An Accessible, 16-Week Neck Strength Training Program Improves Head Kinematics Following Chest Perturbation in Young Soccer Athletes

Context: Neck size and strength may be associated with head kinematics and concussion risks. However, there is a paucity of research examining neck strengthening and head kinematics in youths. In addition, neck training is likely lacking in youth sport due to a perceived inadequacy of equipment or time. Objective: Examine neck training effects with minimal equipment on neck strength and head kinematics following chest perturbations in youth athletes. Design: Single-group, pretest–posttest case series. Setting: Athlete training center. Participants: Twenty-five (14 men and 11 women) youth soccer athletes (9.8 [1.5] y). Intervention: Sixteen weeks of twice-weekly neck-focused resistance training utilizing bands, body weight, and manual resistance. Main Outcome Measures: Head kinematics (angular range of motion, peak anterior–posterior linear acceleration, and peak resultant linear acceleration) were measured by an inertial motion unit fixed to the apex of the head during torso perturbations. Neck-flexion and extension strength were assessed using weights placed on the forehead and a plate-loaded neck harness, respectively. Neck length and circumference were measured via measuring tape. Results: Neck extension (increase in median values for all: +4.5 kg, +100%, P < .001; females: +4.5 kg, +100%, P = .002; males: +2.2 kg, +36%, P = .003) and flexion (all: +3.6 kg, +114%, P < .001; females: +3.6 kg, +114%, P = .004; males: +3.6 kg, +114%, P = .001) strength increased following the intervention. Men and women both experienced reduced perturbation-induced head pitch (all: −84%, P < .001). However, peak resultant linear acceleration decreased in the female (−53%, P = .004), but not male (−31%, P = 1.0) subgroup. Preintervention peak resultant linear acceleration and extension strength (R2 = .21, P = .033) were the closest-to-significance associations between head kinematics and strength. Conclusions: Young athletes can improve neck strength and reduce perturbation-induced head kinematics following a 16-week neck strengthening program. However, further research is needed to determine the effect of improved strength and head stabilization on concussion injury rates.

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Characterization of On-Field Head Impact Exposure in Youth Soccer

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0071 ◽

2020 ◽

pp. 1-7

Author(s):

Brian T. Tomblin ◽

N. Stewart Pritchard ◽

Tanner M. Filben ◽

Logan E. Miller ◽

Christopher M. Miles ◽

...

Keyword(s):

Linear Acceleration ◽

Head Impact ◽

Video Data ◽

Soccer Players ◽

Youth Soccer ◽

Head Impacts ◽

Head Kinematics ◽

Frequency Of Contact ◽

Ball Contact

The objective of this research was to characterize head impacts with a validated mouthpiece sensor in competitive youth female soccer players during a single season with a validated mouthpiece sensor. Participants included 14 youth female soccer athletes across 2 club-level teams at different age levels (team 1, ages 12–13 y; team 2, ages 14–15 y). Head impact and time-synchronized video data were collected for 66 practices and games. Video data were reviewed to characterize the type and frequency of contact experienced by each athlete. A total of 2216 contact scenarios were observed; heading the ball (n = 681, 30.7%) was most common. Other observed contact scenarios included collisions, dives, falls, and unintentional ball contact. Team 1 experienced a higher rate of headers per player per hour of play than team 2, while team 2 experienced a higher rate of collisions and dives. A total of 935 video-verified contact scenarios were concurrent with recorded head kinematics. While headers resulted in a maximum linear acceleration of 56.1g, the less frequent head-to-head collisions (n = 6) resulted in a maximum of 113.5g. The results of this study improve the understanding of head impact exposure in youth female soccer players and inform head impact exposure reduction in youth soccer.

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Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations

Journal of Athletic Training ◽

10.4085/1062-6050-375-17 ◽

2019 ◽

Vol 54 (2) ◽

pp. 182-191 ◽

Cited By ~ 1

Author(s):

Hayley J. Root ◽

Barnett S. Frank ◽

Craig R. Denegar ◽

Douglas J. Casa ◽

David I. Gregorio ◽

...

Keyword(s):

Program Implementation ◽

Administrative Support ◽

Neuromuscular Control ◽

Initial Step ◽

Sport Performance ◽

Implementation Framework ◽

Injury Rates ◽

Youth Soccer ◽

Youth Athletes ◽

Education Workshop

Context Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. Objective To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. Design Descriptive epidemiology study. Setting Youth soccer and basketball organizations. Patients or Other Participants Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. Intervention(s) The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs. Main Outcome Measure(s) Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework. Results A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, “Establishing Administrative Support.” No organization completed all components of steps 1 through 5. Conclusions To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.

