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Parsanejad E, McKay MJ, Ross AG, Pappas E, Peek K. Heading in Football: insights from stakeholders in amateur football. SCI MED FOOTBALL 2024; 8:212-221. [PMID: 37293855 DOI: 10.1080/24733938.2023.2224282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
Despite emerging research questioning the long-term effect of purposeful heading on players' brain health, heading-related perspectives and behaviours of stakeholders in amateur football in Australia (a country without heading guidelines) remain unknown. This study aimed to explore the current heading-related perspectives and behaviours of football stakeholders. In total, 290 players (aged over 11 years), 54 coaches, 34 non-coaching staff and 14 medical staff completed the survey. Of the 290 players, 56.5% reported being formally trained in heading, with female players less likely to be trained than male players (p < 0.05). Players were the least concerned about the long-term effects of heading, while medical staff were the most concerned (33.1% and 57.1%, respectively). From proposed strategies to reduce heading burden, a heading ban for all ages was least popular (2.3%), while teaching heading technique was most popular (67.3%). Our study provides insights into football stakeholders' heading-related perspectives, which could be used, along with scientific evidence, to inform pragmatic future heading guidelines.
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Affiliation(s)
- Elia Parsanejad
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marnee J McKay
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew G Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Evangelos Pappas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Peek K, Ross A, Andersen TE, Meyer T, Dahlen S, Georgieva J, Williamson PR, Clarke M, Serner A. Heading in football: a systematic review of descriptors, definitions, and reporting methods used in heading incidence studies. SCI MED FOOTBALL 2024:1-18. [PMID: 38855969 DOI: 10.1080/24733938.2024.2362191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
The primary objective of this systematic review was to describe the number and type of heading descriptors used in all published studies which report on heading incidence in football. The secondary objective was to detail the data collection and reporting methods used in the included studies to present heading incidence data. Eligible studies were identified through searches of five electronic databases: Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science, using a combination of free-text keywords (inception to 12th September 2023). Manual searching of reference lists and retrieved systematic reviews was also performed. A descriptive overview and synthesis of the results is presented. From 1620 potentially eligible studies, 71 studies were included, with the following key findings: 1) only 61% of studies defined a header with even fewer (23%) providing an operational definition of a header within the methods; 2) important study and player demographic data including year and country were often not reported; 3) reported heading descriptors and their coding options varied greatly; 4) visual identification of headers was essential when inertial measurement units were used to collect heading incidence data; and 5) there was a lack of standardisation in the reporting methods used in heading incidence studies making comparison between studies challenging. To address these findings, the development of a standardised, internationally supported, operational definition of a header and related heading descriptors should be prioritised. Further recommendations include the development of minimum reporting criteria for heading incidence research.
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Affiliation(s)
- Kerry Peek
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Ross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Physiotherapy Department, College of Sport, Health and Engineering, Victoria University, Melbourne, Australia
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
- The Norwegian Football Association's Sports Medical Centre, Oslo, Norway
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Sara Dahlen
- Oslo Sports Trauma Research Center, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Julia Georgieva
- Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Paula R Williamson
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Serner
- FIFA Medical, Fédération Internationale de Football Association, Zurich, Switzerland
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Lin CL, DeMessie B, Ye K, Hu S, Lipton ML. Neck strength alone does not mitigate adverse associations of soccer heading with cognitive performance in adult amateur players. PLoS One 2024; 19:e0302463. [PMID: 38753699 PMCID: PMC11098408 DOI: 10.1371/journal.pone.0302463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES Soccer heading is adversely associated with neurocognitive performance, but whether greater neck strength or anthropometrics mitigates these outcomes is controversial. Here, we examine the effect of neck strength or anthropometrics on associations of soccer heading with neurocognitive outcomes in a large cohort of adult amateur players. METHODS 380 adult amateur league soccer players underwent standardized measurement of neck strength (forward flexion, extension, left lateral flexion, right lateral flexion) and head/neck anthropometric measures (head circumference, neck length, neck circumference and neck volume). Participants were assessed for heading (HeadCount) and cognitive performance (Cogstate) on up to 7 visits over a period of two years. Principal components analysis (PCA) was performed on 8 neck strength and anthropometric measures. We used generalized estimating equations to test the moderation effect of each of the three PCs on 8 previously identified adverse associations of 2-week and 12-month heading estimates with cognitive performance (psychomotor speed, immediate verbal recall, verbal episodic memory, attention, working memory) and of unintentional head impacts on moderate to severe central nervous system symptoms. RESULTS 3 principal components (PC's) account for 80% of the variance in the PCA. In men, PC1 represents head/neck anthropometric measures, PC2 represents neck strength measures, and PC3 represents the flexor/extensor (F/E) ratio. In women, PC1 represents neck strength, PC2 represents anthropometrics, and PC3 represents the F/E ratio. Of the 48 moderation effects tested, only one showed statistical significance after Bonferroni correction, which was not robust to extensive sensitivity analyses. CONCLUSION Neither neck strength nor anthropometrics mitigate adverse associations of soccer heading with cognitive performance in adult amateur players.
