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Safety First Stronger Necks = Fewer Injuries

by: Ryan Cidzik Strength and Conditioning Coach, Columbia University
January 2013
7

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Neck testing and training methods for football are critical ways to reduce injuries. Even though research studies have shown that increases in neck strength decrease the chance of a head injury, there is no national standard for neck testing in collision sports. At the University of Memphis, we developed an innovative program to test, monitor, and strengthen the neck that has decreased our concussions and missed playing time 50% in one year. This past season at Columbia University, we decreased concussions 59% from the previous year. Our system addresses four main areas of concern: 1-Is the athlete insufficient in neck strength? 2-Is the athlete insufficient in neck size? 3-Is the athlete insufficient in neck range of motion? 4-Are we training the neck year-round to address both individual and team deficiencies? We believe that our innovative system gives our athletes the best protection possible when it comes to fighting concussions. HEAD INJURIES AND A STRONG NECK Concussions occur because of linear and/or rotational acceleration-deceleration of the head, as well as axial compression to the cervical spine, which damages brain tissue. Hits to the facemask increase the chance of a concussion due to the rotational acceleration with these types of hits. Concussive hits can cause a buildup of toxic tau protein within the brain, which damages the neural fibers that connect brain tissue. Since the brain is the most complex organ in the human body and is incapable of regeneration, protecting it is critical. A 2007 Neurosurgery study proved that having a stronger neck reduces your risk of a concussion because, with an increase in neck strength and stiffness you decrease the amount of head acceleration following a hit. Not only will strengthening your neck muscles decrease your risk of a neck injury, but it will also likely decrease rehabilitation time in the event of an injury. As strength coaches, we cannot control football technique, injury history, or anticipating a hit. We can, however, control how strong our athletes necks are, how big our athletes necks are, how much range of motion (ROM) they have, and how our athletes train. RISK FACTORS FOR A CONCUSSION #1: INSUFFICIENT NECK STRENGTH My main area of concern when looking at all of the neck strength tests that have been done, was that all have been done in a research or rehab setting. What I did was take all of the principles supported by science and research and come up with a method to safely, effectively, and reliably test neck strength in a weight room setting. Ten things should be present when testing neck strength: 1. 2. 3. Warm-up properly. Test isometrically. Test static strength endurance.

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4. 5. 6. 7. 8. 9. 10.

Test in a neutral head position. Test forward flexion. Dont use complex instruments. Use a firm fixation system. Keep the chin tucked. Load the chin and forehead. Use enough weight to be safe and effective.

Once you have tested all of your players, rank them. If an athlete is insufficient in neck strength, extra neck strength work is needed. For strength work, heavier resistance using 6 reps or 15-20 seconds of work per set is ideal. RISK FACTORS FOR A CONSUSSION #2: INSUFFICIENT NECK SIZE Besides neck strength, other objective tests that can expose potential concussion risks to athletes are neck length, head circumference, and neck circumference. Articles in Spine, the Journal of Biomechanical Engineering, the Journal of Manipulative and Physiological Therapeutics have suggested the importance of these measures in regards to head injury risks. If an athletes neck circumference is not proportionate to the length of his neck and/or the size of his head, extra hypertrophy (size) work is needed. For hypertrophy work, a medium resistance using 12 reps or 40 seconds of work is ideal for each set. RISK FACTORS FOR A CONCUSSSION #3: INSUFFICIENT NECK RANGE OF MOTION An article in the Journal of Athletic Training showed that if an athlete has decreased cervical spine ROM, he/she compromises the ability to move out of the way of the path of the torso during impact loading, therefore increasing the chance of a neck injury. If an athlete is below the minimal clinical standards for ROM, first get with the medical staff and find out if the athlete has a current or past injury. Second, extra re-lengthening (stretching) work is needed, in which we utilize a variety of methods suggested by manual therapists. RISK FACTORS FOR A CONCUSSION #4: INSUFFICIENT NECK TRAINING Too many coaches put very little thought into actually training the neck. More often than not, coaches just tell their athletes to go do one or two sets of 10 reps on the 4-way neck machine, and that is the case all year long. If you wanted to increase your strength in the back squat, would you do the exact same workout every day? No. So, why is the neck any different? While predominantly slow twitch muscles, the cervical muscles need different forms of activation and stimulation just like anything else. We approach neck programming and training with the same, if not more, meticulous and serious thought-process as any other muscle group. What your athletes can handle in training is dependent on their current level of work capacity. If they have only been doing neck strengthening exercises with one day per week, dont expect to jump into a four day-a-week program without getting someone hurt. After a thorough level of training has been established, we train the neck 3-4 days per week. The upper trap, which is also very important for dissipating forces, should be trained 1-2 days per week. It is suggested that a Rate of Perceived Exertion (RPE) scale is used on all exercises. This is important because, while any muscle group can be trained several days per week, the intensity cannot be high every day. For recovery purposes, there must be a balance between high, medium, and low intensive workloads. We use three RPEs in our neck training program: high RPE (9 on a scale of 10), medium RPE (6 on a scale of 10), and low RPE (3 on a scale of 10). A proper warm-up is always required, especially on high or medium RPE days. Whatever training methods you chose to use with your athletes, it is very important that they are not losing ROM due to training or competition. A stiff or sore athlete cannot properly absorb force, hence increasing the chance of an injury. Be sure various stretching and re-lengthening methods are included in your year-round neck program. NECK STRENGTHENING METHODS We utilize a variety of exercises, tempos, methods, and ranges of motion in our neck strength program. The neck should be trained in 10 different patterns, and rotations should be done at least one-two days per week. While most of our training involves manual eccentric-based work, we use various resistances including manual work, weighted resistance, bands, neck machines, stability balls, Airex pads, and combo methods. When performing manual work, it is suggested that coaches do all manual work on their athletes until all athletes thoroughly understand how to perform it on each other. Always be very critical of

