By Carl Valle
If you were to pick the most neglected area in training, you could make a case for a lot of joint systems and muscle groups, but the neck is likely the most ignored. Even today with all of the research on concussions, the neck is still an afterthought. Countless core training programs have taught us to brace or breathe better, but nearly all of them do a once-over type of approach to the neck.
I admit that I treated the neck as something that was nice to train but worried about the ACL or other areas more. Now that coaches are responsible for helping athletes reduce all injuries, it’s time to treat the cervical spine like a priority. This article will help you navigate what you need to know to get started, and time and more education will make you a better coach or therapist. This subject matter demands attention, because if you don’t start today, you’ll never know when you missed an opportunity.
The Scope of the Problem
A fair question to ask is: How bad is the concussion and neck injury rate with sports as a whole? Could you imagine the 1988 diving accident with Greg Louganis being replayed in today’s climate? On the other hand, if you watch the 2018 World Cup 30 years from now, it will be akin to a black-and-white clip from the 1960s, including smelling salts and a tin ladle of water.
Sports greats either had to retire early or had their careers threatened by injury, such as Peyton Manning and Sterling Sharpe. Concussions have forced many athletes to walk away from the game, and traumatic brain injuries have changed the outcomes of wins and losses because of athlete availability. It’s a big problem and I covered the topic briefly with an article on concussions and several interviews.
So how bad is it? It’s hard to say, because the research is only as good as the commitment to finding out the problem. Most people involved in sports don’t like to know the truth, as shutting down a star player is very controversial because of the must-win-now mentality that plagues professional teams. A good estimate comes from journal studies and peer review research, but again, the application is only as good as the cooperation of both the athletes and the leagues they play in.
For example, boxing and combat sports are obvious, but what about gymnastics or heading a soccer ball? Not all sports have a risk of concussions or neck injuries, but some sports that do are surprising. For instance, while polo is viewed as a game of the rich, anyone involved with horses realizes that paralysis is a real problem.
Neck issues are not just about sports, either, as incidents at work and other activities can lead to brain and neck injuries. The military has problems as well—helicopter pilots and even snipers with large-caliber rifles kicking back are affected. It’s all around us. Anyone who’s been in an auto accident and dealt with whiplash knows that the neck is designed for human falls, but not for collisions at 70 miles per hour.
Concussions and Neck Strength
A big discussion is happening with NFL strength coaches, and some of them are correct in explaining that they can only do so much to prepare an athlete for contact. Getting hit by a modern linebacker is perhaps a force that can’t be mitigated by green TheraBands and small head movements. Still, an injured athlete may only be able to do the smallest resistance available, as an injury to the head is not just a brain problem, but a musculoskeletal responsibility. The risk of injury is very high post-concussion; not just because the brain is traumatized, but because the supportive structures and nervous system are impaired.
The neck is a mobile joint system; thus, it needs strength to keep it safe and secure. Neck-strengthening exercises, even crude ones, can make a difference in the incidence and severity of concussions. While I wish that I could share specific stats on actual joint injuries that can be severe for the body, we tend to have better information on neck strength and concussions in sport. Still, giving up on neck strength for reducing neck injuries just because the odds are low is a poor way of thinking.
In the classic book that pioneered the concept of core training, Total Body Training, authors Richard Dominguez and Robert Gajda state that the neck is essential to athlete health and share the following passage on page 12:
“In sports such as boxing, wrestling, rugby, and football, neck training is a must for survival. Even a non athlete can benefit greatly from proper neck training. Whiplash injury as a result of automobile accidents is all too common today, but its severity could be reduced significantly if more people practiced proper neck training.”
I should have included Total Body Training in one of my book lists, as Dominguez and Gajda were showcasing mobility of the body from head to toe a decade before others. As you can see, we have known that neck strength was important, and on the same page, the authors complained that if the neck only received half the attention that biceps did, outcomes with injuries would be different.
Evaluating neck strength is not too far off from one-rep max testing, but it’s more than just newtons or watts with one exercise. The neck can be tested in multiple planes, as well as for the rate of force. Dynamic strength is sometimes about rapid stabilization speed, but it’s fair to ask if any of this matters when a helmet hits another head at 35 kilometers per hour.
The research on women’s soccer—a sport that has more participants internationally—clearly points out that neck strength is a prime reason why some athletes are victims and others are able to dodge the bullet. Other sports including American football have similar conclusions, so training the neck to be strong everywhere is an investment every athlete should make. Today, if you are not doing something to get an athlete’s neck better, you are looking the other way on their health and well-being.
The Anatomy and Current Biomechanical Theories
I hate giving anatomy lessons because it’s condescending, but I need to share the important biological factors that make neck development and rehabilitation effective. The prime reason we don’t know that much about neck training is because the neck is always seen as the stabilizer of the head and not as a way to make an athlete jump higher, run faster, or score more goals. We only care about the neck when it’s injured, so it doesn’t get attention as much as other joints in the sports medicine journals.
