Eight Weeks of Self-Resisted Neck Strength Training Improves Neck Strength in Age-Grade Rugby Union Players: A Pilot Randomized Controlled Trial

Abstract

Background: Greater neck strength is associated with fewer head and neck injuries. Neck-strengthening programs are commonly burdensome, requiring specialist equipment or significant time commitment, which are barriers to implementation. Hypothesis: Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players. Study Design: A pilot randomized controlled exercise intervention study. Level of Evidence: Level 2. Methods: Twenty-eight U18 (under 18) male regional age-group rugby union players were randomized (intervention n =15/control n = 13). An 8-week exercise program was supervised during preseason at the regional training center. Control players continued their “normal practice,” which did not include neck-specific strengthening exercises. The 3-times weekly trainer-led intervention program involved a series of 15-second self-resisted contractions, where players pushed maximally against their own head, in forward, backward, left, and right directions. Outcome Measure: Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer. Results: Postintervention between-group mean differences (MDs) in isometric neck strength change were adjusted for baseline strength and favored the intervention for total neck strength (effect size [ES] = 1.2, MD ± 95% CI = 155.9 ± 101.9 N, P = 0.004) and for neck strength into extension (ES = 1.0, MD ± 95% CI = 59.9 ± 45.4 N, P = 0.01), left side flexion (ES = 0.7, MD ± 95% CI = 27.5 ± 26.9 N, P = 0.05), and right side flexion (ES = 1.3, MD ± 95% CI = 50.5 ± 34.4 N, P = 0.006). Conclusion: This resource-efficient neck-strengthening program has few barriers to implementation and provides a clear benefit in U18 players’ neck strength. While the present study focused on adolescent rugby players, the program may be appropriate across all sports where head and neck injuries are of concern and resources are limited. Clinical Relevance: Greater neck strength is associated with fewer head and neck injuries, including concussion. Performing this neck exercise program independently, or as part of a whole-body program like Activate, an interactive guide for players and coaches, could contribute to lower sports-related head and neck injuries.

Barriers and facilitators to implementing the Activate injury prevention exercise programme – A qualitative study of schoolboy rugby coaches

“…At present, there is a scarcity of research on the physiological effects of Activate , with a single study investigating this area reporting that under-18 youth rugby players had a 24% increase in cervical spine strength after completing the isometric cervical spine exercises for 8 weeks. 36 A few coaches reported that they used Activate to improve their players’ physical characteristics and movement control. There is a high level of evidence that neuromuscular training programmes, primarily football specific programmes such as the 11+ , can promote both acute and chronic physiological adaptations.…”

“…There is a high level of evidence that neuromuscular training programmes, primarily football specific programmes such as the 11+ , can promote both acute and chronic physiological adaptations. 37 However, beyond the neck strength study, 36 it is not clear if Activate does induce acute and/or chronic physiological responses. Thus there is a need to investigate if Activate does improve the physical characteristics of youth rugby players given this may facilitate programme implementation (Table 3).…”

Risk Reduction of Concussion in Athletes: Do Neck Size or Neck Strength Make a Difference?

“…The two major conclusions from the study were as follows: (1) performing a neck exercise program independently, or as part of a whole-body program, could contribute to lower sports-related head and neck injuries; and (2) near-maximal to maximal loads may be required to induce meaningful changes in neck strength when considering isometric or isotonic neck exercises. 24 An additional study by Peek at al. reflected the ease with which a neck strengthening program can be instituted for soccer players.…”

“…24 To combat this issue, Attwood et al performed a study with a under age 18 (U18) male soccer team. 24 Athletes performed isometric neck exercises three times per week for 8 wks. These included maximal contraction of the neck in each direction (flexion, extension, left/right lateral flexion) with resistance provided by their own hands.…”

Soccer (football) and brain health

“…Third, strengthening the neck muscles can minimise head acceleration, reducing the risk of head injuries [ 59 ]. Notably, neck muscles are receptive to short-term training, as demonstrated in professional rugby players [ 59 , 60 ]. However, the effectiveness of neck strengthening on headings is still controversial [ 61 ].…”