902 MEP048 – Evaluating a neck strength protocol for neuromuscular indicators in intercollegiate female athletes to reduce the incidence of concussions Academic Article uri icon

Abstract

  • Background: The proposed presentation includes research findings from a dynamic neck strengthening training protocol implemented with a Division I NCAA volleyball team over the course of two years. The athletes participated in pre- and post-assessments measuring isometric and dynamic neck strength assessments and completing a concussion questionnaire.
    Objective: The primary goal of this research was to determine the efficacy of a neck strengthening protocol to increase isometric neck strength and the rate of force development using a novel dynamic neck strengthening device, the TopSpin360 tool. A secondary goal was to determine if the dynamic neck strengthening tool decreases the incidence of concussions during a full year of collegiate volleyball play.
    Design: The research study was approved by an institutional ethics review board (IRB) record number H21-0259 at UNC Wilmington and supported by The Citadel Military College IRB. This research was conducted in collaboration with the Citadel Military College of South Carolina’s Director of Physical Readiness program and the volleyball team’s athletic trainer and coaching staff. The study was conducted over a period of a full year with some retrospective data regarding concussion occurrence prior to the neck training program. Pre- and post-assessments were conducted in January and April 2022, respectively, and August and November of 2022. The dates were chosen based on the spring off-season and fall in-season game play. All athletes participated in the dynamic neck strengthening protocol throughout the spring and fall. Summer did not include any training or assessments.
    Setting: Both pre- and post-assessments occurred at the Citadel Military College of South Carolina’s Division I strength and conditioning center. The 14-week dynamic neck strength training occurred as a part of the normal training regime for the volleyball team at the Citadel’s training facilities.
    Patients (or Participants): Participants were university-age students recruited from the women’s volleyball team. The participants had the option to opt out of the study if they so wished. Exclusion criteria included head/neck injury within the previous year or if deemed unfit for the research study by the sports medicine staff. The January-April Cohort included a total of 12 participants, 3-Freshman, 5-Sophmore, and 4-Juniors. The age range of the participants was between 18-20. The August-November Cohort included incoming freshman for the team totaling 16 participants, 4-Freshman, 3-Sophmore, 5-Junior, and 4-Seniors.
    Interventions (or Assessment of Risk Factors): The Citadel’s Neck Strengthening program consisted of the following training on the TopSpin360 tool. The warm-up included two-sets at low intensity, 40-50% revolutions per minute peak (RPM). Each set included 100 revolutions, 50 revolutions counterclockwise (CCW) and 50 were clockwise (CW). Each participant completed a total of 200 low intensity revolutions for the warm-up. The training-sets consisted of 50 revolutions at 90-100% Peak ROM for both CCW and CW. Each participant completed 2 rounds of the training-sets. The intervention was conducted for 14 weeks in the spring and 14 weeks during the fall semesters. Summer semester did not include any training nor assessments.
    Main Outcome Measurements: The primary study outcome measures were isometric and dynamic neck strength values. Dynamic neck strength values assessed were the rate-of-force developed (lbs/rev) and RPM during each use of the TopSpin360. Isometric strength values were assessed with a tool developed by the research team at UNC Wilmington, in short the IP was comprised of a tension force gauge with head harness named the NSAT 1.0. The main outcome measures specifically attempting to determine if participants experienced an increase in RPM, RFD, and isometric neck strength values. A secondary outcome assessed included a self-reported survey identifying concussion occurrence throughout the year.
    The primary study outcome measures (dependent variables) should be indicated as planned before data collection began. If the hypothesis being reported was formulated during or after data collection, this fact should be clearly stated.
    Results: Both spring and fall post-assessments indicated improvements in dynamic and isometric neck strength for all participants. The findings from the January to April cohort demonstrated moderate improvement specifically those individuals who had been training on the TopSpin360 during the year prior, such as the juniors and sophomores. The freshman during the spring cohort demonstrated the highest gains in dynamic and isometric neck strength. Reference Table-1 below for Jan-April Cohort averages of each metric assessed categorized by academic class status. The findings from August to November Cohort demonstrated significant increases in both isometric and dynamic neck strength metrics. This cohort included incoming freshmen who had never participated in dynamic neck strengthening previously. Reference Table-2 below for Aug-Nov Cohort averages of each metric assessed categorized by academic class status. Report the main findings of the study. A linear regression model was used to determine the amount of improvement for each metric assessed Jan-April and Aug-Nov.
    The four times are Jan, Apr, Aug, and Nov.
    The model above provided the research team with the rate of change per each metric measured. Once again, statical significance in change was represented by the data. Table 3 below indicates the linear regression model outcome, rate of change per each metric assessed. In Table 3, the β_month represents the change in values from the previous assessment. For instance, β_Apr represents the change in values from January 2022 to April 2022 assessments. In this case, the RPM, RFD, and Isometric values increased from Jan-April 2022. The β_Aug represents the change from January to August, and accounts for the four summer months where the team did not participate in the neck strengthening program. Therefore, the β_Aug assessments indicated a drop in all values. This concept will be expanded upon further in the discussion section of the presentation. The β_Nov represents the change from August to November and demonstrates a significant increase in overall participant values from pre- to post-assessment. This is largely due to the addition of four new freshman athletes who had yet to utilize the TopSpin360 before the August 2022 assessment. As such, their initial values represented in β_Aug were lower than their upperclassman counterparts, demonstrating a greater increase in the β_Nov assessment. The t.β_month (t-value) represents the effect size for each assessment. A t-value of 3 or above may be considered statistically significant.
    The final statistical analysis conducted by the research team included the freshman values. A linear regression model was used solely on the freshman metrics. Table-4 provides the rate of change from August to November for each metric assessed of the freshman. The data indicates a significant increase in all metrics recorded. Reference Table-4, the β_4end represents the estimated changes in metrics; for instance, for RPM-CW, the freshman had an increase on average of 50.167rpm after four months. The Kenward-Roger test suggests an F-statistics of 17.756 with a p-value of 0.003. Thus, the positive change is highly significant. All other metrics follow the same pattern as the RPM-CW statistics.

    Conclusions: The novel dynamic neck strengthening protocol used by the Citadel Volleyball team demonstrated significant improvements in isometric and dynamic neck strength values. In addition, the research reviewed retrospective data from the Citadel Volleyball teams medical history. Previous to using the TopSpin360 the volleyball team had recorded a total of 8 concussions during off- and on-season play. Since using the TopSpin360 neck strength tool from 2021-2022, the team recorded zero concussions. Furthermore, each athlete indicated a positive change in neck strength and overall confidence in avoiding head and neck injuries.

Publication Date

  • 2024-02-01