5. Neck strengthening
A growing number of concussion experts [9], strength and conditioning trainers, and physical therapists, believe that one important way to reduce the risk of sport-related concussion is by strengthening the neck, the theory being that stronger neck muscles will help cushion against and lessen the linear and rotational forces that cause concussion.
The preliminary results of a pilot study [10] presented at the 4th Annual National Youth Sports Safety Summit in Washington, D.C. in February 2013, and subsequently reported in July 2014 in the journal Primary Prevention [34] backs up that theory, suggesting that overall neck strength is a statistically significant predictor of concussion, with the odds of concussion falling by 5% for every one pound increase in aggregate neck strength. The data also showed that the quarter of the subject group of more than six thousand high school athletes playing boys' and girls' soccer, basketball, and lacrosse with the weakest necks suffered the greatest number of concussions, while the quartile with the strongest necks suffered the fewest.
"The evidence [suggests] that neck strengthening programs may be an effective primary concussion prevention mechanism that is inexpensive, easy to adopt, widely available, and fully within the athlete's control," says R. Dawn Comstock, PhD. associate professor in the Department of Epidemiology at the Colorado School of Public Health and principal investigator for the High School RIO TM (an internet-based data collection tool used in the National High School Sports-Related Injury Surveillance Study) from which the study results were drawn.
"We focus so much on how to properly diagnose concussions," Comstock told Time magazine's Sean Gregory. "That's obviously important, but preventing concussions is a much better outcome. We're not saying you won't get a concussion if your neck is stronger. But the data shows that neck strengthening has strong potential as a key concussion prevention tool."
"The results are promising and support what those of us caring for athletes believed to be true, based on our observations, who see strengthening the neck musculature as a means of reducing the risk of sport-related concussion, said William P. Meehan, III, M.D., Director of the Micheli Center for Sports Injury Prevention in the Division of Sports Medicine at Children's Hospital Boston, and a former MomsTEAM concussion expert featured in its PBS high school football documentary, "The Smartest Team."
6. Head impact exposure monitoring
Writing in the March 2012 Clinical Journal of Sports Medicine,[11] the developers of HITSTM (Head Impact Telemetry System) - widely used by researchers in biomechanical studies to measure the force and direction of helmet impacts and the technology now incorporated into Riddell's new helmet featuring what it calls its InSite Impact Response System - advocate for widespread use of helmet sensors at all levels of football, and in other sports where practical, to allow real-time monitoring by sideline personnel of impact exposure, either from a single, forceful blow which may cause concussion or the accumulation of repetitive sub-concussive impacts, which puts an athlete at risk for brain injury.
"The identification of a potentially injurious impact or series of impacts via real-time monitoring of head impact exposure in athletes may [not only] facilitate the early recognition and management of brain injury in helmeted sports," says lead author, Richard M. Greenwald, PhD, of the Thayer School of Engineering at Dartmouth College and co-founder of Simbex LLC, the manufacturer of HITSTM, but "permit early intervention, potentially in advance of an injury, rather than simply as a management tool postinjury."
Greenwald is not alone in trumpeting the potential benefit of impact sensors in identifying athletes for sideline screening for concussion. Writing about head impact sensors in the March 2013 issue of the British Journal of Sports Medicine, [22] Jeffrey S. Kutcher, MD, of the Department of Neurology and Michigan Neurosport at the University of Michigan, concurs that the "development of easily deployable sport equipment-based accelerometer systems ... provide[s] [a] potentially useful, clinical information."
"The first is the ability to monitor impacts during the course of an athletic event for the purpose of screening for potential injury. Although many researchers have analyzed impact counts and characteristics across a variety of settings in the hopes of establishing force 'thresholds' for injury, no such threshold has been discovered. As efforts to improve impact-monitoring accuracy continue, however, so will the search for the 'concussion threshold.'"
"Although an on-board accelerometer system may not be able to accurately predict injury," says Kutcher, "it may have utility as a screening device by alerting sideline personnel of an impact that has occurred above a predetermined magnitude that triggers either observation or clinical evaluation of an athlete."
Not surprisingly, some concussion experts take a more cautious approach to the use of impact sensors. Despite finding that under-reporting continues what she wrote in two 2013 studies to be an "alarming" [23] and "overwhelming" problem [24], Johna Register-Mihalik, Ph.D, LAT, ATC, of the Matthew Gfeller Sport-Related TBI Research Center at the University of North Carolina at Chapel Hill, told MomsTEAM that the the reason the use of impact sensors was not among the recommendations she and her co-authors made to address the problem was that she viewed "the use of impact sensors in concussion detection, as the science, although a growing field of information, is just not quite there in how these may best be used from a clinical standpoint and across all sport settings."
"As it stands, there is no absolute threshold for concussive injury and while these sensors may identify individuals who receive a certain type of hit or impact, we do not yet know if those impacts not identified by a set threshold may lead to concussion. In many ways, this may provide a false sense of security, in that 'if the sensor didn't go off, I must not have a concussion.'"
Register-Mihalik recognized that "there is certainly potential for this type of technology to have great implications in the identification of concussion as the science advances," but, she argued, "we need more scientific and unbiased evidence of their ability to detect concussion before they are widely used and recommended in all settings. Until that time, there are some good examples of identification techniques of having trained observers, a parent advocate and continuing to promote concussion education that we know will increase identification rates."
The recent decision by the National Football League to suspend a pilot program in which sensors were installed in players' helmets may also slow down the push towards more widespread adoption of sensor technology, not because their use is unlikely to make sports like football safer (MomsTEAM thinks it will), but for fear that it may open Pandora's box by making it clear just how hard and how often players are getting hit, and scare off parents from letting kids play the sport.
