Assessing Head/Neck Dynamic Response to Head Perturbation: A Systematic Review
Head/neck dynamic response to perturbation has been proposed as a risk factor for sports-related concussion.
The aim of this systematic review was to compare methodologies utilised to assess head/neck dynamic response to perturbation, report on magnitude, validity and reliability of the response, and to describe modifying factors.
A systematic search of databases resulted in 19 articles that met the inclusion and exclusion criteria.
Perturbation methods for head/neck dynamic response included load dropping, quick release and direct impact. Magnitudes of perturbation energy varied from 0.1 to 11.8 J. Head/neck response was reported as neck muscle latency (18.6–88.0 ms), neck stiffness (147.2–721.9 N/rad, 14–1145.3 Nm/rad) and head acceleration (0.2–3.8g). Reliability was only reported in two studies. Modifying factors for head/neck response included younger and older participants presenting increased responses, females showing better muscular reactivity but similar or increased head kinematics compared with males, and bracing for impact limiting muscular activity and head kinematics.
Substantial differences in experimental and reporting methodologies limited comparison of results. Methodological factors such as impact magnitude should be considered in future research.
Each methodology provides valuable information but their validity for anticipated and unanticipated head impacts measured in vivo needs to be addressed. Reports on head/neck response should include measurement of transmitted force, neck muscle latency, head linear and rotational accelerations, and neck stiffness. Modifying factors of anticipation, participants’ age, sex, and sport are to be considered for head/neck dynamic response.
PROSPERO Registration Number
CRD42016051057 (last updated on 27 February 2017).
The authors thank the Auckland University of Technology for the AUT SRIF RCRG Neck Strength Project grant 2016.
Compliance with Ethical Standards
This systematic review formed part of the AUT SRIF RCRG Neck Strength Project grant 2016. This funding supported development of the research strategy, data extraction and analyses by the primary investigators. The funder had no input into the interpretation or publication of the study results.
Conflict of interest
Enora Le Flao, Matt Brughelli, Patria A. Hume and Doug King declare that they have no conflicts of interest relevant to the content of this review.
According to the definition given by the International Committee of Medical Journal Editors (ICMJE), the authors listed above qualify for authorship based on making one or more substantial contributions to the intellectual content of the manuscript. Enora Le Flao and Matt Brughelli were responsible for the conception and design of the review, and the acquisition, analysis and interpretation of data. They also contributed to the drafting of the manuscript and critical revision. In addition, Matt Brughelli contributed to funding acquisition. Doug King contributed to the drafting of the manuscript and to critical revision. Patria Hume contributed to critical revision and funding acquisition.
- 9.Hume PA, Theadom A, Lewis GN, Quarrie KL, Brown SR, Hill R, et al. A comparison of cognitive function in former rugby union players compared with former non-contact-sport players and the impact of concussion history. Sports Med. 2017;47(6):1209–20. https://doi.org/10.1007/s40279-016-0608-8.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.King AI, Yang KH, Zhang L, Hardy W, Viano DC (eds). Is head injury caused by linear or angular acceleration. In: International research council on biomechanics of Injury (IRCOBI) conference; 2003.Google Scholar
- 19.McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47. https://doi.org/10.1136/bjsports-2017-097699.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Gennarelli T, Segawa H, Wald U, Czernicki Z, Marsh K, Thompson C. Physiological response to angular acceleration of the head. Head injury: basic and clinical aspects. 1982;1982:129–40.Google Scholar
- 29.Eckner JT, Oh YK, Joshi MS, Richardson JK, Ashton-Miller JA. Effect of neck muscle strength and anticipatory cervical muscle activation on the kinematic response of the head to impulsive loads. Am J Sports Med. 2014;42(3):566–76. https://doi.org/10.1177/0363546513517869.CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Gilchrist I, Storr M, Chapman E, Pelland L. Neck muscle strength training in the risk management of concussion in contact sports: critical appraisal of application to practice. J Athl Enhanc. 2015;4(2):19.Google Scholar
