Are Clinical Measures of Cervical Spine Strength and Cervical Flexor Endurance Risk Factors for Concussion in Elite Youth Ice Hockey Players?

Abstract

Background Symptoms of dizziness, neck pain and headaches have previously been identified as risk factors for concussion. Clinical measures associated with these symptoms have not previously been evaluated as risk factors for concussion. Objectives To evaluate clinical measures of cervical endurance and strength as risk factors for concussion in elite youth ice hockey players. Design Prospective cohort study. Setting Community ice rinks and Sport Medicine Clinic. Participants Bantam (12-14 years) and Midget (15-17 years) male and female elite youth ice hockey players (n=466). Risk factor assessment Participants completed baseline clinical tests of cervical flexor endurance and cervical spine isometric strength at the beginning of the 2011-2012 season. Main outcome measurements Players with a suspected concussion (identified by team therapists) were referred to the study sport medicine physician for assessment (diagnosed as per the 3 rd International Consensus on Concussion in Sport Guidelines). Results Concussion incidence rate ratios were estimated using Poisson regression (adjusted for cluster by team and exposure hours). 466 elite youth ice hockey players completed clinical baseline tests at the start of the 2011-2012 hockey season. Players performing in the lowest 25 th percentile were not at an increased risk of concussion during the season of play [cervical strength right sided IRR=1.33 (95%CI; 0.98-1.83); left IRR=1.07 (95% CI; 0.64-1.78] or cervical flexor endurance [IRR=1.27 (95% CI; 0.74-2.20)]. Conclusion Clinical tests of cervical flexor endurance and isometric cervical strength were not predictive of concussion risk. Further evaluation of other baseline clinical measures is necessary to inform future development of prevention strategies for concussion in youth.

Adapting the Dynamic, Recursive Model of Sport Injury to Concussion: An Individualized Approach to Concussion Prevention, Detection, Assessment, and Treatment

“…105 Possible explanations for the increased risk include altered neuromuscular control, sensorimotor control, balance, or cervical spine strength. 101 High school athletes with lower neck strength may have a greater risk of concussion. 19 In youth ice hockey players, an increased risk of concussion has been reported in players who did not meet the Canadian recommendations for daily physical activity ( activity) in the 6 weeks prior to study entry.…”

Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial

“…If one or more of these systems provide inaccurate information about spatial location, alteration in balance and dizziness may result due to mismatching of sensory information. Additionally, dysfunction of these systems may persist and may alter risk of future concussion 17 18…”

Neck strength alone does not mitigate adverse associations of soccer heading with cognitive performance in adult amateur players

“…Studies on the protective role of greater neck strength in sports have shown mixed results. Neck strength was not found to be predictive of concussion risk for ice hockey players [ 26 ]. However, a small study (n = 17) of adolescent female soccer players found that greater neck strength is negatively correlated with head acceleration during heading [ 9 ], and a large study (n = 6,704) of male and female adolescent basketball, soccer, and lacrosse athletes found that for every 1 pound increase in neck strength, the odds of concussion decreased by 5% [ 27 ].…”