Neck strength and concussion prevalence in football and rugby athletes

To determine the maximal isometric neck strength of male and female rugby and football (soccer) athletes, and to investigate the relationship between neck strength and sport played, sex, age, anthropometric measurements and concussion history.

Cross-sectional observational study.

In total, 358 (70% male) healthy football and rugby playing adolescents and adults participated. Isometric neck strength and anthropometry measurements were collected, as well as completion of a sociodemographic survey. The mean (standard deviation) of all measurements for each age group was calculated and compared between sports and sexes, with correlation analyses performed to determine associations between all variables.

In general, rugby athletes had stronger neck musculature compared to football athletes, and males had stronger neck musculature compared to age-matched females, with these strength differences becoming increasingly significant with age (p < 0.05). The athletes with stronger neck muscles were older, taller, heavier, had higher bilateral grip strength and larger neck girth compared to those with weaker neck muscles (p < 0.05). Male rugby athletes who self-reported higher rates of a previous concussion had lower neck flexor/extensor strength ratio (p < 0.01). In 11-12-year-old male footballers, increased heading was associated with increased self-reported previous concussion (p < 0.01).

These normative neck strength data can form important reference values for rugby and football athletes from adolescence into adulthood. Male rugby athletes with a previous history of concussion demonstrated strength imbalances of their neck musculature (lower flexor/extensor ratio), with this finding having potentially important implications for training protocols and injury prevention initiatives.