Check Up from the Neck Up
Insights and perspectives on injury prevention, rehabilitation, health and fitness
By Ralph Cornwell, Ph.D., Ph.D. Candidate, Virginia Polytechnic Institute and State University
In a tradition that dates back centuries, physicians take the Hippocratic Oath before they practice medicine. In the original interpretation of the oath, a doctor would swear to “prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” This code of moral conduct offers up valuable lessons to strength coaches and athletic trainers who work with the “patient” in their world: the athlete.
Strength coaches are charged primarily with the duty of preparing athletes for the rigors of their chosen sport. Referring back to the Hippocratic Oath, one could argue that increasing the performance of an athlete should become the second priority for strength coaches because a great athlete standing on the sidelines injured does no one any good.
The top priority for strength coaches instead should be a training regimen targeted first at protecting their athletes from harm as their “patients” are tuned for competition. Strength coaches who help athletes achieve their goals while maintaining their overall good health ensure that these athletes are prepared for any and all possibilities they may face in competition. And just as amazingly, those coaches who have shifted their priorities have realized that performance is not diminished but rather enhanced by a more completely trained athlete.
Of course, it goes without saying that the chance of injury is always a possibility during sports competitions. Simply being in the wrong place at the wrong time can cause an injury despite the best of precautions. Strength-training professionals, however, who take their cue from that vital part of the Hippocratic Oath, can step to the forefront to strengthen any perceived weak links in the human chain.
If strength coaches look first to protect their athletes from potential harm and prepare properly and diligently the most vulnerable region of athletes’ bodies, one could also argue then that the number of serious sports injuries could be reduced or minimized.
And what would be the most vulnerable region of the body that if traumatized could lead to a serious, possibly life-threatening injury? Without question, it is the neck region (cervical spine).
The neck supports the head, which encases the hierarchy of human beings’ functions, the brain. The trapezius–either of the two large muscles that run from the base of the back of the skull to the middle of the back–makes it possible for persons to raise their heads and shoulders. In essence, all these muscles act as the foundation support the driving force at the top of the body—back to the brain. If the foundation is strong, then the head is better supported and the brain better protected.
Given the critical role these muscles play, one would think the neck and trapezius would be at the top of strength coaches’ regimens for their athletes. But maybe not. For instance, in a recent survey of over 200 college and university strength coaches that asked about their neck/trapezius training regimens, the results revealed this muscle region as low or no priority. This could be explained by the fact that many coaches are simply unaware of the importance of training the neck and the trapezius muscles on which the neck relies to dissipate forces.
Survey questions ranged from “does your weight room have a four-way neck machine” and “do you do any direct stimulation to strengthen the neck” to simply “how important is training the neck in your program.” The results overwhelmingly pointed back to little emphasis and interest. If strength coaches knew of the vital role the neck plays in sports performance, as well as the importance of increasing neck strength, then these results may have been very different.
Muscle regions other than the neck/trapezius area were emphasized in most strength-training programs. Does this sound familiar when examining many of the nation’s strength training programs: bench press for the upper body; squats and leg presses for the lower body; and some abdominal and lower back work. This is a complete regimen, as many would suggest, if the strength coach’s only priority is the performance of the athlete rather than protection of that individual.
But actually by training the neck and trapezius muscles, strength coaches can enhance both protection and performance of their athletes. A stronger neck increases the strength of an athlete, who then functions as a complete working unit. For example, consider that the trapezius muscles run from the base of the back of the skull all the way to thoracic vertebrae 12. Overlooking such a critical and major muscle group certainly would not enhance an athlete’s overall performance.
By neglecting the neck/trapezius area in training regimens, what could that lead to in the lives of athletes? While orthopedic surgeons can repair many soft-tissue and bone-related injuries that can allow athletes to compete again, the neck and cervical spine, however, are not areas of the body where successful surgical outcomes are likely, even with the advances in modern medicine.
If an athlete is fortunate enough not to sustain a catastrophic neck injury, there is still the very real danger of a brain concussion. For example, the Centers for Disease Control recently reported that approximately 300,000 sports-related concussions occur annually in the United States. (A concussion is an immediate and transient impairment in the brain’s ability to function properly.)
Concussions are not only a significant finding among professional and collegiate athletes, but they are occurring more often than necessary among younger players. For example, high-school football players suffer concussions more often than their collegiate and professional counterparts. Additionally, concussions are not gender specific. Studies have revealed that female athletes suffer concussions more often and with less impact than male athletes.