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Our yearly collegiate neck strengthening and testing progression is as follows: Early Off-Season (January) Neck strength, neck circumference, neck length, head circumference, and ROM are tested at the start of January. Train the neck 3 days per week. (Monday is a high RPE day, Wednesday is a low RPE day, and Friday is a medium RPE day). Upper trap work is done one day per week. Re-teach the athlete proper form, increase work capacity and begin re-educating the neck muscles. Progress the difficulty of exercises throughout the month. Early Off-Season (February) Train the neck four days per week. (Monday is a high RPE day, Tuesday is a low RPE day, Thursday is a high/medium RPE day, Friday is a low RPE day). Upper trap work is done two days per week. Begin to physically prepare the athletes neck for the physical demands of Spring ball. Continue to increase work capacity. Begin introducing Perturbations which: - Improves reaction time. - Enhances proprioceptor signals to the muscles. - Decreases risk of injury. Neck strength, neck circumference, and ROM are tested before Spring ball starts. Spring Ball (March-April) Train the neck three days per week. Upper trap work is done one day per week. Your higher RPE day should not be placed the day of (or day before) the practice with the most contact. Decrease volume to accommodate for the increased stress of practice. Make sure to re-lengthen the muscles post-workout and practice. ROM is tested as needed with athletes. Summer Phase I (May, June) Neck strength and neck circumference are tested at the start of June. Train the neck four days per week. (Monday is a high RPE day, Tuesday is a low RPE day, Thursday is a high RPE day, Friday is a low/medium RPE day). Extra work is needed for those with a lower strength and/or circumference score. Upper trap work is done two days per week.

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Begin more advanced methods of training. Perturbations should be done one day per week. Neck circuits are used to reformulate capacity. Summer Phase II (June, July) Train the neck four days per week (Monday is a high RPE day, Tuesday is a low RPE day, Thursday is a high RPE day, Friday is a low/medium RPE day). Extra work is still needed for those with a lower strength and/or circumference score. Upper trap work is done two days per week. Continue more advanced methods of training, including perturbations one-two days per week. Neck strength, neck circumference, and ROM are tested at the end of July. Pre-Season Camp (August) Train the neck two-three days per week. Upper trap work is done one day per week. Most of the neck work is either a medium or lower RPE with full range of motion. In-Season (August December) Train the neck three days per week. Upper trap work is done one day per week. Day one is a low RPE day with focus on full range of motion. Day two is a high RPE day but with a lower volume than the summer to accommodate for the stresses of the season. Day three is a medium RPE day, usually proprioceptive in nature. Do not introduce any new exercises in-season. Make sure to re-lengthen the muscles post-workout and post-practice. Measure neck circumference every four weeks, and make adjustments to the training program if a significant amount of hypertrophy has been lost. ROM is tested as needed. While we cannot truly prevent all injuries from occurring, we need to do our part in providing our athletes with the best protection possible. If we can determine if an athlete is insufficient in neck strength, size, ROM, or training, we can help minimize head injury risks by addressing those issues. Dr. Robert Cantu, who just received a $1 million grant from the NFL to study brain injuries said, Its just straight physics. If you see the blow coming and you have a very strong neck and contract the neck muscles, you have a much greater chance to have significantly reduced the forces the brain will see. p About the Author: Ryan Cidzik is the Director of Strength and Conditioning at Columbia University. He has been a strength coach in the NFL with both the Cleveland Browns and New York Jets. In addition to eight years of college coaching experience most recently at the University of Memphis he was the Strength and Conditioning Coordinator for NFL Europe for four years.

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