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Affiliation(s)
- Chin Lun Lin
- Montefiore Medical Center, Bronx, New York, United States of America
| | - Bluyé DeMessie
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Kenny Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
- Department of Systems and Computational Biology, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Shanshan Hu
- The Epoch Times, New York, New York, United States of America
| | - Michael L. Lipton
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, United States of America
- Department of Biomedical Engineering, Columbia University, New York, New York, United States of America
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McLean C, Lavender AP, Pereira E, Peek K, Davey P, Ma’ayah F, Morris S, Georgieva J. The Acute Effects of Ball Pressure on Anticipation Timing Following a Series of Purposeful Headers in Adult Football (Soccer) Players. Sports (Basel) 2024; 12:102. [PMID: 38668570 PMCID: PMC11053744 DOI: 10.3390/sports12040102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
The purpose of this study is to investigate the acute effects of ball pressure on anticipation timing following a series of purposeful headers in adult football (soccer) players. There is evidence to suggest acute neurophysiological changes to the brain following purposeful heading; this may lead to altered anticipation timing as a result, potentially having future safety implications for players. A repeated measures crossover design was used. Seventeen participants aged between 20 and 30 years performed (i) 20 rotational headers with a lower-pressure match ball (58.6 kPa; 8.5 psi), (ii) 20 rotational headers with a higher-pressure match ball (103.4 kPa; 15 psi), or (iii) 20 non-headers (kicks) as a control each on separate days. The effect of ball pressure on anticipation timing accuracy, measured as absolute, constant, and variable errors, was assessed before and immediately after each intervention session using an anticipation timing task. Differences between group means were compared using repeated measures ANOVA and linear mixed effects models, with p-values of <0.05 considered statistically significant. No significant differences in anticipation timing accuracy across interventions were detected between control, occluded, and non-occluded trials. This finding differs from the previous literature regarding the measurable, acute effects of purposeful heading. The anticipation timing task may lack sensitivity for detecting the effects of repeated heading on brain function.
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Affiliation(s)
- Chad McLean
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia (S.M.); (J.G.)
| | - Andrew P. Lavender
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, VIC 3350, Australia
| | - Ethan Pereira
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia (S.M.); (J.G.)
| | - Kerry Peek
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW 2006, Australia;
| | - Paul Davey
- Curtin School of Nursing, Curtin University, Bentley, WA 6102, Australia;
| | - Fadi Ma’ayah
- School of Education, Curtin University, Bentley, WA 6102, Australia;
| | - Susan Morris
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia (S.M.); (J.G.)
| | - Julia Georgieva
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia (S.M.); (J.G.)
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Shibukawa K, Hoshikawa Y. Decrease in aerial challenges after revision of goal kick rules in Japan Professional Soccer League: explorative study of the possibility of a risk reduction for head injury, concussion, and brain damage by a rule revision. SCI MED FOOTBALL 2024; 8:15-20. [PMID: 36315233 DOI: 10.1080/24733938.2022.2142274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/05/2022]
Abstract
In 2019, FIFA revised the goal kick (GLK) rule such that a GLK could be performed even if the kicker had teammates in the penalty area. This study aimed to examine whether the rule revision reduced the frequency of aerial challenge (AC) and long GLKs (LGLKs), which are risk factors for head injury and concussion in soccer. We analyzed all official league matches (306 matches/season) of the Japan Professional Soccer League 1st Division before (2018 season) and after the rule revision (2020 season). The analysis categorized GLKs into short GLKs (SGLKs) and LGLKs, depending on the GLK distance, and included the frequency and causes of AC, in each match following a GLK, which were compared between the 2018 and 2020 seasons. The average number of LGLKs per match in the 2020 season (8.85) decreased compared to that in the 2018 season (14.20). Additionally, for ACs following a GLK, the frequency of ACs decreased from 6.08 to 3.92 per match. Meanwhile, the frequency of LGLKs tended to increase toward the end of the first and second halves in matches. The results of this study revealed that the 2019 GLK rule revision reduced the number of LGLKs and ACs.
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Affiliation(s)
- Kenichi Shibukawa
- Sports & Health Sciences Lab, Faculty of Sciences, Toho University, Chiba, Japan
| | - Yoshihiro Hoshikawa
- Department of Sports Science, Japan Women's College of Physical Education, Tokyo, Japan
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Wahlquist VE, Glutting JJ, Kaminski TW. Examining the influence of the Get aHEAD Safely in Soccer™ program on head impact kinematics and neck strength in female youth soccer players. Res Sports Med 2024; 32:17-27. [PMID: 35611394 DOI: 10.1080/15438627.2022.2079982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
The objective was to examine the efficacy of the Get aHEAD Safely in Soccer™ intervention on head impact kinematics and neck strength in female youth soccer players. The control group (CG) consisted of 13 players (age: 11.0 ± 0.4 yrs), while the experimental group (EG) consisted of 14 players (age: 10.6 ± 0.5 yrs). Head impact kinematics included peak linear acceleration (PLA), peak rotational acceleration (PRA), and peak rotational velocity (PRV). Pre- and post-season measures included strength measures of neck/torso flexion (NF/TF) and extension (NE/TE). Data were analysed using a multilevel linear model and ANOVA techniques. No differences in PLA, PRA, or PRV were observed between groups. The EG showed significant improvement in NF strength while the CG showed significant improvement in NE strength. Both groups significantly improved in TF pre- to post-season. The foundational strength components of the Get aHEAD Safely in Soccer program appear to show a benefit in youth soccer players beginning to learn the skill of purposeful heading.
