The Journal of Primary Prevention

, Volume 35, Issue 5, pp 309–319

Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports

  • Christy L. Collins
  • Erica N. Fletcher
  • Sarah K. Fields
  • Lisa Kluchurosky
  • Mary Kay Rohrkemper
  • R. Dawn Comstock
  • Robert C. Cantu
Original Paper

DOI: 10.1007/s10935-014-0355-2

Cite this article as:
Collins, C.L., Fletcher, E.N., Fields, S.K. et al. J Primary Prevent (2014) 35: 309. doi:10.1007/s10935-014-0355-2


As the number of high school students participating in athletics continues to increase, so will the number of sports-related concussions unless effective concussion prevention programs are developed. We sought to develop and validate a cost-effective tool to measure neck strength in a high school setting, conduct a feasibility study to determine if the developed tool could be reliably applied by certified athletic trainers (ATs) in a high school setting, and conduct a pilot study to determine if anthropometric measurements captured by ATs can predict concussion risk. In the study’s first phase, 16 adult subjects underwent repeated neck strength testing by a group of five ATs to validate the developed hand-held tension scale, a cost effective alternative to a hand-held dynamometer. In the second phase, during the 2010 and 2011 academic years, ATs from 51 high schools in 25 states captured pre-season anthropometric measurements for 6,704 high school athletes in boys’ and girls’ soccer, basketball, and lacrosse, as well as reported concussion incidence and athletic exposure data. We found high correlations between neck strength measurements taken with the developed tool and a hand-held dynamometer and the measurements taken by five ATs. Smaller mean neck circumference, smaller mean neck to head circumference ratio, and weaker mean overall neck strength were significantly associated with concussion. Overall neck strength (p < 0.001), gender (p < 0.001), and sport (p = 0.007) were significant predictors of concussions in unadjusted models. After adjusting for gender and sport, overall neck strength remained a significant predictor of concussion (p = 0.004). For every one pound increase in neck strength, odds of concussion decreased by 5 % (OR = 0.95, 95 % CI 0.92–0.98). We conclude that identifying differences in overall neck strength may be useful in developing a screening tool to determine which high school athletes are at higher risk of concussion. Once identified, these athletes could be targeted for concussion prevention programs.


Head injury Prevention Athlete Soccer Basketball Lacrosse 

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Christy L. Collins
    • 1
  • Erica N. Fletcher
    • 1
  • Sarah K. Fields
    • 2
  • Lisa Kluchurosky
    • 3
  • Mary Kay Rohrkemper
    • 4
  • R. Dawn Comstock
    • 5
    • 6
  • Robert C. Cantu
    • 7
    • 8
    • 9
    • 10
    • 11
    • 12
  1. 1.Center for Injury Research and PolicyThe Research Institute at Nationwide Children’s HospitalColumbusUSA
  2. 2.Department of CommunicationUniversity of Colorado-DenverDenverUSA
  3. 3.Sports MedicineNationwide Children’s HospitalColumbusUSA
  4. 4.Central Ohio Primary CareColumbusUSA
  5. 5.Pediatric Injury Prevention, Education, and Research (PIPER) Program, Department of EpidemiologyColorado School of Public HealthAuroraUSA
  6. 6.University of Colorado School of Medicine, Pediatric Emergency MedicineAuroraUSA
  7. 7.Department of Neurology, Center for the Study of Traumatic EncephalopathyBoston University School of MedicineBostonUSA
  8. 8.Sports Legacy InstituteWalthamUSA
  9. 9.Department of NeurosurgeryBoston University School of MedicineBostonUSA
  10. 10.Department of NeurosurgeryEmerson HospitalConcordUSA
  11. 11.Department of SurgeryEmerson HospitalConcordUSA
  12. 12.Department of Neurosurgery, Neurologic Sports Injury CenterBrigham and Women’s HospitalBostonUSA

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