Combining Evidence and Practice to Optimise Neck Training to Reduce Head Acceleration Events in Sport: A Systematic Review and Delphi-Consensus Study
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Abstract
This two-part study aimed to 1) systematically review the literature of neck strength training interventions in collision and combat sports; and 2) undertake a Delphi consensus on the best practices for neck strength implementation from a panel of experts with the aim to reduce head acceleration events (HAEs) in sport. In part I, a systematic search of four databases (PubMed, Scopus, CINHAL, SPORTDiscus) was undertaken from the earliest records to June 2024. The updated Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed, and a quality assessment was completed using a modified Downs and Black assessment tool. Papers were eligible if they implemented repeatable exercise intervention targeting the neck and assessed changes in the physical profile of the neck, head-neck injury incidence, and/or HAEs within a collision or combat sporting population. In part II, an expert panel of 18 international experts with experience in research and/or applied practice of neck strengthening, concussion and/or HAEs in sport was formed. Experts reviewed the findings from part I before completing a three-round Delphi consensus (defined by ≥70% agreement) methodology. Nineteen papers were included in part I which included a total of 586 participants and highlighted the heterogenous nature of existing neck strength interventions. In part II, a total of 57 statements reached expert consensus and were coded into five categories: contextual factors (n=17), neck training periodisation (n=12), training adaptations (n=10), neck training content (n=13), and athlete compliance (n=3). This study has developed a broad set of guidelines to be adapted for neck strengthening interventions for the reduction of HAEs. This will help the design and interpretation of future interventions in practice and research.