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Affiliation(s)
| | | | - Thomas W Kaminski
- Athletic Training Research Laboratory, University of Delaware, Newark, DE, USA
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Garrett JM, Mastrorocco M, Peek K, van den Hoek DJ, McGuckian TB. The Relationship Between Neck Strength and Sports-Related Concussion in Team Sports: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2023; 53:585–593. [PMID: 37428807 DOI: 10.2519/jospt.2023.11727] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE: We aimed to quantify the relationship between neck strength and sports-related concussion (SRC) for athletes participating in team sports. DESIGN: Etiology systematic review with meta-analysis. LITERATURE SEARCH: PubMed, PsycINFO, MEDLINE, CINAHL, CENTRAL, and Scopus were searched on March 17, 2022, and updated on April 18, 2023. STUDY SELECTION CRITERIA: Team sports where an opponent invades the player's territory (eg, football, rugby, basketball) that reported at least 1 measure of neck strength, and 1 measure of SRC incidence, using cohort, case-control, or cross-sectional study designs. The Newcastle-Ottawa scale was used to assess risk of bias; certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Studies were summarized qualitatively and quantitatively. To understand the relationship between neck strength and future SRC incidence, random-effects meta-analysis was conducted on prospective longitudinal studies. RESULTS: From a total of 1445 search results, eight studies including 7625 participants met the inclusion criteria. Five studies reported a relationship between greater neck strength or motor control and reduced concussion incidence. Pooled results from 4 studies indicated small (r = 0.08-0.14) nonsignificant effects with substantial heterogeneity (I2>90%). The considerable heterogeneity is likely a result of synthesized studies with vastly different sample characteristics, including participant age, playing level, and sports. CONCLUSIONS: There was very low-certainty evidence suggesting a small, nonsignificant relationship between greater neck strength and a lower risk of sustaining a SRC. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 10 July 2023. doi:10.2519/jospt.2023.11727.
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Peek K, Duffield R, Cairns R, Jones M, Meyer T, McCall A, Oxenham V. Where are We Headed? Evidence to Inform Future Football Heading Guidelines. Sports Med 2023; 53:1335-1358. [PMID: 37285067 PMCID: PMC10289964 DOI: 10.1007/s40279-023-01852-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 06/08/2023]
Abstract
Given the scientific and public concern regarding the short-, medium- and long-term consequences of heading on brain health, being proactive about developing and implementing guidelines that help reduce the burden (volume, impact magnitude and injury risk) of heading in young and beginner players appears justified. This narrative review explores the evidence underpinning strategies that could be incorporated into future heading guidelines to reduce heading burden in players across all levels of football. A four-step search strategy was utilised to identify all data-based papers related to heading in football. Eligibility criteria for inclusion were: (1) original data, (2) study population included football players, (3) outcome measures included one or more of the following: number of headers, measurement of head acceleration during heading, or head/brain injury incidence, and (4) published in English or English translation available. In total, 58 papers were included that outlined strategies based on (1) game or team development, (2) player skill development and (3) equipment. In particular, greater emphasis existed for small-sided games (particularly in young players) where fewer headers are observed when compared with the conventional 11 versus 11 game, as well as reducing headers from goal kicks and corners. Evidence also existed for developing a heading coaching framework that focusses on technical proficiency as well as neuromuscular neck exercises integrated into general injury reduction exercise programs, enforcement of rules related to deliberate head contact and using lower-pressure match and training balls. To mitigate potential risks of heading on brain health, a number of pragmatic strategies have been examined in scientific studies and may be considered as part of future heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Rob Duffield
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Ross Cairns
- Newcastle Sports Medicine, Warners Bay, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Mark Jones
- Football Australia, Sydney, NSW Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Alan McCall
- School of Sport, Exercsie & Rehabilitation, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
- Football Australia, Sydney, NSW Australia
| | - Vincent Oxenham
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW Australia
- Department of Neuropsychology, Royal North Shore Hospital, Sydney, NSW Australia
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Peek K, Versteegh T, Veith S, Whalan M, Edwards S, McKay M, Gardner AJ. Injury-Reduction Programs Containing Neuromuscular Neck Exercises and the Incidence of Soccer-Related Head and Neck Injuries. J Athl Train 2023; 58:519-527. [PMID: 36645836 PMCID: PMC10496449 DOI: 10.4085/1062-6050-0340.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
CONTEXT Concern is growing among soccer players, coaches, and parents regarding head and neck injuries, including concussion, particularly from heading a ball. Thus, we need to explore soccer-specific head injury risk-reduction initiatives. One such initiative is to condition the neck musculature of young players by adding neuromuscular neck exercises to existing injury-reduction exercise programs. OBJECTIVE To investigate the effect of neuromuscular neck exercises completed as part of an injury risk-reduction exercise program on the incidence of soccer-related head and neck injuries in adolescent soccer players. DESIGN Prospective cohort study. SETTING Two sports high schools and 6 soccer clubs during the 2021 soccer season. PATIENTS OR OTHER PARTICIPANTS A total of 364 male and female soccer players, aged 12 to 18 years. INTERVENTION(S) Members of 1 sports high school and 2 soccer clubs performed neuromuscular neck exercises as part of an injury-reduction program during training (neck training group). Members of another sports high school and 4 soccer clubs performed an injury-reduction program but without neck exercises (comparison group). MAIN OUTCOME MEASURE(S) Self-reported injury data were collected from each player at the end of the season and used to calculate incidence rate ratios (IRRs) with 95% CIs. RESULTS In total, 364 players completed the study, including 146 players in the neck training group and 218 players in the comparison group. Despite players in the neck training group being less likely to self-report a concussion (IRR = 0.23; 95% CI = 0.03, 1.04) and pain on heading a ball (IRR = 0.62; 95% CI = 0.34, 1.07), only a lower incidence of possible concussive events (IRR = 0.38; 95% CI = 0.14, 0.90; P < .05) was significant. CONCLUSIONS Integrating neuromuscular neck exercises into injury-reduction exercise programs has the potential to reduce the risk of adolescent soccer players sustaining a possible concussive event, concussion, or pain on heading a ball.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | | | - Stella Veith