- 39.von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. The Lancet. 2007;370(9596):1453–7. https://doi.org/10.1016/S0140-6736(07)61602-X.CrossRefGoogle Scholar
- 41.Popay J, Roberts H, Sowden A, Petticrew M, Arai L, Rodgers M, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme version. 2006;1:b92.Google Scholar
- 43.Foust DR. Cervical range of motion and dynamic response and strength of cervical muscles. In: Proceedings of the 17th stapp car crash conference; 17–19 Nov 1973: Coronado, CA.Google Scholar
- 44.Fukushima M, Kaneoka K, Ono K, Sakane M, Ujihashi S, Ochiai N. Neck injury mechanisms during direct face impact. Spine. 2006;31(8):903–8. https://doi.org/10.1097/01.brs.0000209257.47140.fc.CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Portero R, Quaine F, Cahouet V, Thoumie P, Portero P. Musculo-tendinous stiffness of head–neck segment in the sagittal plane: An optimization approach for modeling the cervical spine as a single-joint system. J Biomech. 2013;46(5):925–30. https://doi.org/10.1016/j.jbiomech.2012.12.009.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Portero R, Lecompte J, Thoumie P, Portero P. Musculo-tendinous stiffness of the in vivo head-neck segment in response to quick-releases: a reproducibility study. Isokinet Exerc Sci. 2011;19(1):7–12.Google Scholar
- 50.Tierney RT, Sitler MR, Swanik CB, Swanik KA, Higgins M, Torg J. Gender differences in head-neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc. 2005;37(2):272–9. https://doi.org/10.1249/01.mss.0000152734.47516.aa.CrossRefPubMedPubMedCentralGoogle Scholar
- 52.Portero R, Quaine F, Cahouet V, Lecompte J, Thoumie P, Portero P. In vivo neck musculo-tendinous stiffness in response to quick-releases. In: 6th world congress of biomechanics (Wcb 2010), Pts 1-32010, pp. 593–6.Google Scholar
- 53.Vasavada A, Trask D, Knottnerus A, Lin D (eds). Effects of head position and impact direction on neck muscle response to perturbations. In: American society of biomechanics proceedings; 2009.Google Scholar
- 54.Debison-Larabie C. Examining the relationship between cervical anthropometrics, head kinematics and cervical muscle responses to sudden head perturbations in competitive ice hockey players. Oshawa: University of Ontario Institute of Technology; 2016.Google Scholar
- 55.Lucas GQ. A mechanical apparatus to quantify the reflex response of the human head/neck system. Pullman: Washington State University; 2006.Google Scholar
- 62.Tucker R, Raftery M, Kemp S, Brown J, Fuller G, Hester B, et al. Risk factors for head injury events in professional rugby union: a video analysis of 464 head injury events to inform proposed injury prevention strategies. Br J Sports Med. 2017;51(15):1152–7. https://doi.org/10.1136/bjsports-2017-097895.CrossRefPubMedPubMedCentralGoogle Scholar
- 67.Guskiewicz KM, Mihalik JP, Shankar V, Marshall SW, Crowell DH, Oliaro SM, et al. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–52. https://doi.org/10.1227/01.neu.0000306103.68635.1a (discussion 52–3).CrossRefPubMedPubMedCentralGoogle Scholar
- 68.Weik MH. Nyquist theorem. In: Computer science and communications dictionary. Boston: Springer; 2001. p. 1127.Google Scholar
- 73.Elkin BS, Elliott JM, Siegmund GP. Whiplash injury or concussion? A possible biomechanical explanation for concussion symptoms in some individuals following a rear-end collision. J Orthop Sports Phys Ther. 2016;46(10):874–85. https://doi.org/10.2519/jospt.2016.7049.CrossRefPubMedPubMedCentralGoogle Scholar
- 74.Gadd CW. Use of a weighted-impulse criterion for estimating injury hazard: SAE technical paper 1966. Report no. 0148-7191.Google Scholar
- 75.Greenwald RM, Gwin JT, Chu JJ, Crisco JJ. Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery. 2008;62(4):789–98. https://doi.org/10.1227/01.neu.0000318162.67472.ad (discussion 98).CrossRefPubMedPubMedCentralGoogle Scholar
- 79.King D, Hume P, Gissane C, Brughelli M, Clark T. The influence of head impact threshold for reporting data in contact and collision sports: systematic review and original data analysis. Sports Med. 2016;46(2):151–69. https://doi.org/10.1007/s40279-015-0423-7.CrossRefPubMedPubMedCentralGoogle Scholar