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Football concussion case series using biomechanical and video analysis

Neurology ◽

10.1212/01.wnl.0000550623.36010.20 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S2.2-S2

Author(s):

Mirellie Kelley ◽

Jillian Urban ◽

Derek Jones ◽

Alexander Powers ◽

Christopher T. Whitlow ◽

...

Keyword(s):

Video Analysis ◽

Case Series ◽

Linear Acceleration ◽

The United States ◽

Head Impact ◽

Rotational Acceleration ◽

Impact Location ◽

Injury Mechanisms ◽

The Mean ◽

Impact Data

Approximately 1.1–1.9 million sport-related concussions among athletes ≤18 years of age occur annually in the United States, but there is limited understanding of the biomechanics and injury mechanisms associated with concussions among lower level football athletes. Therefore, the objective of this study was to combine biomechanical head impact data with video analysis to characterize youth and HS football concussion injury mechanisms. Head impact data were collected from athletes participating on 22 youth and 6 HS football teams between 2012 and 2017. Video was recorded, and head impact data were collected during all practices and games by instrumenting players with the Head Impact Telemetry (HIT) System. For each clinically diagnosed concussion, a video abstraction form was completed, which included questions concerning the context in which the injury occurred. Linear acceleration, rotational acceleration, and impact location were used to characterize the concussive event and each injured athlete's head impact exposure on the day of the concussion. A total of 9 (5 HS and 4 youth) concussions with biomechanics and video of the event were included in this study. The mean [range] linear and rotational acceleration of the concussive impacts were 62.9 [29.3–118.4] g and 3,056.7 [1,046.8–6,954.6] rad/s2, respectively. Concussive impacts were the highest magnitude impacts for 6 players and in the top quartile of impacts for 3 players on the day of injury. Concussions occurred in both practices (N = 4) and games (N = 5). The most common injury contact surface was helmet-to-helmet (N = 5), followed by helmet-to-ground (N = 3) and helmet-to-body (N = 1). All injuries occurred during player-to-player contact scenarios, including tackling (N = 4), blocking (N = 4), and collision with other players (N = 1). The biomechanics and injury mechanisms of concussions varied among athletes in our study; however, concussive impacts were among the highest severity for each player and all concussions occurred as a result of player-to-player contact.

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Differences in Percutaneous Injury Patterns in A Multi-Hospital System

Infection Control and Hospital Epidemiology ◽

10.1086/502121 ◽

2003 ◽

Vol 24 (10) ◽

pp. 731-736 ◽

Cited By ~ 15

Author(s):

Hilary M. Babcock ◽

Victoria Fraser

Keyword(s):

Case Series ◽

Rural Hospitals ◽

Teaching Hospitals ◽

Radiology Department ◽

Chi Square ◽

Hospital System ◽

Injury Rates ◽

Urban Hospitals ◽

Rural And Urban ◽

Different Types

AbstractObjective:Determine differences in patterns of percutaneous injuries (PIs) in different types of hospitals.Design:Case series of injuries occurring from 1997 to 2001.Setting:Large midwestern healthcare system with a consolidated occupational health database from 9 hospitals, including rural and urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from 113 to 1,400 beds.Participants:Healthcare workers injured between 1997 and 2001.Results:Annual injury rates for all hospitals decreased during the study period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001). Average annual injury rates were higher at larger hospitals (22.5 vs 9.5 Pis/100 beds; P = .0001). Among small hospitals, rural hospitals had higher rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At small hospitals, an increased proportion of injuries occurred in the emergency department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P = .0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural hospitals had higher injury rates in the radiology department (7.7% vs 2%; P = .0015) versus urban hospitals. Injuries at the teaching hospitals occurred more commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P = .0006) than at community hospitals. Injuries involving butterfly needles were more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The prevalence of source patients infected with HIV and hepatitis C was higher at large hospitals.Conclusions:Significant differences exist in injury rates and patterns among different types of hospitals. These data can be used to target intervention strategies.

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WEB device for treatment of posterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017405 ◽

2021 ◽

pp. neurintsurg-2021-017405

Author(s):

Guilherme Aguiar ◽

Jildaz Caroff ◽

Cristian Mihalea ◽

Jonathan Cortese ◽

Jean-Baptiste Girot ◽

...