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, New South Wales, Australia
| | - Matt Whalan
- Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, New South Wales, Australia
| | - Suzi Edwards
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, University of Sydney, New South Wales, Australia
| | - Andrew John Gardner
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
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Fuller C, Falvey É, Schneider K. Reliability of a neck strength test in schoolboy rugby players. Musculoskelet Sci Pract 2022; 60:102566. [PMID: 35644049 DOI: 10.1016/j.msksp.2022.102566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In rugby union, a bracing mechanism of the neck and trunk is normally adopted in contact situations where high linear and angular forces are produced, which may contribute to the risk for sports-related concussion (SRC). OBJECTIVES To examine the feasibility of and test-retest reliability, both inter-rater and intra-rater reliability, of a novel neck strength test in schoolboy rugby players and to summarize neck strength values for this cohort, including rugby position-specific estimates. MATERIALS AND METHODS 52 male schoolboy rugby union players completed the neck strength test protocol twice, eight days apart using a novel device. RESULTS Intra-class correlation coefficients (ICCs) were good to excellent for test-retest reliability (range from 0.86 to 0.92) in all four directions. Intra-rater (ICCs range from 0.706 to 0.981) and inter-rater (ICCs range from 0.669 to 0.982) ranges were calculated. Significant differences were identified between forwards and backs for non-normalised force measures but no significant difference when normalised to bodyweight. The flexor:extensor ratio was 0.68 (SD 0.2) for forwards, 0.71 (SD 0.16) for backs and 0.67 (SD 0.16) for the cohort. DISCUSSION & CONCLUSION While there is limited direct evidence to support a direct link between neck strength and SRC risk at present, investigating the relationship of neck strength, stiffness and impact anticipation might be a useful direction for further research. In conclusion, we describe a portable, user-friendly and safe neck strength test with good-to-excellent test-retest reliability, and intra-, inter-rater reliability. Test-retest ICC values compare favourably to gold standard fixed-frame dynamometry and are superior to hand-held dynamometry.
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Affiliation(s)
- Colm Fuller
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Éanna Falvey
- Sports Medicine Research Department, Sports Surgery Clinic, Dublin, Ireland; College of Medicine and Health, University College Cork, Cork, Ireland; World Rugby, World Rugby House 8-10 Lower Pembroke Street, Dublin 2, Ireland
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre and Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Cooney NJ, Sowman P, Schilaty N, Bates N, Hewett TE, Doyle TLA. Head and Neck Characteristics as Risk Factors For and Protective Factors Against Mild Traumatic Brain Injury in Military and Sporting Populations: A Systematic Review. Sports Med 2022; 52:2221-2245. [PMID: 35522377 PMCID: PMC9388456 DOI: 10.1007/s40279-022-01683-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Investigators have proposed that various physical head and neck characteristics, such as neck strength and head and neck size, are associated with protection from mild traumatic brain injury (mTBI/concussion). OBJECTIVES To systematically review the literature and investigate potential relationships between physical head and neck characteristics and mTBI risk in athletic and military populations. METHODS A comprehensive search of seven databases was conducted: MEDLINE, EMBASE, CINAHL, Scopus, SPORTDiscus, Cochrane Library, and Web of Science. Potential studies were systematically screened and reviewed. Studies on military and athletic cohorts were included if they assessed the relationship between physical head-neck characteristics and mTBI risk or proxy risk measures such as head impact kinematics. RESULTS The systematic search yielded a total of 11,723 original records. From these, 22 studies met our inclusion criteria (10 longitudinal, 12 cross-sectional). Relevant to our PECO (Population, Exposure, Comparator, and Outcomes) question, exposures included mTBI incidence and head impact kinematics (acceleration, velocity, displacement) for impacts during sport play and training and in controlled laboratory conditions. Outcome characteristics included head and neck size (circumference, mass, length, ratios between these measures), neck strength and endurance, and rate of force development of neck muscles. DISCUSSION We found mixed evidence for head and neck characteristics acting as risk factors for and protective factors against mTBI and increased susceptibility to head impacts. Head-neck strength and size variables were at times associated with protection against mTBI incidence and reduced impact kinematics (14/22 studies found one or more head-neck variable to be associated with protection); however, some studies did not find these relationships (8/22 studies found no significant associations or relationships). Interestingly, two studies found stronger and larger athletes were more at risk of sustaining high impacts during sport. Strength and size metrics may have some predictive power, but impact mitigation seems to be influenced by many other variables, such as behaviour, sex, and impact anticipation. A meta-analysis could not be performed due to heterogeneity in study design and reporting. CONCLUSION There is mixed evidence in the literature for the protective capacity of head and neck characteristics. We suggest field-based mTBI research in the future should include more dynamic anthropometric metrics, such as neck stiffness and response to perturbation. In addition, laboratory-based mTBI studies should aim to standardise design and reporting to help further uncover these complicated relationships.
