Tuesday, 25 October 2011

The neck, my favourite structure that supports the head.

     I currently coach football, wrestling and rugby and work as a strength and conditioning coach for these sports as well.  Over the years I have had many athletes and coaches alike ask what is the best exercise for strengthening the neck?  My usual answer was to do 50meter sprints in a 40meter gym to not only strengthen the neck but also to improve one’s physical appearance.  All joking aside, my neck injuries are what ended my athletic career and is a very common injury concern for all contact sport athletes.  I have had a lot of help from Andrea on this article and I hope that you find it useful.  She is smart and I am not and I trust her views on this issue!  I hope to have some videos up in the near future of some of the movements described in this article.
     You may be asking yourself why anyone would write about the neck, unless it details how to get rid of the pack of hotdogs on the back of it, or the more attractive turkey gobbler in the front.  At Level 10 Fitness Inc. we work with a myriad of athletes and active rehab clients.  For the average person, neck strengthening is never really an issue unless they are coming off an injury and need to reactivate muscles that may have been shut down from the trauma.    For athletes, neck strengthening is always an issue specifically in contact sports.   The intent of this article is meant more to touch on athletes involved in MMA, wrestling, rugby and football where head to head, head to body and head to ground contact at high velocities may occur.  This does not mean athletes from other sports should stop reading.  Any sport where there is physical contact with other bodies, the ground or barriers at high speeds should be weary of neck injuries.  Please keep in mind, we are airing on the side of caution when we talk about what movements to avoid!  Remember, what works for one does not always work for all!
     As per any of my informative articles, I consult Andrea Engelmann (one of our physiotherapists and trainers) to ensure that my ranting is offset by some useful information!   Basically anything that sounds smart is from Andrea, and the rest of the nonsense is from me. 
The function of the neck:
1.       Support the weight of the head.
2.       Act as a mobile multi-directional platform for the head.
3.       Protect the spinal cord and associated major nerves and blood vessels. 
Why would anyone strengthen the neck?
1.       Contact sport conditioning and traumatic injury prevention/reduction.
2.       Improve posture and prevent postural strain related injuries.
3.       Decrease existing neck, headache or arm pain related to postural strain.
Traumatic Injury-the big concerns:
1.       Spinal cord injury-often a force that causes a fracture, which allows a dislocation of the vertebrae and injury to the spinal cord inside.
·         The magnitude of the forces involved make it unlikely that neck strengthening can be considered preventative.    To give you an idea of some of the collisions in these contact sports, I looked up some info from the show ‘Sport Science’ on the FSN network.
o   “Ultimate fighter Rampage Jackson registered a head injury criteria (HIC) number about four times as high as that of a 35mph head-on crash when he body-slammed a 180-lb crash test dummy”.
o   “A blind-side hit by NFL  linebacker Joey Porter generated 1.600 lb-f, about the same as that generated by a bull, kicking with its hind legs”.
2.       Vertebral Fracture (without spinal cord injury)
·         If fracture is unstable a shift can cause a spinal cord injury (i.e. that’s why you see the spine board come out with a big NFL hit).
·         Flexion, Extension, Shearing and Compression forces can all cause fractures, with combined flexion and rotation (MMA, wrestling, Rugby) frequently yielding unstable fractures.
3.       Vertebral Artery
·         Extreme extension or extreme rotation-and especially the combination position the vertebrae such that they pinch down/kink the vertebral artery, decreasing blood flow to the brain and upper spinal cord.   If the movement is violent enough, the vertebral artery can be torn in this vulnerable position.
4.       Cervical “Bulged” Disc
·         Not as common as the lumbar disc injury, and occurs in younger persons (20-40).
·         Most often caused by axial compression (force down head, compressing neck).
·         Intense muscular effort (i.e. heavy lift) especially with strong recruitment of upper trap-Shrugging movements.    The common prescription for neck strengthening has been to incorporate “shrugs” into programs as a means to protect the neck.  The problem that we encounter with this is most of our athletes already have over-active/tight upper traps (see postural concerns #6) and can lead to shoulder injuries as well if not treated correctly.  The Upper trap inserts into the base of the skull so intense muscular contraction can cause enough compression to actually “blow” a disc in the neck.
·         The above injuries are often associated with large forces and any amount of neck strength exercises cannot be presented as able to prevent these serious outcomes from contact sports-the risk of serious injury cannot be eliminated (as we saw in the sport science show). Although we are aware of the fact that we cannot reduce the chance of injury with major trauma, it still seems reasonable to try to reduce the day to day wear and tear injuries and chronic neck strains that occur in training and competition with conservative neck strengthening.    Some of the most common are listed below.
5.       Neck Muscle Injury/inflammation
·         Acute or chronic muscle strain.
·         Acute decreased range of motion; “ropey” feeling (spasm); or “knots” aka trigger points in chronic strain.
6.       Poor Posture (forward neck and shoulders) can lead to:
·         Rotator cuff problems due to pinching tendons from poor joint positioning and mechanics created by poor posture.
·         Weakness/numbness (thoracic outlet syndrome) due to pinching of nerves and/or blood vessels at neck or shoulder girdle secondary to poor posture.
·         Tension Headaches, from tight neck muscles undergoing chronic traumatic or postural strain.
·         In only the last 2 groups of injuries described can neck strengthening be appropriately termed preventative. 
     This is clearly a large amount of information but it is important to understand these basic points before moving forward to the actions described below.    There are more advanced exercises than the ones described below, but these should act as a base first.  Any time we look to strengthen the neck, there is a risk of injury and the utmost caution should be taken.  More is not better!  Quality controlled reps must be the foundation for any of the following movements.
·         Neutral, chin tuck position, and reinforce shoulder girdle retraction (shoulders down and back) with neutral spine throughout. 
·         Isometrics in neutral.   Use your own hand and gently press and hold the head in a contracted position for 3-5 second holds to start.  In the past we have used partners to give the resistance, but have found that a partner may offer more resistance than needed.  It is important to note that only a small amount of pressure is needed.
·         Building to neutral unsupported exercises. I.e. crunches in neutral, bench press with head off the bench etc.
·         SB Neck bridge beginning with shoulders on stability ball.  Have the athlete gently press their head into the ball (extension) while keeping the space between the chin and superior aspect of the sternum constant.  As the chin begins to drop rest and repeat.  Make sure the athlete keeps their hips elevated and glutes squeezed throughout. 
·         SB Neck Bridge with dumbbell press (advanced).  Same start position as above only have the athlete use a light dumbbell (5-15lbs) and press it from their chest then pass it to the other hand and repeat.  The goal is to keep the hips elevated and maintain the space between the chin and superior aspect of the sternum constant. 
     This is just a few exercises to get you started.  As a wrestling, rugby and football coach we do use some more advanced movements in our routines, but it is important to monitor these with a close eye and make it clear that we are looking for a gradual build and any sign of pain or the symptoms noted above the athlete should stop immediately.

