{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T02:35:37Z","timestamp":1789785337000,"version":"4.0.1"},"reference-count":54,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2022,2,2]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Concussion is one of the highest burden injuries within professional Rugby Union (\u2018rugby\u2019) and comes with a high health and financial cost to players and teams. Limited evidence exists as to the existence of modifiable intrinsic risk factors for concussion, leaving athletes and clinicians with few options when developing prevention strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate whether neck strength is significantly associated with concussion incidence in professional male rugby players.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>225 rugby players were assessed for neck strength at three time points throughout the 2018\/2019 season using a method of isometric contraction. Associations with clinically diagnosed concussion injuries are presented as incidence rate ratios (IRRs) with 95% CIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty concussions occurred in 29 players during the study period; a rate of 13.7 concussions per 1000 hours played. Greater neck strength was observed at mid and end of season time points versus preseason across the study population. There was a significant association between extension strength and concussion; a 10% increase for extension strength was associated with a 13% reduction in concussion rate (adjusted IRR (95%\u2009CI) 0.87 (0.78 to 0.98). No other significant associations were observed between concussion incidence and any other unique neck strength range or composite score.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Higher neck extension strength is associated with lower concussion rates in male rugby players. Neck strength is a modifiable intrinsic risk factor for concussion and may be an important component of a strength and conditioning regime.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2021-104414","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T18:32:13Z","timestamp":1645641133000},"page":"616-621","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Poor isometric neck extension strength as a risk factor for concussion in male professional Rugby Union players"],"prefix":"10.1136","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6493-1312","authenticated-orcid":false,"given":"Theo","family":"Farley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed","family":"Barry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Sylvester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akbar De","family":"Medici","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-0168","authenticated-orcid":false,"given":"Mathew G","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,2,23]]},"reference":[{"key":"2024051414563198000_56.11.616.1","doi-asserted-by":"publisher","DOI":"10.1097\/00042752-200603000-00013"},{"key":"2024051414563198000_56.11.616.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1440-2440(04)80035-5"},{"key":"2024051414563198000_56.11.616.3","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510376737"},{"key":"2024051414563198000_56.11.616.4","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1080\/02699052.2019.1629626","article-title":"Predicting functional recovery after mild traumatic brain injury: the SHEFBIT cohort","volume":"33","author":"Booker","year":"2019","journal-title":"Brain Inj"},{"key":"2024051414563198000_56.11.616.5","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.ptsp.2018.11.010","article-title":"The epidemiology of concussion in professional rugby union in Ireland","volume":"35","author":"Cosgrave","year":"2019","journal-title":"Phys Ther Sport"},{"key":"2024051414563198000_56.11.616.6","unstructured":"Union TRF . England professional rugby injury surveillance project, 2018. Available: https:\/\/www.englandrugby.com\/dxdam\/96\/960006d9-269d-4250-a15f-d9e62f8bfe70\/PRISP_1718.pdf"},{"key":"2024051414563198000_56.11.616.7","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515599634"},{"key":"2024051414563198000_56.11.616.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2010.08.009"},{"key":"2024051414563198000_56.11.616.9","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0b013e31816a1c9a"},{"key":"2024051414563198000_56.11.616.10","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.32.4.319"},{"key":"2024051414563198000_56.11.616.11","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097883"},{"key":"2024051414563198000_56.11.616.12","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1080\/17461391.2015.1046192","article-title":"Contact technique and concussions in the South African under-18 Coca-Cola Craven week rugby tournament","volume":"15","author":"Hendricks","year":"2015","journal-title":"Eur J Sport Sci"},{"key":"2024051414563198000_56.11.616.13","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514536685"},{"key":"2024051414563198000_56.11.616.14","doi-asserted-by":"publisher","DOI":"10.1177\/0363546513517869"},{"key":"2024051414563198000_56.11.616.15","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0B013E31822C8A5C"},{"key":"2024051414563198000_56.11.616.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097699"},{"key":"2024051414563198000_56.11.616.17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0268-0033(97)00057-0","article-title":"Critical load of the human cervical spine: an in vitro experimental study","volume":"13","author":"Panjabi","year":"1998","journal-title":"Clin Biomech"},{"key":"2024051414563198000_56.11.616.18","doi-asserted-by":"publisher","DOI":"10.1007\/s10935-014-0355-2"},{"key":"2024051414563198000_56.11.616.19","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-097912"},{"key":"2024051414563198000_56.11.616.20","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2007.037499"},{"key":"2024051414563198000_56.11.616.21","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181c07b5b"},{"key":"2024051414563198000_56.11.616.22","doi-asserted-by":"publisher","DOI":"10.1177\/0009922813518429"},{"key":"2024051414563198000_56.11.616.23","doi-asserted-by":"crossref","DOI":"10.1186\/2052-1847-6-32","article-title":"Cervical isometric strength and range of motion of elite rugby union players: a cohort study","volume":"6","author":"Hamilton","year":"2014","journal-title":"BMC Sports Sci Med Rehabil"},{"key":"2024051414563198000_56.11.616.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2007.01.009"},{"key":"2024051414563198000_56.11.616.25","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jmpt.2013.05.026","article-title":"Intrarater reliability of neck strength measurement of rugby union players using a handheld dynamometer","volume":"36","author":"Geary","year":"2013","journal-title":"J Manipulative Physiol Ther"},{"key":"2024051414563198000_56.11.616.26","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1080\/00913847.2021.1886574","article-title":"Neck strength in rugby union players: a systematic review of the literature","volume":"49","author":"Chavarro-Nieto","year":"2021","journal-title":"Phys Sportsmed"},{"key":"2024051414563198000_56.11.616.