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Affiliation(s)
- Nicholas J Cooney
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Paul Sowman
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nathan Schilaty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.,Center for Neuromusculoskeletal Research, University of South Florida, Tampa, FL, USA
| | - Nathaniel Bates
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy E Hewett
- Hewett Global Consulting, Minneapolis, MN, USA.,Rocky Mountain Consortium for Sports Injury Research, Aspen, CO, USA
| | - Tim L A Doyle
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
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The implementation of a neck strengthening exercise program in elite rugby union: A team case study over one season. Phys Ther Sport 2022; 55:248-255. [DOI: 10.1016/j.ptsp.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022]
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13
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The assessment of neck strength: A guide for sports medicine clinicians. Phys Ther Sport 2022; 55:282-288. [DOI: 10.1016/j.ptsp.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
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14
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Peek K, McKay M, Fu A, Meyer T, Oxenham V, Esopenko C, Caccese J, Andersen J. The effect of ball characteristics on head acceleration during purposeful heading in male and female youth football players. SCI MED FOOTBALL 2022; 5:195-203. [PMID: 35077287 DOI: 10.1080/24733938.2021.1897657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The objective of this cross-sectional study was to explore the effects of different ball types and characteristics on head acceleration during purposeful heading in youth football players. Methods: Experienced male and female players (n = 61) aged between 12-17 years completed heading trials with 4 different balls (Ball 1 mass 192 grams (g), pressure 5.0 pounds per square inch (psi); Ball 2 432 g, 5.0 psi; Ball 3 255 g, 5.0 psi; Ball 4 430 g, 10.5 psi) whilst wearing a head-mounted accelerometer and gyroscope. Balls 1, 2 and 4 were size 5 balls; Ball 3 was a size 4 ball.Results: Multivariate analysis of variance and post-hoc univariate analyses revealed a statistically significant difference between ball type and head acceleration during heading for both linear acceleration (adjusted R2 = 0.68; F = 140.90; p = <0.001) and angular velocity (adjusted R2 = 0.28; F = 26.52; p = <0.001). Ball 1 (lightest size 5 ball) and Ball 3 (size 4 ball) demonstrated linear head accelerations up to 59% lower (p = <0.01) when compared with Ball 4 (size 5 regulated match ball).Discussion: Head acceleration during purposeful heading is influenced by changes to ball pressure, ball size and/or ball mass. Changing ball characteristics, particularly in youth football training when heading is being taught, should be an easy strategy to implement.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allan Fu
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Saarbrücken, Germany
| | - Vincent Oxenham
- Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, Rutgers Biomedical Health Sciences, Newark, USA
| | - Jaclyn Caccese
- School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, USA
| | - Jordan Andersen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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15
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Abstract
Purpose: To quantify the incidence and characteristics of purposeful headers and unintentional head impacts in football (soccer) in boys' football over three seasons.Methods: This retrospective longitudinal study analysed purposeful headers and unintentional head impacts collected over three seasons (under-10 to under-12) using match video analysis from boys' team in Australia. Total headers and head impacts, as well as incidence rate (IR) per 1000 match-hours for different match characteristics, were calculated.Results: Total number of headers and heading IR increased significantly (r = 0.99) with age from under-10 (n = 29; IR: 483) to under-12 (n = 149; IR: 1515). All but three players (87%) were observed to head the ball at least once during a season (mean: 10, range 0-25) with the accumulative number of headers performed by out-field players over three seasons ranging from 6 to 40. Players in defensive positions (n = 121) headed the ball more frequently than midfielders (n = 83) or attackers (n = 53). Five (IR: 22) unintentional head impacts were observed, of which four required medical attention.Conclusion: Although the number of headers performed by young players in under-10 to under-12 age groups was low, the range of headers performed by individuals varied greatly. These results could be used to guide age-specific heading coaching practices.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, University of Sydney, Lidcombe, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Marnee McKay
- Discipline of Physiotherapy, University of Sydney, Lidcombe, Australia
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16
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Peek K, Andersen J, McKay MJ, Versteegh T, Gilchrist IA, Meyer T, Gardner A. The Effect of the FIFA 11 + with Added Neck Exercises on Maximal Isometric Neck Strength and Peak Head Impact Magnitude During Heading: A Pilot Study. Sports Med 2022; 52:655-668. [PMID: 34590247 PMCID: PMC8480461 DOI: 10.1007/s40279-021-01564-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Higher neck strength has been postulated to reduce head impact magnitude during purposeful heading in football. OBJECTIVES This pilot trial explored the effect of a neck exercise programme on (1) neck strength and (2) head impact magnitude during heading in male and female adolescent football players. METHODS Boys and girls (aged 12-17 years) were randomised by team to the intervention (5 weeks of supervised neuromuscular neck exercises integrated into part 2 of the FIFA 11 + , completed three times per week) or the control group (usual part 2 of the FIFA 11 + , no neck exercises). Outcomes included isometric neck strength and head impact magnitude (peak linear acceleration and peak angular velocity) during standardised heading from a throw-in (at baseline and 6 weeks) plus completion of an evaluation survey by intervention players and coaches. RESULTS In total, 52 players (n = 31 intervention; n = 21 control) completed the study. Mixed-model analysis of variance (ANOVA) revealed significant differences in neck strength variables (p < 0.001), peak linear acceleration (p = 0.04) and peak angular velocity (p = 0.04) between the intervention and control groups over time. Intervention players demonstrated increases in mean composite neck strength (53.8% intervention vs 15.6% control) as well as decreases in mean peak linear head acceleration during heading (- 11.8% vs - 5.0%) from baseline to follow-up. Reduction in peak angular velocity was more pronounced in girls (- 27.7%) than boys (- 11.5%) in the intervention group. The addition of neck exercises into part 2 of the FIFA 11 + was feasible and accepted by players and coaches. CONCLUSION On average, players who completed neck exercises demonstrated an increase in isometric neck strength and a decrease in head impact magnitude during heading. These exercises were easily incorporated into usual training. Australian New Zealand Clinical Trials Registry (no: ACTRN12619001375145).
