Effectiveness of a tailored neck training program on neck strength, movement, and fatigue in under-19 male rugby players: a randomized controlled pilot study

Efficacy of exercise interventions on prevention of sport-related concussion and related outcomes: a systematic review and meta-analysis

OBJECTIVE

To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT).

DESIGN

Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines.

DATA SOURCES

Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population.

RESULTS

A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD -0.43; 95% CI -1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI -0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9-13).

CONCLUSION

RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication.

PROSPERO REGISTRATION NUMBER

CRD42023435033.

Drive away neck pain: Transformative motor control therapeutic neck exercises and tailored programs redefine posture for automotive workers

BACKGROUND

Neck discomfort, arising from strained muscles, poor posture, accidents, or underlying medical conditions, significantly impacts daily activities and overall well-being, presenting a substantial healthcare challenge.

OBJECTIVE

This study aims to evaluate the efficacy of motor control therapeutic neck exercise and a Structured Exercise Program on neck pain and posture among automobile industrial workers.

METHODS

Using a lottery technique, 106 participants aged 20 to 45 were selected from the vicinity of Chennai's auto industries based on predetermined eligibility and exclusion criteria. Subsequently, participants were randomly assigned to either the motor control therapeutic neck exercise group or the structured exercise program group, each comprising 53 individuals. Participants received a comprehensive overview of the study and respective interventions, and their informed consent was obtained. Demographic details, Neck Injury and Disability scores, and Assessment of Postural and Ergonomic Characteristics data were then collected.

RESULTS

Statistical analysis revealed a significant difference between the groups, with the Motor Control Therapeutic Neck Exercise group demonstrating superior outcomes in reducing pain and improving posture, with p-values less than 0.001.

CONCLUSIONS

This study highlights the efficacy of Motor Control Therapeutic Neck Exercise over Structured Exercise in improving neck pain and posture among automobile industrial workers. These findings contribute valuable insights for the development of targeted interventions in occupational health settings.

A Profile of Isometric Cervical Strength in Elite Professional Male Rugby Players

OBJECTIVES: To (1) provide position-specific normative data for isometric cervical muscle strength and endurance in professional, male rugby players and (2) assess the relationship between age, height, weight, and playing position with cervical muscle strength and endurance. DESIGN: Cross-sectional study. METHODS: Professional rugby players completed peak isometric cervical strength testing followed by a test of cervical muscle endurance. Descriptive statistics for continuous variables with strength normalized to body weight were performed. Multiple linear regression was used to estimate associations between strength measurements. RESULTS: In total, 136 players participated including front-row forwards (27%), other forwards (28%), and backs (45%). Front-row forwards had significantly greater peak isometric cervical muscle strength than other position groups, with backs having the lowest strength. Extension produced the highest force for all 3 position groups (429 N ± 104 N), whereas flexion produced the least (275 N ± 65 N). Age was associated with increased isometric cervical muscle strength. There was a statistically significant relationship between peak flexion strength and flexion endurance (P = .003). The average time for the endurance tests were 55.7 (±17.1) seconds and 52.9 (±20.1) seconds for extension and flexion, respectively. Other forwards had lower cervical extension muscle endurance than backs and front-row forwards. CONCLUSIONS: Normative values for peak and endurance isometric strength in professional rugby players illustrate significant differences between playing position. Consider age, body weight, and intraindividual variability when interpreting cervical strength and endurance results. J Orthop Sports Phys Ther 2024;54(3):1-8. Epub 29 January 2024. doi:10.2519/jospt.2024.11830.

Reliability of Repeated Isometric Neck Strength in Rugby Union Players Using a Load Cell Device

Concussion is the most common injury in professional Rugby Union (RU) players, with increasing incidence and severity each year. Strengthening the neck is an intervention used to decrease concussion incidence and severity, which can only be proven effective if strength neck measures are reliable. We conducted a repeated-measures reliability study with 23 male RU players. Neck strength was assessed seated in a ‘make’ test fashion in flexion, extension, and bilateral-side flexion. Flexion-to-extension and left-to-right side ratios were also computed. Three testing sessions were undertaken over three consecutive weeks. Intrasession and intersession reliabilities were assessed using typical errors, coefficient of variations (CV), and intraclass correlation coefficients (ICC). Intrasession reliability demonstrated good-to-excellent relative (ICC > 0.75) and good absolute (CV ≤ 20%) reliability in all directions (ICC = 0.86−0.95, CV = 6.4−8.8%), whereas intersession reliability showed fair relative (ICC: 0.40 to 0.75) and acceptable absolute (CV ≤ 20%) reliability for mean and maximal values (ICC = 0.51−0.69, CV = 14.5−19.8%). Intrasession reliability for flexion-to-extension ratio was good (relative, ICC = 0.86) and acceptable (absolute, CV = 11.5%) and was fair (relative, ICC = 0.75) and acceptable (absolute, CV = 11.5%) for left-to-right ratio. Intersession ratios from mean and maximal values were fair (relative, ICC = 0.52−0.55) but not always acceptable (absolute, CV = 16.8−24%). Assessing isometric neck strength with a head harness and a cable with a load cell device seated in semi-professional RU players is feasible and demonstrates good-to-excellent intrasession and fair intersession reliability. We provide data from RU players to inform practice and assist standardisation of testing methods.

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

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.

Web-Based Exercise Program Increases Cervical Strength in Adolescent Athletes

ABSTRACT

Wilson, JC, Levek, C, Daoud, AK, Brewer, M, Brooks, K, Sochanska, A, Randall, M, and Provance, AJ. Web-based exercise program increases cervical strength in adolescent athletes. J Strength Cond Res 35(4): 1149-1155, 2021-This cohort study aimed to evaluate the efficacy of a web-based 6-week cervical strengthening program on cervical strength in adolescent athletes. It was hypothesized that subjects completing the program would demonstrate significant increase in cervical muscle strength compared with baseline strength. Eighty-three high school soccer athlete subjects were recruited from 2 local nationally competitive soccer clubs. Teams were assigned to either control or intervention groups to minimize information crossover. Fifty subjects were recruited to the intervention group (29 male, 21 female; average age 15.1 years). Thirty-three subjects were recruited to the control group (21 male, 12 female; average age 15.1 years). Intervention group subjects completed a web-based progressive cervical strengthening program over 6 weeks. Cervical strength in flexion, extension, right and left lateral flexion (LLF) was measured in Newton (N) of force at 3 time points during the competitive season for both control and intervention groups. Intervention group subjects significantly increased cervical strength [mean difference (95% confidence interval)] in LLF [24.1 (15.9-32.4)], extension [27.9 (18.4-37.5)], right lateral flexion [18.8 (11.6-26.1)], and flexion [mean ratio: 1.2 (1.1-1.2)] at follow-up testing; whereas control subjects did not see significant changes in strength. A web-based progressive cervical strengthening program improves cervical muscular strength in a population of adolescent athletes over a period of 6 weeks. Such a program could be used by researchers in future studies evaluating the influence on concussion risk and by practitioners as a means of reducing sport-related head and neck injuries.