Keyword(s):

Case Series ◽

Posterior Communicating Artery ◽

Neck Size ◽

Ruptured Aneurysms ◽

Antiplatelet Medication ◽

Woven Endobridge ◽

Web Device ◽

Intraoperative Rupture ◽

Wide Neck

BackgroundWoven EndoBridge (WEB) device treatment of wide-neck bifurcation aneurysms has proved to be safe and effective, but the use of these devices in sidewall aneurysms has been reported only in a small number of case series.ObjectiveTo report our results in a cohort of consecutive patients in whom a WEB device was used as first-line treatment for posterior communicating artery (PComA) aneurysms.MethodsWe conducted a retrospective analysis of a prospectively maintained database of PComA aneurysms treated with a WEB device in our institution from June 1, 2012 to November 15, 2020. Clinical and radiological findings were evaluated at immediate and last follow-up.ResultsA total of 219 aneurysms were treated with a WEB device, including 15 PComA aneurysms in 15 patients, 10 of which were ruptured. Aneurysms were wide necked, with a mean aspect ratio of 1.6 (range 0.7–3.0) and a mean neck size of 4.2 mm (range 2.6–7.4 mm). No intraoperative rupture occurred and only one thromboembolic event was noted. Among the group with at least a 3-month digital subtraction angiography (DSA) follow-up, complete and adequate occlusion were obtained in 54% and 72%, respectively (average follow-up 13 months). Re-treatment was needed for two initially ruptured aneurysms. No procedure-related morbidity or mortality was reported.ConclusionThis series suggests the high safety profile of WEB devices even when used in off-label indications. Treatment with these devices seems to be a valuable strategy for ruptured wide-neck PComA aneurysms, avoiding the need for antiplatelet medication. However, occlusion rates should be investigated in further larger studies.

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The Influence of Neck Stiffness on Head Kinematics and Maximum Principal Strain Associated With Youth American Football Collisions

Journal of Applied Biomechanics ◽

10.1123/jab.2020-0070 ◽

2021 ◽

pp. 1-8

Author(s):

Janie Cournoyer ◽

David Koncan ◽

Michael D. Gilchrist ◽

T. Blaine Hoshizaki

Keyword(s):

American Football ◽

Principal Strain ◽

Neck Stiffness ◽

Head Impacts ◽

Head Kinematics ◽

Upper Trapezius ◽

Maximum Principal Strain ◽

Direct Head ◽

Hybrid Iii ◽

Neck Strength

Understanding the relationship between head mass and neck stiffness during direct head impacts is especially concerning in youth sports where athletes have higher proportional head mass to neck strength. This study compared 2 neck stiffness conditions for peak linear and rotational acceleration and brain tissue deformations across 3 impact velocities, 3 impact locations, and 2 striking masses. A pendulum fitted with a nylon cap was used to impact a fifth percentile hybrid III headform equipped with 9 accelerometers and fitted with a youth American football helmet. The 2 neck stiffness conditions consisted of a neckform with and without resistance in 3 planes, representing the upper trapezius, the splenius capitis, and the sternocleidomastoid muscles. Increased neck stiffness resulted in significant changes in head kinematics and maximum principal strain specific to impact velocity, impact location, and striking mass.

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Injuries on the Youth Soccer (Football) Field: Do Additional Referees Reduce Risk? Randomized Crossover Trial

Journal of Pediatric Psychology ◽

10.1093/jpepsy/jsaa050 ◽

2020 ◽

Vol 45 (7) ◽

pp. 759-766

Author(s):

David C Schwebel ◽

D Leann Long ◽

Leslie A McClure

Keyword(s):

Mixed Model ◽

Crossover Trial ◽

Injury Rates ◽

Financial Investment ◽

Youth Soccer ◽

Randomized Crossover Trial ◽

Risky Play ◽

Boys And Girls Clubs ◽

Football Field ◽

Soccer Fields

Abstract Objective Youth soccer injury can be prevented through various means, but few studies consider the role of referees. Following previous research suggesting children take fewer risks when supervised intensely, this randomized crossover trial evaluated whether risky play and injuries decrease under supervision from three referees instead of one referee. Methods Youth soccer clubs serving a metropolitan U.S. area participated. Boys’ and girls’ clubs at under age 10 (U10) and under age 11 (U11) levels were randomly assigned such that when the same clubs played each other twice in the same season, they played once with one referee and once with three referees. A total of 98 games were videotaped and subsequently coded to obtain four outcomes: collisions between players, aggressive fouls (involving physical player-to-player contact) called by the referee(s) on the field, aggressive fouls judged by trained coders, and injuries requiring adult attention or play stoppage. Results Poisson mixed model results suggest players in the 98 games committed fewer aggressive fouls, as identified independently by referees (rate ratio [RR] 0.58; 95% confidence interval [CI] 0.35–0.96) and by researchers (RR 0.67; 95% CI 0.50–0.90), when there were three referees versus one referee. Collisions (RR 0.98; 95% CI 0.86–1.12) and injury rates (RR 1.15; 95% CI 0.60–2.19) were similar across conditions. Conclusion When the same youth soccer clubs played with three referees rather than one, they committed fewer aggressive fouls. More intense supervision created better rule adherence. Injury rates were unchanged with increased supervision. Results raise questions concerning whether financial investment in additional referees on youth soccer fields yields safety benefits.