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, NSW, Australia.
| | - Jordan Andersen
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Marnee J. McKay
- Discipline of Physiotherapy, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown, Sydney, NSW Australia
| | - Theo Versteegh
- School of Physical Therapy, Western University, London, ON Canada
| | - Ian A. Gilchrist
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON Canada
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Saarbrücken, Germany
| | - Andrew Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia ,Hunter New England Local Health District Sports Concussion Research Program, Calvary Mater Hospital, Waratah, NSW Australia
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17
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Müller C, Zentgraf K. Neck and Trunk Strength Training to Mitigate Head Acceleration in Youth Soccer Players. J Strength Cond Res 2021; 35:S81-S89. [PMID: 33065700 DOI: 10.1519/jsc.0000000000003822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carsten Müller
- Institute of Sport and Exercise Sciences, University of Münster, Münster, Germany.,University Sports, University of Münster, Münster, Germany; and
| | - Karen Zentgraf
- Department of Movement Science and Training in Sports, Institute of Sport Sciences, Goethe-University Frankfurt, Frankfurt, Germany
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18
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Filben TM, Pritchard NS, Miller LE, Miles CM, Urban JE, Stitzel JD. Header biomechanics in youth and collegiate female soccer. J Biomech 2021; 128:110782. [PMID: 34656012 DOI: 10.1016/j.jbiomech.2021.110782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
Concerns about the effects of intentional heading in soccer have led to regulatory restrictions on headers for youth players. However, there is limited data describing how header exposure varies across age levels, and few studies have attempted to compare head impact exposure across different levels of play with the same sensor. Additionally, little is known about the biomechanical response of the brain to header impacts. The objective of this study was to evaluate head kinematics and the resulting tissue-level brain strain associated with intentional headers among youth and collegiate female soccer players. Six youth and 13 collegiate participants were instrumented with custom mouthpiece-based sensors measuring six-degree-of-freedom head kinematics of headers during practices and games. Kinematics of film-verified headers were used to drive impact simulations with a detailed brain finite element model to estimate tissue-level strain. Linear and rotational head kinematics and strain metrics, specifically 95th percentile maximum principal strain (ε1,95) and the area under the cumulative strain damage measure curve (VSM1), were compared across levels of play (i.e., youth vs. collegiate) while adjusting for session type and ball delivery method. A total of 483 headers (n = 227 youth, n = 256 collegiate) were analyzed. Level of play was significantly associated with linear acceleration, rotational acceleration, rotational velocity, ε1,95, and VSM1. Headers performed by collegiate players had significantly greater mean head kinematics and strain metrics compared to those performed by youth players (all p < .001). Targeted interventions aiming to reduce head impact magnitude in soccer should consider factors associated with the level of play.
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Affiliation(s)
- Tanner M Filben
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - N Stewart Pritchard
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA.
| | - Logan E Miller
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Christopher M Miles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jillian E Urban
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
| | - Joel D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; School of Biomedical Engineering and Sciences, Virginia Tech - Wake Forest University, Winston-Salem, NC, USA
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19
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Chavarro-Nieto C, Beaven M, Gill N, Hébert-Losier K. Neck strength in Rugby Union players: a systematic review of the literature. PHYSICIAN SPORTSMED 2021; 49:392-409. [PMID: 33554689 DOI: 10.1080/00913847.2021.1886574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence and severity of concussion injuries are increasing every year. Scientific evidence indicates that neck strength and girth could play a role in preventing head and neck injuries, or at least mitigating their severity. We aimed to examine the scientific literature addressing neck strength in Rugby Union with a focus on the potential role of neck strength on injury incidence, neck assessment protocols, neck strength measures, and neck strengthening exercises.We conducted a systematic search of the literature in January 2021 to locate published peer-reviewed articles from PubMed, SPORTDiscusTM, Web of Science®, and Scopus® e-databases. Overall, senior elite male players were stronger than younger-aged players. Forwards were stronger in extension than any other directions assessed, and were generally stronger and possessed larger necks and greater cross-sectional areas when compared to backs. Implementation of isometric exercise routines in professional players was reported to improve neck strength in all directions. There were no studies evaluating the incidence of concussion and neck strength or neck strengthening strategies in Rugby Union. Strengthening the neck continues to be one of the targeted modifiable risk factors with respect to limiting the severity and temporal effects of head injuries in Rugby Union, despite limited evidence regarding direct associations between neck strength and concussion.