AVOID (For novices and use sparingly for elite athletes):
·         Neck harnesses.
·         Weighted neck exercises
·         Avoid reverse neck bridging in strength and conditioning settings-these exercises are meant for athletes for whom this is functional or directly sport related (wrestling, MMA etc).  In most cases many of these contact sport athletes are in neck bridging positions for much of their training and competition already, so it is already sufficiently incorporated into their mat work. 

My Final Thoughts:
     My athletic career was cut short due to a neck injury.  Over my playing career I worked with and under many strength coaches, physiotherapists, chiropractors, doctors and specialists.  In this time I received mixed messages as to what would be the best way to fix the pain and nerve damage that was inflicted upon me.  Many of the therapists felt the neck was not meant to be strengthened and should be left alone, while others thought I needed to strengthen it.  As an athlete, you tend to trust that your rehab specialists have the same goal as you do, which is to get you back to competition as fast as possible.  In retrospect, I think I would have taken a little advice from everyone and 1) considered not using my head as a weapon and 2) done some specialized neck strengthening.  Too often we wait until an injury occurs to do the appropriate strengthening, and mine was a case of too little too late.  Whether or not therapists like the idea of strengthening the neck, it is my opinion that it should be done to help deal with the stress of contact sports.    I am quite certain that therapists will agree that the neck is not meant to be used as it is in sport either, but we have to work with whatever the situation is to help the athlete.  It is not the ideal solution considering the neck’s purpose, but if we can put off the general wear and tear and prepare for some of the forces that get placed on it in a safe manner, why not?    
In conjunction with the neck strengthening, it is important to not fall into the shrug pit.  As strength coaches we have always worked on the upper traps to help support the neck.  However in actuality, there is more benefit to incorporate mid and lower trap work over the upper trap work (I am not saying you shouldn’t work the upper traps, just balance it with mid and lower trap work) in conjunction with neck and pec/shoulder stretching. 
Realistically, if you are in one of these contact sports, you should be getting more than enough upper trap work through your Olympic lifting and variations. 
Keep in mind that this article is taking a conservative approach.  Elite athletes that have a long training history may be able to incorporate more advanced movements not listed in this article. If you have any questions or concerns, please don’t hesitate to contact me.

Yours in Strength,
Joe McCullum
 @level10fitness, @bigjoesrant

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