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Combining evidence and practice to optimise neck training aimed at reducing head acceleration events in sport: a systematic review and Delphi-consensus study
  1. Molly Fownes-Walpole1,2,
  2. Omar Heyward1,3,
  3. Kevin Till1,2,
  4. Lois Mackay1,4,
  5. Anna Stodter1,5,
  6. Marwan Al-Dawoud1,
  7. Melanie Dawn Bussey6,
  8. Leigh Gordon7,
  9. James Hairsine3,
  10. Christopher Kirk8,
  11. Rob Madden9,10,
  12. Lesley McBride11,
  13. Alexander McDaniel12,
  14. Pete McKnight13,
  15. Nathan Mill14,
  16. Kerry Peek15,
  17. Gavin Pratt16,
  18. Des Ryan17,
  19. Danielle Salmon18,19,
  20. Lindsey Schroeder12,
  21. Craig Twentyman20,
  22. Theo Versteegh21,
  23. Elisabeth Williams22,
  24. Ben Jones1,7,23,24,25
  1. 1Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  2. 2Leeds Rhinos Rugby League Club, Leeds, UK
  3. 3Rugby Football Union, Twickenham, UK
  4. 4England Netball, Loughborough, UK
  5. 5Centre for Sport Coaching, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
  6. 6School of Physical Education Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
  7. 7Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
  8. 8Sport and Human Performance Research Group, Sheffield Hallam University, Sheffield, South Yorkshire, UK
  9. 9OPTIM7SE, London, UK
  10. 10Team Anthony Joshua, London, UK
  11. 11School of Healthcare, University of Leicester, Leicester, UK
  12. 12University of North Carolina Wilmington, Wilmington, North Carolina, USA
  13. 13Freelance Performance Consultant, Yorkshire, UK
  14. 14Saint Helens R.F.C, Merseyside, UK
  15. 15Discipline of Physiotherapy, The University of Sydney, Camperdown, New South Wales, Australia
  16. 16Ultimate Fighting Combat Performance Institute, Las Vegas, Nevada, USA
  17. 17University of Galway, Galway, Ireland
  18. 18International Rugby Players Association, Dublin, Ireland
  19. 19Sport Injury Prevention Research Centre, University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
  20. 20All Blacks Sevens, Wellington, New Zealand
  21. 21TopSpin Technologies Ltd, Ontario, Toronto, Canada
  22. 22Applied Sports, Technology, Exercise and Medicine Research Centre (A-STEM), Faculty of Science and Engineering, Swansea University, Swansea, Wales, UK
  23. 23Premiership Rugby, London, UK
  24. 24England Performance Unit, Rugby Football League, Manchester, UK
  25. 25School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
  1. Correspondence to Molly Fownes-Walpole; m.fownes-walpole{at}leedsbeckett.ac.uk

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.