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Affiliation(s)
- Christian Chavarro-Nieto
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
| | - Martyn Beaven
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
| | - Nicholas Gill
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand.,New Zealand Rugby, Thorndon, Wellington, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, University of Waikato, Tauranga, New Zealand
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20
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Blyth RJ, Alcock M, Tumilty DS. Why are female soccer players experiencing a concussion more often than their male counterparts? A scoping review. Phys Ther Sport 2021; 52:54-68. [PMID: 34419893 DOI: 10.1016/j.ptsp.2021.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The risk of concussion is particularly high in female soccer players. There is no consensus as to why female soccer players are at an elevated risk. OBJECTIVE To synthesise current evidence investigating reasons for the increased concussion rate in female soccer players. SOURCES Searching of six databases (MEDLINE, Scopus, CINAHL, SportDiscus, Web of Science and the Cochrane Library) and grey literature was performed between 13/07/2020-31/07/2020. Keywords were concussion-related terms, terms relating to female football/soccer and terms relating to the mechanism/cause. No constraints were placed on publication date and quantitative or exploratory studies meeting inclusion criteria were eligible. Exclusion criteria were studies not published in English and qualitative studies. RESULTS Several hypotheses were identified to explain increased concussion rates in female soccer players, these include, reduced neck strength/anthropometrics, increased head acceleration, increased ball-to-head concussions, differences in hormones and brain structure/function, and reduced visual awareness. CONCLUSION Promising ideas/reasons have been identified for increased concussion rates in female soccer players. Despite hypothesis generation there is scarce high-level evidence which is required to guide injury prevention and/or rule changes to protect female soccer players. The level of evidence for included studies is level 2-3 with most being observational cross-sectional or cohort studies.
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Affiliation(s)
- Rebecca Jane Blyth
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand.
| | - Mark Alcock
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
| | - Dr Steve Tumilty
- School of Physiotherapy, University of Otago, 325 Great King Street, North Dunedin, Dunedin, 9016, New Zealand
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21
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Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review. Sports Med 2021; 51:2373-2388. [PMID: 34143411 DOI: 10.1007/s40279-021-01501-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sport-related head and neck injuries, including concussion, are a growing global public health concern with a need to explore injury risk reduction strategies such as neck exercises. OBJECTIVES To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) SRC. METHODS Five databases (Ovid MEDLINE, CINAHL, EMBASE, SPORTDiscus, and Web of Science) and research lists of included studies were searched using a combination of medical subject headings and keywords to locate original studies which reported the association between incidence of head and/or neck injury and neck strength data, or included a neck exercise intervention either in isolation or as part of a more comprehensive exercise program. RESULTS From an initial search of 593 studies, six were included in this review. A narrative synthesis was performed due to the heterogeneity of the included studies. The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a SRC. Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including SRC. CONCLUSION Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including SRC. SYSTEMATIC REVIEW REGISTRATION PROSPERO (registration number: 194217).
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22
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Wahlquist VE, Kaminski TW. Analysis of Head Impact Biomechanics in Youth Female Soccer Players Following the Get aHEAD Safely in Soccer™ Heading Intervention. SENSORS (BASEL, SWITZERLAND) 2021; 21:3859. [PMID: 34204896 PMCID: PMC8199772 DOI: 10.3390/s21113859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022]
Abstract
The effects of repetitive head impacts associated with soccer heading, especially in the youth population, are unknown. The purpose of this study was to examine balance, neurocognitive function, and head impact biomechanics after an acute bout of heading before and after the Get aHEAD Safely in Soccer™ program intervention. Twelve youth female soccer players wore a Triax SIM-G head impact sensor during two bouts of heading, using a lightweight soccer ball, one before and one after completion of the Get aHEAD Safely in Soccer™ program intervention. Participants completed balance (BESS and SWAY) and neurocognitive function (ImPACT) tests at baseline and after each bout of heading. There were no significant changes in head impact biomechanics, BESS, or ImPACT scores pre- to post-season. Deficits in three of the five SWAY positions were observed from baseline to post-season. Although we expected to see beneficial changes in head impact biomechanics following the intervention, the coaches and researchers observed an improvement in heading technique/form. Lightweight soccer balls would be a beneficial addition to header drills during training as they are safe and help build confidence in youth soccer players.
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Affiliation(s)
| | - Thomas W. Kaminski
- Athletic Training Research Laboratory, University of Delaware, Newark, DE 19716, USA;
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23
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Peek K, Vella T, Meyer T, Beaudouin F, McKay M. The incidence and characteristics of purposeful heading in male and female youth football (soccer) within Australia. J Sci Med Sport 2021; 24:603-608. [PMID: 33414022 DOI: 10.1016/j.jsams.2020.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/25/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To quantify the incidence and characteristics of purposeful headers and unintentional head impacts during male and female youth football (soccer) games in Australia. DESIGN Cross-sectional observational study. METHODS Ten match-videos (total n=110) per playing age (under 13-20 males; under 13-17 females) from the 2019 National Premier League season were coded for purposeful headers and unintentional head impacts. Total headers and head impacts as well as incidence rate (IR) per 1000 match-hours for different match characteristics were calculated. RESULTS Purposeful headers accounted for 99% (n=4615, IR:1618) of total head impacts. The IR of purposeful headers per 1000 match-hours was highest for under-15 males (IR:2117) and under-17 females (IR:2090) followed by under-20 males (IR:1761). Midfielders completed the most headers in all female age groups (mean IR:713) and under 13-14 males (mean IR:891), with defenders completing the most headers in under 15-20 males (mean IR:760). Heading duels accounted for 16% of total headers with most headers performed during free play (68%), throw-ins (15%), free kicks (12%) and corner kicks (5%). Only 57 head impacts (IR:20) were coded as unintentional head impacts resulting from being struck by the ball or opponent body part with 4 (IR:1.4) requiring medical attention. CONCLUSIONS Heading is a complex skill. Given the propensity of youth players of all ages to purposefully head the ball, consideration should be given to coaching heading technique based on specific game scenarios for their playing position and age group. The findings of this study can be used to inform heading guidelines.