Usually, the neck is equated with neurological examinations for obvious reasons (spinal cord), but the muscles and ligaments around it are seen as an extension of the more popular core. How many coaches can name the spinal muscles of the abdominal area but not the neck? I was one of them and regret not investing more time in college learning about the neck instead of just trying to get a good grade. I spent a lot of time reading about neck anatomy because I was concerned about posture, but I didn’t go deeper.
Balancing the head and stabilizing the head are real responsibilities of the neck, and I believe ballet science is the leader in understanding how stabilization and orientation work. While I don’t agree with everything in the book, Conditioning for Dance does spend a lot of time explaining how important the neck is in deep anatomy. The book creates a model for triangular support, balancing the scalene and levator scapulae, as well as providing sensory-motor development with very low load exercises.
Similarly, while Anatomy Trains isn’t a perfect concept and was likely way overhyped by strength coaches, the concepts from Tom Myers are eerily sophisticated. The best example of Tom’s thinking is on page 135, where he expanded on the lateral line and connected the structures of the spine to a shark, something I referenced in the science of vibration. The stretch reflexes in the spine may not have us swim faster, but they will have the system perform better from the rapid stabilization engineering.
One of the difficulties of the biomechanics of the neck is not the anatomical information, but the specific contributions of muscles beyond assumptions. For example, electromyography studies are difficult to do because muscle groups that are deep and not superficial are fine wire investigations, so most of the information is very clinical and not representative of sports training or sporting action. Also, the joint system of the neck isn’t just the cervical region—we must use the nuchal ligament and even the jaw, shoulder, and clavicle. A recommended book on clear joint action of the neck is Anatomy in Movement by Blandine Calais-Germain, as it’s a wonderful resource.
When the neck is structurally injured, sometimes bulging discs are asymptomatic, but if they are causing actual impairments to the nerves from more extensive damage, simple activities like using the upper limbs and other prime functions can ruin lives, not just careers. There is a big difference between neck pain and nerve function, so we need to move away from simple pain models and focus on function. The neck isn’t fragile, but it’s not designed to handle extreme impacts and landings either. In summary, the neck is part of us talking, eating, looking, and listening, and it also protects the brain.
Performance and Functional Needs in Sport
Strangely, coaches tend to fear injury and not look at how the neck works in sports performance. Due to the limitations of the neck for head support, coaches treat the neck like a burden rather than an advantage. One way to make compliance easier with neck training is selling other benefits besides concussions and focusing on an athletic neck. Sometimes athletes don’t like the association of having a potentially thicker neck, but you don’t necessarily need hypertrophy to be stronger. If you want more ammunition to get athletes interested in neck training, start with performance benefits not just scare tactics.
The neck isn’t a hamstring or an ACL, so it’s not going to get the same attention for injury rates and sports performance. You can do a lower body program to reduce knee injuries and walk away faster and stronger. Necks are not like knees or legs, so the perks are not there, for the most part. However, the truth is the neck is part of our sporting ability, as the eyes are connected to the most complicated joint and muscle system next to the foot and hip.
The neck is what helps humans be humans, and we have adaptations and evolutionary traits that make us different and sometimes superior to other animals. Having eyes in front of our skull makes us a predator even if our diets can succeed without animal flesh. If you watch a tiger eat in the wild, tearing apart a carcass, you realize that in the animal kingdom, the neck is indeed a weapon. In fact, what made the saber tooth tiger nasty was more about its neck than its famous teeth. Could you imagine a weak neck for a giraffe or bird of prey? The neck is a weapon, but for athletes it’s about assisting in tracking.
In the two classic movies, Robocop and Jurassic Park, I loved the attention given to head movement. While Peter Weller isn’t viewed as a leading actor, his work was very underrated as his amount of movement training for the film was fascinating. He specifically worked on his neck motions to improve his robotic physical performance, which was superb. In Jurassic Park, the portrayal of the velociraptors was true to Crichton’s description in the book, ensuring the bird-like motions of the dinosaurs was an essential detail, although not perfectly accurate.
Vision is what makes a predator great and the neck is instrumental to fixing sight on the prey. In sport, vision is a weapon as well, and the neck is part of that guidance system. Tracking a ball or another body in motion is everything, and a mobile and fast neck can do more than just handle a tackle or fall.
Screening Athletes Before Training
Before you get worried that I am going to give you another movement screen discussion, this is more about coaches knowing how to get started the right way, with an assessment and clearance to do more aggressive training. This is not a physical; it’s a way for everyone involved to document who is ready and who needs remedial work. Athletes are not ticking time bombs, but they are as self-healing as we want them to be.
Screening is not about who is dysfunctional or who is injured, but rather, who is prepared, and that means baseline concussion and neck evaluations. Sure, you can do jump testing, hamstring assessment, and even speed evaluation, but make sure you also do neck testing. I am confident that neck testing can be implemented by the strength staff. However, if risk is part of the equation, the medical staff can make sure the athlete knows that strength is an important safety variable. There’s nothing wrong with a coach testing, but having everyone involved shows that it’s a big deal and not just busy work.