Moreover, researchers today are discovering that subconcussive forces over time can have a cumulative effect on athletes and can be just as debilitating as those who have suffered full concussions. Recent studies on brain trauma suggest that repetitive blows to the head over time—subconcussive forces—might cause a form of dementia known as chronic traumatic encephalopathy (CTE), a progressive, degenerative brain disease.
Consider, for example, the medical condition known as “dementia pugilistica.” Once thought to afflict only boxers, dementia pugilistica is now at the forefront of brain research being done at several major universities. Subconcussive injuries are particularly dangerous because an athlete may not show any symptoms after receiving such blows—not until much later.
The problem with bruises to the brain is that they cannot be seen like the ugly, black and blue torn hamstring. But these hurtful injuries to the brain do exist, and with alarming frequency among a variety of athletes. To minimize these injuries, let’s revisit again the neck/trapezius area and how these muscles play a critical role.
Neck muscles act as springs and shock absorbers; bigger, stronger necks can better absorb with less deformation. Recalling the laws of physics, consider the neck as a cylinder. The larger the circumference of the cylinder, the more load it can support without buckling.
As training the neck area increases strength there, the soft tissue thickens and the neck becomes stiffer. Using physics again to explain the necessity for stiffness, view the neck as a coiled spring. The thicker the coils of the spring, the greater the stiffness ratio. A smaller, less stiff spring is easier to compress from an axial-loading standpoint. A stiffer spring—“stronger neck”—deflects greater frontal or side impact forces.
All variables being equal, if a given cylinder increases its diameter by two inches—say from six inches to eight inches–the deformation decreases 43 percent. Common sense, simple logic or even strong speculation would suggest that a bigger, stronger neck would give an athlete a better chance of avoiding serious injury when having to absorb impact forces during collisions.
And female athletes should not avoid training the neck area, as many think they will get a “fat neck” from such conditioning. Biologically, females do not achieve the hypertrophy that males do, but they can benefit greatly from the strength gained in this region of the body.
Training the neck area in four directions—flexion, extention, and left and right lateral flexion—followed by a shoulder shrug exercise offers the most effective direct stimulus to this region of the body. Neck machines are great devices to help with this training, but if strength coaches cannot afford these machines, they should educate themselves on the protocol of manual neck resistance, along with a barbell or dumbbell shrug.
Relating back to the original premise, if strength coaches truly believe their first priority is to protect the athlete and prevent injury and that the neck and cervical spine are at risk during competition, why would they not train this region of athletes’ bodies religiously? If strength coaches train all the agonist and antagonist muscle groups but neglect the neck and trapezius area are they truly preparing their athletes effectively for the rigors of their sport? Well-informed strength and conditioning professionals would see the logic in this premise and would want to help their athletes in any way they could.
Strength coaches need to find 30 minutes twice a week to train the neck and trapezius area. With effective time management and efficiencies, strength and conditioning program could meet this objective. In setting up a strength training facility, would it not make sense also that for every station, say, for squatting, there would also be a station for protecting the brain and turning the head?
As these questions tumble forth, again the Hippocratic Oath comes back into play—“to prescribe regimens for the good of my patients.” Maybe the essence of that document created long ago can have relevance in more ways than one to strength coaches everywhere today.
I would like to thank Dan Riley for all of his help and wisdom over the years. I would like to thank Mike Gittleson for his guidance with this article and the completion of my Doctoral Degree. Also, special thanks to Chris Potter Mechanical/Structural Engineer for his help and insight. Lastly, I would like to thank Tyler Hobson for the use of a great neck machine that will allow me to finish my research.
Ralph Cornwell is a Ph.D. candidate in health promotion/human performance at Virginia Polytechnic Institute and State University, with additional course work in sports psychology. A Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. An honors society member, he currently is conducting a case study on neck injuries and the prevention of or leasing of concussive forces. He has more than 17 years experience as a strength and conditioning coach, consultant and lecturer. Having derived his training philosophy from Dan Riley while at the Washington Redskins, Cornwell has worked with high-school, collegiate and professional athletes–including those in the National Football League, Major League Baseball and Major League Soccer—as well as women’s soccer and lacrosse players, NFL Europe athletes, European and Russian basketball players, and several international players from Africa and Australia. He has been the head strength and conditioning coach at Radford University, the University of North Carolina at Greensboro, and North Carolina Agricultural and Technical State University, and assistant coach at the United States Military Academy at West Point. Cornwell points to the fact that he never had an injury in a weight room where he was the head coach. At age 45, he still trains as hard as any of his athletes.