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ptsp.2013.08.002"},{"key":"2024051414563198000_56.11.616.28","doi-asserted-by":"crossref","first-page":"58","DOI":"10.3138\/ptc.2013-66","article-title":"Evaluating the reliability of a novel neck-strength assessment protocol for healthy adults using self-generated resistance with a hand-held dynamometer","volume":"67","author":"Versteegh","year":"2015","journal-title":"Physiother Can"},{"key":"2024051414563198000_56.11.616.29","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1097\/EDE.0000000000000247","article-title":"Models with transformed variables: interpretation and software","volume":"26","author":"Barrera-G\u00f3mez","year":"2015","journal-title":"Epidemiology"},{"key":"2024051414563198000_56.11.616.30","doi-asserted-by":"publisher","DOI":"10.1002\/bimj.200410135"},{"key":"2024051414563198000_56.11.616.31","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094982"},{"key":"2024051414563198000_56.11.616.32","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098417"},{"key":"2024051414563198000_56.11.616.33","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jelekin.2018.01.011","article-title":"Characterization of cervical neuromuscular response to head-neck perturbation in active young adults","volume":"39","author":"Alsalaheen","year":"2018","journal-title":"J Electromyogr Kinesiol"},{"key":"2024051414563198000_56.11.616.34","first-page":"310","article-title":"Resistance training and head-neck segment dynamic stabilization in male and female collegiate soccer players","volume":"40","author":"Mansell","year":"2005","journal-title":"J Athl Train"},{"key":"2024051414563198000_56.11.616.35","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1113\/jphysiol.1995.sp021103","article-title":"Neck muscle responses to abrupt free fall of the head: comparison of normal with labyrinthine-defective human subjects","volume":"489 (Pt 3","author":"Ito","year":"1995","journal-title":"J Physiol"},{"key":"2024051414563198000_56.11.616.36","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3233\/IES-2011-0390","article-title":"Musculo-tendinous stiffness of the in vivo head-neck segment in response to quick-releases: a reproducibility study","volume":"19","author":"Portero","year":"2011","journal-title":"Isokinet Exerc Sci"},{"key":"2024051414563198000_56.11.616.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2012.12.009"},{"key":"2024051414563198000_56.11.616.38","doi-asserted-by":"publisher","DOI":"10.1007\/s002210050221"},{"key":"2024051414563198000_56.11.616.39","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2519\/jospt.1987.8.7.351","article-title":"A comparative assessment of neck muscle strength and vertebral stability","volume":"8","author":"Franco","year":"1987","journal-title":"J Orthop Sports Phys Ther"},{"key":"2024051414563198000_56.11.616.40","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1519\/JSC.0000000000000689","article-title":"Reliability of repeated isometric neck strength and endurance testing in a simulated contact posture","volume":"29","author":"Salmon","year":"2015","journal-title":"J Strength Cond Res"},{"key":"2024051414563198000_56.11.616.41","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/0363546518812820","article-title":"Association of dynamic balance with sports-related concussion: a prospective cohort study","volume":"47","author":"Johnston","year":"2019","journal-title":"Am J Sports Med"},{"key":"2024051414563198000_56.11.616.42","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsem-2019-000645"},{"key":"2024051414563198000_56.11.616.43","first-page":"729","article-title":"Effects of a 6-week strength training of the neck flexors and Extensors on the head acceleration during Headers in soccer","volume":"18","author":"Becker","year":"2019","journal-title":"J Sports Sci Med"},{"key":"2024051414563198000_56.11.616.44","article-title":"A systematic review of strength and conditioning protocols for improving neck strength and reducing concussion incidence and impact injury risk in collision sports; is there evidence?","volume":"6","author":"Daly","year":"2021","journal-title":"J Funct Morphol Kinesiol"},{"key":"2024051414563198000_56.11.616.45","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094978"},{"key":"2024051414563198000_56.11.616.46","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1007\/s40279-017-0854-4","article-title":"Epidemiology of head injuries focusing on concussions in team contact sports: a systematic review","volume":"48","author":"Prien","year":"2018","journal-title":"Sports Med"},{"key":"2024051414563198000_56.11.616.47","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1080\/02640414.2020.1752059","article-title":"Ten-season epidemiological study of match injuries in men\u2019s international rugby sevens","volume":"38","author":"Fuller","year":"2020","journal-title":"J Sports Sci"},{"key":"2024051414563198000_56.11.616.48","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.1055\/a-0808-2551","article-title":"Time trends of head injuries over multiple seasons in professional male football (soccer)","volume":"3","author":"Beaudouin","year":"2019","journal-title":"Sports Med Int Open"},{"key":"2024051414563198000_56.11.616.49","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1089\/neu.2017.5611","article-title":"Short-Term impact of concussion in the NHL: an analysis of player longevity, performance, and financial loss","volume":"35","author":"Navarro","year":"2018","journal-title":"J Neurotrauma"},{"key":"2024051414563198000_56.11.616.50","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.061481"},{"key":"2024051414563198000_56.11.616.51","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-314279"},{"key":"2024051414563198000_56.11.616.52","doi-asserted-by":"publisher","DOI":"10.1080\/13803390701443662"},{"key":"2024051414563198000_56.11.616.53","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.37.1.13"},{"key":"2024051414563198000_56.11.616.54","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.ptsp.2019.04.022","article-title":"Intrinsic modifiable risk factors in ballet dancers: applying evidence based practice principles to enhance clinical applications","volume":"38","author":"Campbell","year":"2019","journal-title":"Phys Ther Sport"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2021-104414","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T22:17:37Z","timestamp":1715725057000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2021-104414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,23]]},"references-count":54,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,5,17]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/bjsports-2021-104414"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2021-104414","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,23]]}}}