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Sensitivity of Neck Musculoskeletal Model Predictions to Variation in Intervertebral Kinematics

Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions ◽

10.1115/sbc2013-14841 ◽

2013 ◽

Author(s):

Derek D. Nevins ◽

Liying Zheng ◽

Anita N. Vasavada

Keyword(s):

Sagittal Plane ◽

Center Of Mass ◽

Chronic Neck Pain ◽

Neck Muscle ◽

Neck Extension ◽

In Vivo Measurement ◽

Biomechanical Models ◽

Neck Strength ◽

Flexion Strength

In-vivo measurement of loads and displacements in the head and neck is very difficult. Musculoskeletal biomechanical models are useful tools for investigating biomechanical phenomena in this system, but they require several assumptions and simplifications regarding tissue mechanical properties and intervertebral kinematics (IVK). In particular, IVK show considerable variation among subjects [1], and quantifying the influence of this variation on model estimates is important for the application of models toward understanding neck biomechanical function. Variation in IVK parameters may affect model estimates of neck strength (neck muscle moment, the product of muscle force and muscle moment arm), as well as the location of the head center of mass, which influences the gravitational load on the neck due to the weight of the head. The magnitude of gravitational load relative to neck extension strength, referred to here as fatiguability, is an estimate of demand on neck muscles and may be related to chronic neck pain induced by forward head postures [2]. The goal of this study was to quantify variation in model estimates of flexion strength, extension strength and fatigability over sagittal plane postures, due to variation in IVK.

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Risk of Secondary ACL Injury in Adolescents Prescribed Functional Bracing After ACL Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119879880 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711987988

Author(s):

Gabriel S. Perrone ◽

Kate E. Webster ◽

Chris Imbriaco ◽

Gabriela M. Portilla ◽

Amishi Vairagade ◽

...

Keyword(s):

Acl Reconstruction ◽

Case Series ◽

Acl Injury ◽

High Rate ◽

Control Group ◽

Acl Injuries ◽

Injury Rates ◽

Increased Risk ◽

Early Graft ◽

Retear Rate

Background: There is a high incidence of a secondary anterior cruciate ligament (ACL) injury in unbraced adolescent athletes. Little is known about the effect of functional bracing with regard to the risk of secondary ACL injuries among adolescents. Hypothesis: Our primary hypothesis was that adolescents would have a high rate of secondary ACL injury even with brace use. A secondary hypothesis was that the reinjury rate with brace use would be lower than that of a historical control group of unbraced patients. Study Design: Case series; Level of evidence, 4. Methods: A group of 219 patients (age <20 years at surgery) who underwent ACL reconstruction and were prescribed postoperative functional bracing during cutting and pivoting sports for 2 years after surgery completed a survey regarding reinjury to either knee. Rates of knee injuries following ACL reconstruction were calculated and compared with those reported in a similar unbraced cohort. The effect of demographic and anatomic factors on risk of secondary ACL injuries was also investigated. Results: The overall follow-up rate was 65% (142/219) at a mean 5.6 years after surgery. In the braced cohort, the overall graft retear rate was 10%, with the highest retear rates observed in male patients 17 years of age and younger (18%). The overall contralateral ACL injury and combined (graft or contralateral ACL) secondary injury rates were 13% and 23%, respectively, with female patients younger than 18 years having the highest contralateral and combined injury rates (17% and 26%, respectively). Younger age (odds ratio [OR], 0.70; P = .021), family history of ACL injury (OR, 2.81; P = .015), and higher lateral tibial slope (OR, 1.25; P = .016) were associated with increased risk of secondary knee injury in the braced cohort. Compared with the unbraced cohort, the braced cohort had a lower overall graft retear rate ( P = .028), a lower graft retear rate in patients younger than 18 years ( P = .012), lower early graft retear rate (within the first year after surgery) ( P = .011), and lower early graft retear rate in subjects younger than 18 years ( P = .003). Conclusion: Postoperative use of functional bracing can result in reduced risk of graft retear and no change in contralateral injury rates. Clinicians may want to consider the use of postoperative functional bracing in adolescent patients.

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