Baseline testing starts the discussion and gives an athlete awareness that if you value measuring it, it’s going to be monitored and tracked down the road. Obviously, a baseline creates comparison for further development or restoring an athlete after injury, but measuring how strong a neck is and the function with both motor control and joint mobility creates an awareness effect with athletes. Coaches and medical staff need to be responsible, but education with athletes and clear messaging about expectations is also important. It seems that measurement or quantification or anything data is taboo now, but if change is going to happen, you need to accept that standards matter.
The goal of screening is not to stop training or train like an invalid, but it does raise the bar with athlete care. Having an organized process that records a baseline and educates an athlete of the value of strengthening the neck intelligently is a great step forward. Down the road, the solution to neck performance will evolve naturally, but for now doing something structured is a good starting point.
Training to Build a Dynamic Neck
In this last part of the article, instead of succumbing to the common and popular way to share information by listing exercises with sets and reps, I leave that to more experienced coaches. What I do best isn’t posting videos or workouts; it’s asking the questions that most coaches want to know, such as where to look for more information and how to take the known information to the next level.
Based on a few years of reflection, I have divided neck conditioning into three parts, each with a specific perspective and strategy and links to some good information. Don’t fret that this is the end and the goodies are not new exercises or equipment, but be patient as other posts from guest authors will get into the weeds more with exact details.
Notice the subtitle is a dynamic neck, since strength is not the only quality to worry about. Some coaches will mention range of motion and others will talk about motor control—I just care about all of the qualities being checked off and addressed in some way. In addition to the taxonomy and perspectives of neck training below, think about roles and who is best suited for training. Don’t bring in a neck specialist unless it’s for rehabilitation and specific neck work.
General training is a foundational need, and great coaches are likely already doing a good job here. I personally believe the goal of the therapist is to get an athlete back to baseline or beginner level with a clean slate. Having coaches do the rehabilitation early doesn’t make sense to me from a resource point of view.
Indirect General Neck Training
My biggest fault with those with an excessive fear of injuries is that indirect but valuable training is cut out of a training program. While Nordic hamstring exercises and Copenhagen adduction exercises are great, they won’t develop an athlete alone—they are small parts to the solution. Every time I see piecemeal sessions where exercises are stacked, it seems to disconnect when the athlete is on their feet, playing the game.
I am not saying you have to be standing and playing the game to have a better neck, but just doing isometric stabilization routines doesn’t seem to be enough to prepare the body. Push-ups and planks are nice, but so are medicine ball training and other exercises that seem to address motor control, mobility, and low level strength. Remember to balance between general and specific to create a complete solution.
Direct Specific Neck Training
A strength coach needs to be smart and very patient when challenging the neck. Any coach can find a way to load an athlete, but getting them better over the course of a career is superior to being an individual hero for one season. Plenty of exercises and coaching cues exist, but it’s important to think about how much strength is appropriate, and what are the best ways to develop and maintain it within the confines of small amounts of time and expertise.
You can be a genius in exile, but a team approach might be necessary, such as teaching other coaches and even the athletes themselves to be able to help. Many coaches like manual neck work, but if you are by yourself, you may need athletes to assist in the process or know how an athlete can use a station on their own.
Specific Neck Medical Rehabilitation
Managing symptoms and dealing with tricky pathologies is a medical responsibility. The last thing I want to do is make a problem worse by going outside my lane too much. My relay analogy of working with a return-to-play team is to think about the relay of athlete to medical to performance to team coach. If one of the phases of the exchange is too early or too late, the relay is disqualified.
In this case, if you don’t complete the job or if a strength coach tries to start too early, that exchange is botched. Staying in your lane is important, but it’s more about what lines are crossed as you need to overlap roles a bit to ensure the passing of the athlete is safe and effective. Communication of medical information is the last step, since many AMS systems need to keep the training and therapy shared and accessible.
Again, there are plenty of other resources that can do a better job than this section, but at least it organizes the training into a strategy instead of a list of exercises alone. Both learning to perform the exercises and knowing how to progress and program them are needed, so don’t just rush into a training program and start adding stuff. Most of the process with new information can be helped by talking to others, but eventually you have to figure it out yourself.
Closing Thoughts on Neck Training – Do Something Proactive
The article does enough to get you started, with links to sample exercises and ways to collaborate with the sports medical community. Don’t wait for a perfect program; do something conservative and you will be surprised. The biggest gap we see is in women’s soccer and other sports that are afterthoughts in the research because they are not NCAA or NFL players. CTE isn’t the only issue; neck injuries go beyond concussion risk.
The statistics I share are real. They are not fear mongering in order to sell neck training courses, but examples that if you ignore the known science, you are responsible for the consequences. Do something today by addressing the neck in a proactive manner, and you will know you are part of the solution, and not the problem.