the University of Tulsa, I would spend a large portion of the training session, cranking on the necks of every Golden Hurricane football player for five reps and four directions. Griswold wanted to ensure that training the neck was a priority and there was never a question of the intensity and focus of every rep.

Ted Rath of the Detroit Lions talked about specifics in manual resistance training for the neck. Rath who is the head strength and conditioning coach for the Lions pleaded the importance of the athlete locking the jaw when performing resistance training, a point that is validated through some of Greg Pysczynski’s research on muscle activation while clinching the jaw. Rath also reiterated the importance of the coach controlling the rep speed for the concentric and eccentric phases of the movement.  Coaches should also be aware of providing less resistance once the range of motion is past the neutral position according to Rath.

Front Flexion using Manual Resistance

Another key concept in terms of strength development of the neck is that coaches not only must think about what essential movements happen in each sport but also how those movements take place. For example, extension and retraction of the neck usually happens in an isometric nature in the game of football–such as when holding the head in a position to collide with another player with the “head up.” In the same sense, wrestlers would need to perform this same movement concentrically, isometrically, and eccentrically.

Another example would be the difference between the dynamic frontal flexion of a soccer player when performing a header as opposed to the proprioceptive nature of protrusion and frontal flexion when a a hockey player makes contact with the front of his helmet. In this sense, it is important to address all three phases of muscle contraction for the head and neck.

A unique exercise that team elitefts™ Coach and owner of The Spot Athletics JL Holdsworth shared with me along with its variations involves the athlete statically holding a neutral position of the cervical spine.

Static Neck Bridge using Manual Resistance

Band Resistance

One of the easiest methods of training the neck in a large team setting is to incorporate band resistance with each power rack in the facility. This is another systematic approach to neck training learned from Blair Wagner and Greg Pysczynski during a visit to Eastern Michigan University. Attach one of the resistance bands around each J-hook and have the athlete lie on a bench. The athlete would then position himself with their head under the horizontally place band. Tension can be adjusted by raising or lowering the J-Hooks very simply. There will not be much discrepancy between athletes because of bench height and little variation head size and shoulder width (lateral flexion) between athletes.

Protrusion using Elitefts™ Resistance Bands in a Power Rack

Stability Ball

Using stability balls for static contractions and limited range of motion concentric work is ideal, especially for side flexion. Correct setup would enable the athlete to start each repetition from a neutral position and attain any desired time under tension while limiting the range of motion.

Side Flexion Using Elitefts™ Stability Ball

Programming

One of the most asked questions that coaches and trainers often have, revolves around programming a small group of muscles with a limited range of motion. Just by training the neck at all, coaches will put their athletes in a position where they are ahead of the game when it comes to preventing injuries. Volume, intensity, and frequency are all factors that must be manipulated. Increasing strength and size of the neck needs to be balanced with fatigue. The musculature in the head, jaw, and neck tend to fatigue quickly. Volume tends to be based more on time-under-tension and intensity if often subjective. Here is a basic template I have used in the past during the off-season for both football and lacrosse.

elitefts neck-training1Balancing the specific movement of the head and neck with the type of tension provided can allow coaches to cover all grounds when it comes to prevention.

Testing and Evaluation

“Coaches don’t take it seriously enough,” explains Gabe Harrington in an interview at the 2012 CSCCa national conference. Harrigton has been baffled about the lack of standardized baseline tests for neck strength. With his athletes, Harrington uses a neck flexion test on a machine using a beeper to time repetitions. Ryan Cidzik, strength and conditioning coach at Columbia University, also utilizes standardized test for neck strength. These tests create standards and a baseline for return-to-play status. A procedure Harrington feels is incomplete and lacking a critical component.

From the Consensus Statement on Concussion in Sport from the 3rd International Conference on the subject held in Zurich, Switzerland, a graduated return to-play protocol was developed. One aspect strength coaches have been petitioning with athletic trainers is to institute strength training earlier in the process, specifically a test for neck strength. Dr. Jeremy Ng, Sports Medicine Concussion Management Specialist at Coastal Orthopedics, warns that the physical activity during recovery will not make a concussion worse, although it may prolong the recovery.

return-to-play
Another form of objective data collection that has had a direct correspondence with the reduction of concussion according to Wagner and Pysczynski is measuring neck circumference. More teams are adapting a minimum neck circumference by position which not only encourages a results-centered approach to training the neck, but ultimately protects the athlete. Playing the game of football with a 15- inch neck is no less dangerous than playing at 125 pounds. It is borderline negligent. Below is a chart I adapted from Eastern Michigan University.

elitefts-minimum-neck-circumference

Hypertrophy and strength in the muscle groups of the neck and traps are a trainable and essential element for any sports performance program. Having the physical development to play a sport at the absolute highest level while reducing injury is a necessary per-cursor to success.

Conclusion

According to fellow strength coaches like Mike Gittelson, what we all control as coaches is to strength the head, jaw, and neck as a preventative measure to protect the athlete. “Developing the muscular structures that dissipate the forces that can cause concussions,” is one of the integral principles of The Football Strength Clinic, shared by the fraternity of strength coaches who have seen the negative effects associated with concussions. After his presentation at the NSCA national conference in Las Vegas, Nevada, Dr. Ng  has admitted that the only indicators there are to reduce the chance of concussions is to strengthen the muscles in the neck. More research needs to be done on the subject. In the meantime, strength and conditioning professionals will continue to forge their athletes into suits of armor.

References

SSI task force explores issues, challenges around concussions – NCAA

Consensus Statement on Concussion in Sport – NATA

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