The DOI matches its Crossref record; 30 of the 31 references it cites were found in a registry or an index.
Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports
Abstract
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.
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“Under physiological conditions, sex-specific differences in mitochondrial respiration, bioenergetics, and reactive oxygen species production have been reported in both human and animal studies.”
From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [117]
In the citing paper
“In healthy human subjects, women had higher levels of N -acetylaspartate, a marker of neuronal bioenergetics, in gray and white matter.”
From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [117]
Citations
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- Gessel, L. M., Fields, S. K., Collins, C. L., Dick, R. W., & Comstock, R. D. (2007). Concussions among high school and college athletes. Journal of Athletic Training, 42(4), 495–503.
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Items 301–325 of 325
Injury Risk Reduction Strategies in Professional Football (Soccer): What Is the Evidence?
Khodaee, M., Tuttle, M., Gati, S., Webner, D., Chang, C. J., Collings, T., Pruna, R., Buckthorpe, M. W., Mauri, E. P., & Spittler, J. (2025) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001290
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Garnett, D., Patricios, J., & Cobbing, S. (2021) · Figshare · doi:10.6084/m9.figshare.14608895
Garnett, D., Cobbing, S., Viljoen, C. T., & Patricios, J. (2024) · Figshare · doi:10.6084/m9.figshare.26738139
Cheever, K., King, J., & Kawata, K. (2022) · Figshare · doi:10.6084/m9.figshare.21629145
Rodríguez, A. V. C., Hutchinson, M. R., D’Arcangelo, A. M. M., & Rozenštoka, S. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-31638-8.00018-4
Developing a Novel, Accessible Method for Estimating Cervical Muscle Volume in Adolescent Athletes
Peters, Q., Wang, Y., Kim, H., Yablon, C. M., Jacobson, J., Vasavada, A. N., He, X., Ashton‐Miller, J. A., & Eckner, J. T. (2025) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002916
Fukuda, T., Yamazaki, K., & Zhou, B. (2026) · The Asian Journal of Kinesiology · doi:10.15758/ajk.2026.28.1.11
“Collins et al. [24] reported that low neck strength and small neck circumference correlated with SRC.”
Fourie, E., Viviers, P., & Brink, Y. (2026) · Jurnal sport science · doi:10.1080/02640414.2026.2626659
“Some studies have reported that greater neck strength and girth are associated with reduced head acceleration and lower concussion risk (Collins et al., 2014; Leung et al., 2025) while others, including recent systematic reviews and large cohort studies, have found only weak or nonsignificant…”
Head Acceleration Events Measured by Instrumented Mouthguards in Elite Australian Football
Evans, L. J., Hickey, J. W., Reyes, J., Xie, B., Gillespie-Jones, K., Giesler, L. P., Shultz, S. R., O'Brien, T. J., Makdissi, M., Willmott, C., et al. (2026) · Sports Medicine - Open · doi:10.1186/s40798-026-00982-6
“While some studies suggest greater neck strength may reduce concussion risk, others have found no significant association between neck strength and impact kinematics [36, 39, 40].”
Milton, N., Gorman, B. T., Cosgrave, C. H., Fuller, C., & Kung, S. M. (2026) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2026.101903
Osmotherly, P. G. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.03.005
Neuro-ophthalmic sequelae of sports-related injuries: mechanisms, diagnosis, and emerging directions
Douglas, K. A., Pluenneke, M., Panzo, N., Sporn, K., Douglas, V. P., Kumar, R., Ong, J., Waisberg, E., & Lee, A. G. (2026) · Expert Review of Ophthalmology · doi:10.1080/17469899.2026.2673961
“Smaller neck circumference and weaker neck musculature are both strongly associated with increased concussion risk, and every additional pound of neck strength reduces concussion odds by approximately 5% [169].”
Ivanic, B., Cronström, A., Rasi, M., & Ageberg, E. (2026) · Sports Medicine · doi:10.1007/s40279-026-02448-x
“As cervical neuromuscular control and strength are still maturing during adolescence, high school athletes may exhibit lower cervical stabilisation capacity compared with mechanical demands of play, which can result in greater head acceleration during impacts [74] and an increased SRC risk [75, 76].”