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Affiliation(s)
- Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - Teale Vella
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Florian Beaudouin
- Institute of Sports and Preventive Medicine, Medical Faculty, Saarland University, Germany
| | - Marnee McKay
- Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia
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24
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de Souza NL, Dennis EL, Brown AM, Singh S, Wilde EA, Buckman JF, Esopenko C. Relation between Isometric Neck Strength and White Matter Organization in Collegiate Athletes. Neurotrauma Rep 2020; 1:232-240. [PMID: 34223543 PMCID: PMC8240886 DOI: 10.1089/neur.2020.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Soccer athletes frequently experience repetitive head impacts (RHI) during games and practices, which may affect neural integrity over time and lead to altered brain structure. Neck strength is hypothesized to limit the transfer of force to the brain and decrease the effect of RHI on brain structure. The goal of our work was to examine whether greater neck strength is associated with more intact white matter organization (WMO) in collegiate athletes exposed to RHI. Collegiate soccer (n = 17) and limited/non-contact sport (n = 39) athletes were assessed prior to their athletic seasons. Participants completed neck strength assessments using handheld dynamometry in six test positions and diffusion tensor imaging. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated for 20 white matter (WM) regions. A multi-variate approach was used to examine the relationship between neck strength and diffusion measures in soccer and limited/non-contact athletes. Neck strength was positively associated with FA and negatively associated with RD across several WM regions in soccer players only. Neck strength was not significantly associated with MD or AD in either group. Greater neck strength was related to more intact WMO in athletes with high exposure to RHI, particularly in regions prone to damage from brain trauma such as the basal ganglia, superior longitudinal fasciculus, and frontoparietal WM. Future studies should examine neck strength as a factor to moderate neural outcomes in athletes with exposure to RHI.
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Affiliation(s)
- Nicola L de Souza
- School of Graduate Studies, Biomedical Sciences, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Emily L Dennis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Allison M Brown
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Sasha Singh
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA.,George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Jennifer F Buckman
- Department of Kinesiology and Health, Rutgers University - New Brunswick, Piscataway, New Jersey, USA
| | - Carrie Esopenko
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
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25
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Snowden T, Reid H, Kennedy S, Kenny R, McQuarrie A, Stuart-Hill L, Garcia-Barrera MA, Gawryluk J, Christie BR. Heading in the Right Direction: A Critical Review of Studies Examining the Effects of Heading in Soccer Players. J Neurotrauma 2020; 38:169-188. [PMID: 32883162 DOI: 10.1089/neu.2020.7130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The practice of heading in soccer has become a public concern because of the potential for subconcussive impacts to cause cumulative concussive-like effects; however, experimental evidence for this hypothesis has been mixed. This systematic review used pre-defined search parameters to assess primary literature that examined changes in cognitive, behavioral, structural, and/or biological processes after acute heading exposure in youth and young adult soccer players. The findings were synthesized into a concise and comprehensive summary of the research following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format, and suggestions for standardization of acute heading protocols are described. A total of 1189 articles were considered for this review, with 19 articles meeting all of the inclusion criteria for full analysis. An attempt was made to identify methods with significant sensitivity and reliability by grouping studies based on their outcome measures. Because of lack of standardization across intervention types and data collection protocols, no sensitive and reliable methods could be identified conclusively to assess the effects of acute heading exposure in soccer players. Based on this review, there is not enough evidence to either support or refute the potential of effects of subconcussive events from acute soccer heading exposure. Recommendations for standardization of acute heading exposure studies based on the included literature are discussed. Standardization is required to better understand the impact of acute heading exposure in soccer players, while allowing for the development of guidelines that mitigate any potential risks and allowing athletes to remain active and develop their skills.
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Affiliation(s)
- Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Hannah Reid
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Samantha Kennedy
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada
| | - Rebecca Kenny
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Amanda McQuarrie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
| | - Lynneth Stuart-Hill
- School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
| | | | - Jodie Gawryluk
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brian R Christie
- Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada.,Island Medical Program, University of British Columbia, Victoria, British Columbia, Canada.,School of Exercise Science, Physical and Health Education, and University of Victoria, Victoria, British Columbia, Canada
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26
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Abstract
Repeated purposeful heading in soccer has come under increased scrutiny as concerns surrounding the association with long-term neurodegenerative disorders in retired players continue to grow. Although a causal link between heading and brain health has not been established, the "precautionary principle" supports the notion that soccer governing bodies and associations should consider implementing pragmatic strategies that can reduce head impact during purposeful heading in youth soccer while this relationship is being investigated. This Viewpoint discusses the current evidence to support low-risk head impact reduction strategies during purposeful heading to protect young, developing players, and how such strategies could be implemented now while research and debate continue on this topic. J Orthop Sports Phys Ther 2020;50(8):415-417. doi:10.2519/jospt.2020.0608.
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