Improving neck strength during adolescence: Risk, recommendations and benefits

Your weekly research review

Tom Green

By Tom Green
January 18th, 2020 | 4 min read

Contents of Research Review

  1. Background & Objective
  2. What They Did
  3. What They Found
  4. Practical Takeaways
  5. Reviewer’s Comments
  6. About the Reviewer

Background & Objective

Complex movements require large muscle groups to work together and are often pursued in a resistance programme as they offer a high physical ‘return to time’ ratio. At times, strength programmes could be criticised for avoiding smaller muscle groups, such as those of the cervical spine, which are very important as a preventative measure for injury and concussion.

Collision sports such as rugby and American Football have recently placed a high emphasis on neck related strengthening, due to the nature of the sport (head contact, neck/shoulder collision) and volumes of concussion. In football however, few authors have pursued this line of thought, which Wilson and colleagues have addressed in their investigation of a cervical strengthening programme over 6 weeks.

What They Did

Eighty-three athletes (male and female) aged between 14 and 15 were assigned to either an intervention group (n = 50), or a control group (n = 33). The intervention group performed a web-based cervical exercise programme, progressing through a majority of isometric exercises in phase 1, concentric in phase 2, and eccentric contractions in phase 3 over a 6 week period. The webpage consisted of demonstration videos of the exercises and instructions for the warm-up.

The control group received no specific cervical strengthening work, with the aim of seeing how the intervention group benefitted when compared to a ‘typical’ adolescent. To measure all variables, an Ergo FET Push-Pull Force Handheld Dynamometer was attached to a head strap, and measured isometric cervical strength, flexion, extension, right lateral flexion and left lateral flexion in Newton’s (N).

What They Found

In this study, the intervention group significantly increased left lateral flexion (24.1 [15.9-32.4 ± SD]), extension (27.9 [18.4-37.5]), right lateral flexion (18.8 [11.6-26.1]), and flexion (1.2 [1.1-1.2]). In comparison, the control participants did not reveal any significant changes in cervical neck strength. Interestingly, an increase in neck size (0.8-0.9 cm) was also found in both the control and intervention group.

Despite this, only the intervention group demonstrated strength improvements. This was therefore attributed to normal growth patterns seen in adolescents, and not exclusively as a result of muscle hypertrophy from the protocol.

Practical Takeaways

This study suggests that performing 4-6 strength exercises over 3-7 days, depending on the phase can significantly improve cervical neck strength. Increasing cervical strength is important for youth athletes, as this decreases the risk of head/neck injury and concussion risk.

What is important to take away is that for every pound gained in neck strength (equivalent to 4.45 N) the risk of concussion decreases by 5%. According to this study, typical improvements can range from 8 to 50% when pursuing a neck strengthening protocol. As a result of this, players may wish to incorporate some neck related work in their sessions.

In addition to proving effective as an intervention, this protocol benefits from being a relatively cheap initiative, costing little, if anything to replicate. As a result of this, schools or clubs on a budget can have an immediate impact on performance and injury prevention for free. As a resource, please see this poster (HERE) that can be placed inside your gym/handed out to athletes to complete, with a series of pictures, cues, and progressions.

Reviewer’s Comments

“When reading an article, I’m always looking to understand how this could look in practice. By following this protocol, the participants have clearly produced some impressive results, and considering the risk associated with concussion described in the attached video (HERE), it is not surprising that we’d want to reduce this risk.

However, the following question has come to mind: ‘Would an adolescent follow this routine unsupervised?’. I fear that ‘buy-in’ from grassroots players would prove challenging, with many struggling to adhere to this on a daily basis. In addition, paired work may prove challenging, as some adolescents may not manage this task maturely and could cause undue harm to a peer.

Hypothetically, if all of our athletes did complete this protocol 3 or more times a week, we would have to ask ourselves as practitioners if this is the best use of their time. In contact sports (rugby, Muay Thai, racing etc.), this may be considered an easy win on the athletic development journey, as the risk of concussion may be high.

However, in football or athletics, the risk of an ACL injury, hamstring, or ankle injury may be far greater and worthier of their training time. Moreover, pursuing these qualities may support other athletic aptitudes (strength, power, speed as examples), which could also support performance and injury prevention. With limited time as a practitioner, it may be more beneficial to tackle areas where there is an increased likelihood of injury built on the sports need analysis. In my own practice, I’m going to include two isometric neck strengthening activities every session (3 times a week) for a few weeks as part of the warm-up to see how this goes.”

Want to learn more?
Then check these out…

Watch this video
Read this article

The full study can be read here.

Tom Green

Tom Green

Tom Green is currently the Head of Athletic Development at St Peters RC High School in England. Tom has extensive experience in a range of sports at varied levels. He holds a BSc and MSc in Strength and Conditioning, is a qualified teacher, and sits on the UKSCA board for S&C in Schools.

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