Farley, T., Hogben, P., McBride, L. J., Williams, T., Habets, H., Baker, E. B., McHale, G., Gidwani, J., Phillips, T., Raza, Y., et al. (2026) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2026.101966
Çakır, F., Özer, Ö., Gürses, V. V., UYHAN, O., & Başaran, M. S. (2026) · Journal of Physical Education and Sports Studies · doi:10.55929/besad.1847982
Consequences of repetitive head trauma: a historical reappraisal of Hobey Baker
Plassche, G. C., Ferrer, X. E., Reynolds, A. W., Morrissette, C. R., Fortney, T. A., Popkin, M. K., & Popkin, C. A. (2026) · Frontiers in Neurology · doi:10.3389/fneur.2026.1842231
“His physique—a slender build with a narrow neck has been associated with high concussion risk in modern analyses (10).”
Associations between sleep disturbances and concussions in US high school athletes
Nelson, M., Reese, M., Nolan, D., Bray, N., & Hartwell, M. L. (2026) · Journal of Osteopathic Medicine · doi:10.1515/jom-2026-0002
Leung, W.-C., Yung, K. K., Habiba, U., Tung, M. J.-Y., Pan, W., Ling, S. K.-K., & Yung, P. S. (2026) · Asia-Pacific Journal of Sports Medicine Arthroscopy Rehabilitation and Technology · doi:10.1016/j.asmart.2026.08.005
“28,29 This disparity is likely multifactorial, attributed to a combination of biomechanical factors such as lesser neck strength and mass, which reduce the ability to stabilize the head upon impact, 30,31 and neuro-physiological influences of sex hormones.”
Cardenas, D. A. (2026) · IntechOpen eBooks · doi:10.5772/intechopen.1016257
Hides, J. A., Currie, B. M., Warner, E. A., Oostenbroek, T., Dyer, B. P., Treleaven, J. M., & Leung, F. T. (2026) · JSAMS Plus · doi:10.1016/j.jsampl.2026.100157
“Consistent with this proposed mechanism, prospective studies in rugby union and rugby league have reported associations between lower neck strength and increased risk of SRC [18,19], while other studies have suggested that greater neck strength may have a protective effect [20].”
Physical Performance and Head Impact Exposure in Boys' Youth Ice Hockey
Swenson, A. G., Smith, C. D., Cavallero, N. J., Agudelo, G. A. R., Pritchard, N. S., Bullock, G. S., Miles, C. M., Mihalik, J. P., Urban, J. E., & Stitzel, J. D. (2026) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000005663
Bastock, A. (2014) · Carroll Collected (John Carroll University)
Metadata
- Authors
- Collins, C. L., Fletcher, E. N., Fields, S. K., Kluchurosky, L., Rohrkemper, M. K., Comstock, R. D., & Cantu, R. C.
- Affiliations
- Nationwide Children's Hospital (US)
- University of Colorado Denver (US)
- Colorado School of Public Health (US)
- Boston University (US)
- Corresponding author
- Comstock, R. Dawn
- Venue
- The Journal of Primary Prevention
- Published
- 2014-06-15
- Volume
- 35
- Issue
- 5
- Pages
- 309-319
- ISSN
- 0278-095X (ISSN-L)
- 1573-6547
- OpenAlex
- W2077683717
- Cited by
- 327
- References
- 31
- Citations by year
- 2026: 16 · 2025: 37 · 2024: 31 · 2023: 27 · 2022: 25 · 2021: 41 · 2020: 32 · 2019: 32 · 2018: 32 · 2017: 23 · 2016: 16 · 2015: 9 · 2014: 6
- FWCI
- 13.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- The Journal of Primary Prevention (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Operating Committee on Standards for Athletic Equipment
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
- Keywords
- neck muscle strength, sports-related concussion, high school athletes, hand-held dynamometry, anthropometry, neck circumference, athletic trainers, concussion screening, concussion prevention, soccer, basketball, lacrosse
- MeSH terms
- Adolescent, Adult, Age Factors, Anthropometry, Brain Concussion, Equipment Design, Feasibility Studies, Female, Humans, Male, Neck Muscles, Pilot Projects, Risk Factors, Sex Factors, Reproducibility of Results, Incidence, Muscle Strength, Muscle Strength Dynamometer
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