With the Six Nations in full swing we wanted to give some insight into the challenges that rugby faces in regards to concussion, and whether there is anything we can do to help reduce our risk of sustaining a concussion.
What is a concussion
What is a concussion
A concussion is an injury to the brain that results in temporary loss of normal brain function. Slightly more specifically, currently it is theories that concussions occur due to acceleration or deceleration forces to the head (and so brain). Due to differences in the weight of the white and grey maFer within the brain, a shearing effect occurs leading to damage to some of the thousands of axons (nervous system connections) within the brain.
How does it occur
In rugby, this acceleration or deceleration of the head most commonly occurs during the tackle (either when tackling or being tackled). This can be due to direct blow the head or due to high force impacts to the body.
What are the typical symptoms
There are a large range of concussion symptoms, which include loss of consciousness (but is important to be aware that this only occurs in 5-10% of players that experience a concussion), dazed/ stunned appearance, loss of balance, memory loss, dizziness, headache to name just a few. For a more exhaustive list, please see world.rugby/the-game/player- welfare/medical/concussion/concussion-guidelines
.Why is it of concern?
The consequences of concussion are of major concern, due to their players having an increased risk of having a subsequent injury in the short term (both another concussion and risk of other injuries, likely due to players returning to rugby before all functional changes from a concussion have fully recovered). Additionally, there have been serious links between concussions and cognitive decline and chronic traumatic encephalopathies in later life.
How common are concussions?
Concussion is the most common match-play injury in:
- Men’s English Premiership rugby - 28% of all injuries
- Premier 15s (Women’s) – 40% of all injuries
- British Universities and Colleges Sport super rugby competitions - 20% of all injuries
- School boy (U13-U18) – 37% of all injuries (Head injuries, no specifically concussion)
Can we stop concussions occurring?
The simple answer to this question is no. Due to rugby being a high speed and impact sport there will always be occasions where unintentionally concussions could occur. However, what we can do is try to reduce the number of concussions that occur. Changes in rules such as reducing tackle height, and improving players tackle technique have been discussed at length over the past couple of years. However, something that is slightly less well discussed is the impact of having a stronger neck may have on your risk of getting a concussion.
Neck strength and concussion risk
Although further research into this topic is still required, recent research by Farley et al. (2022) suggests that rugby players with stronger necks (in particular, into neck extension) may have a reduced risk of sustaining a concussion. The exact mechanisms of why greater neck strength may reduce concussion risk still require further investigating; however, it is thought that greater neck strength may lead to greater control of the head during collisions and therefore reduce the acceleration and deceleration forces associated with sustaining a concussion.
As a result, we wanted to share a couple of isometric neck exercises which we commonly prescribe patients to help improve their neck strength. However, please see a healthcare practitioner if you have any history neck pain or have sustained a recent concussion.
Low to high tech. exercises to strengthen your neck
Hand resisted neck isometrics
Flexion
Technique: Put the palm of your dominant hand on the centre of your forehead and reinforce it with your other hand. Keeping your neck/head in a neutral position, push your palm back into your forehead and hold at the intensity, and for the duration, advised below
Extension
Technique: Put your hands behind the back of your head. Keeping your neck/head in a neutral position, push your hands into the back of your head and hold at the intensity, and for the duration, advised below
Left and right side flexion
Technique: Put the palm of your hand just above your ear. Keeping your elbow high, and neck/head neutral, push through your palm into the side of your head and hold at the intensity, and for the duration, advised below
Band resisted neck isometrics
Flexion
Technique: AFach a band to an immovable object at a height so that once there is tension in the band it is parallel to the ground. Place the band around your head as shown above, with the band aFachment straight behind you. Move away from the aFachment and hold at the intensity, and for the duration, advised below. Increase or reduce the resistance of the band as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Extension
Technique: AFach a band to an immovable object at a height so that once there is tension in the band it is parallel to the ground. Place the band around your head as shown above, with the band aFachment straight in front of you. Move away from the aFachment and hold at the intensity, and for the duration, advised below. Increase or reduce the resistance of the band as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Left and right side flexion
Technique: AFach a band to an immovable object at a height so that once there is tension in the band it is parallel to the ground. Place the band around your head as shown above, with the band aFachment straight to the side of you. Move away from the aFachment and hold at the intensity, and for the duration, advised below. Increase or reduce the resistance of the band as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Cable resisted neck isometrics
Flexion
Technique: Change the height of the cable machine so that once there is tension in the cable it is parallel to the ground. Strap the head harness around (video demonstrates and adapted version a cable harness), with the cable attachment straight behind you. Move away from the aFachment keeping your neck/ head in neutral and hold at the intensity, and for the duration, advised below. Increase or reduce the weight as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Extension
Technique: Change the height of the cable machine so that once there is tension in the cable it is parallel to the ground. Strap the head harness around (video demonstrates and adapted version a cable harness), with the cable aFachment straight in front of you. Move away from the aFachment keeping your neck/ head in neutral and hold at the intensity, and for the duration, advised below. Increase or reduce the weight as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Left and right side flexion
Technique: Technique: Change the height of the cable machine so that once there is tension in the cable it is parallel to the ground. Strap the head harness around (video demonstrates and adapted version a cable harness), with the cable aFachment straight to the side of you. Move away from the attachment keeping your neck/ head in neutral and hold at the intensity, and for the duration, advised below. Increase or reduce the weight as required to achieve the advised intensity
Seated advised (move bench so that in optimal position), or standing
Exercise prescripton
Multiple studies have shown that neck strength changes can be seen as early as 5-6 weeks early starting a neck strengthening program. Here is an example of what a 6-week program looks like:
How often:
3 days a week (48 hours rest between sessions)
Weeks 1-3 (endurance phase):
15 second hold (each position)
3 sets
30 seconds rest between sets
Intensity – Week 1 - 5/10, Week 2 - 6/10, Week 3 - 7/10
Weeks 4-6 (maximum strength phase):
5 second hold (each position)
3 sets
60 seconds rest between sets
Intensity – Week 4 – 8/10, Week 5 - 9/10, Week 6 - 10/10
Intensity scale:
