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Abstract
Head acceleration events (HAEs) can potentially have adverse consequences for athlete brain health. In sports, in which head injuries have the highest incidence, identifying strategies to reduce HAE frequency and magnitude is a priority. Neck training is a potential strategy to mitigate against the magnitude of HAEs. This two-part study aimed to (1) systematically review the literature of neck training interventions in sport and (2) undertake an expert Delphi consensus on the best practices for neck training implementation to reduce HAEs in sport. Part I: a systematic search of four databases was undertaken from the earliest records to September 2024. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines were followed, and a quality assessment was completed using a modified Downs and Black assessment tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation). Papers were eligible if they both (1) implemented a reproducible exercise intervention targeting the neck within collision, combat or motor sport, and (2) assessed outcomes relating to either: the physical profile of the neck; head/neck injury incidence; and/or HAEs. Part II: 18 international experts, with experience in research and/or applied practice of neck exercise training, concussion and/or HAEs, reviewed the part I findings before completing a three-round Delphi consensus process. Part I included 21 papers, highlighting the heterogeneity of existing interventions. Part II resulted in 57 statements coded into five categories: contextual factors (n=17), neck training periodisation (n=12), training adaptations (n=10), neck training content (n=15) and athlete adherence (n=3). This study presents recommendations for neck exercise training aiming to reduce HAEs in sport, supporting both practice and future research.
- Neck
- Training
- Sport
- Brain Concussion
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Footnotes
X @MFownesWalpole, @Omar_Heyward, @KTConditioning, @loismackay, @annastodr, @bussey_melanie, @ChrisKirk_ASP, @LMcBPhysio, @peek_kerry, @23benjones
Contributors MF-W, KT, OH, AS and BJ conceptualised and designed the research project. MF-W, LM and KT completed the systematic review. MFW and OH completed the GRADE. MF-W, KT, OH, AS and BJ constructed the Delphi-consensus-Round-1 survey. MF-W constructed the Round 2 and 3 surveys and completed the inductive content analysis. OH reviewed the statements and text. MF-W was responsible for the interpretation of results and drafted the manuscript. Other authors contributed towards the consensus statements and all authors critically reviewed and edited the manuscript prior to submission. MF-W is the author guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests One author (TV) works for a company that designs and sells a neuromuscular neck training device. All other authors have no competing interests to declare, however, due to the nature of the study many of the authors work in research or practice involving neck strength or other interventions to reduce concussion/head acceleration events in sports.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.