This blog post will touch on the importance of a strong and adaptable neck and it’s relationship with the eyes. We will round up with some anecdotes from my clinical experiences.
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Before delving into the topic at hand, it's important to note that the following blog post presents one particular interpretation of medical research related to neck management. Ongoing research efforts are actively working to enhance our comprehension of factors such as dosage, specific types of interventions, and the targeted demographic groups. In this blog post, we will focus specifically on the interpretation of this research as it pertains to the combat sports community.
The neck continues to be a key area in maintaining athlete availability and improving performance. When the neck is strong the connection between the body and head is stable [1, 2]. Observations in the space has lead to characteristics such as: neck circumference (thickness) and the head flexion and extensions ratios (the balance between the looking up and looking down head positions) as the primary characteristics behind good neck health. That is, these characteristics improves the athletes resistance to head knocks and other angular head accelerations [3]. Maintaining a balanced or symmetrical tension ratio between these two positions not only prevents head and neck injury, it promotes increases to the muscular size (hypertrophy) of the neck or circumference of the neck. These are but a few examples as to why a strong neck is a key outcome measure for combat sports athletes [4].
One way to influence this neck ratio is through resistant isometric or weighted concentric neck extensions and flexions [2]. This muscular endurance-based ratio has been correlated to a reduction of concussions and better prognosis (the expected rate of recovery) in patients that incur whiplash and concussion related disorders, with an observational study stating that with every pound (450 grams) of force exerted equals a 5% reduced chance of concussion injury [2, 5]. Additionally, patients experiencing low to moderate pain have been shown to demonstrate a coordination or motor-control deficiency in their neck and head movements [6]. It seems a disparity between this relationship can result in miss-firing connections between the head and body [7]. Until this system has been normalised some head and neck-based symptomatology is thought to remain [8].
When considering the neck, it is difficult to neglect the influence of the eyes. As mentioned previously, the neck and head work together to establish proper position. This position is based off the visual stimulus from the eyes. It is not uncommon for the first point of compensation shift to occur in the neck as the eyes always want to remain horizontal with the horizon [7]. Research into this eye, head and neck relationship has identified a 'vestibular/balance' change in cervical muscle activation in rotation after whiplash [9]. Re-correcting this through specific rotation-based gaze stabilisation exercises encourage the training of head and neck to move smoother with a visual point of focus (usually on a wall). This exercise is a great method to improve the 'proprioception/coordination' between the head, neck, and eyes. A variation of gaze stabilisation exercises with and without the use of laser is implemented in tandem with isometric neck exercises to restore the neck tension ratio. The gaze stabilisation component of the exercises is considered a vestibular exercise and is used clinically for dizziness, vertigo, and post-traumatic rehabilitation.
Finally, the rotational capacity for the head and neck is addressed through resistant rotation-based exercises [10]. The rotation movement primarily involves the group of muscles at the base of the skull known as the suboccipital muscles, These muscles reside in the upper neck vertebrae (see image 1: C0, C1, C2 & C3) and are responsible for the connection of the base of the head to the spine. The C0 – C1 vertebrae (the highest vertebrae that sits closest to the head) is responsible for up to 60%of all neck rotation [11]. If this area becomes sensitised to the degree where it emits pain, its function of rotation can become inhibited and painful.
Anecdotally as an exercise based Chiropractor I utilise these exercises as they become staples in the strength phase, or the later stage of neck pain management i.e., when pain isn’t as intense and small neck movements are not painful. Without a graded exercise approach it is difficult for symptoms to dissipate and remain resolved without needing to continually seek hands on treatment. In saying this, exercise given to a neck that is ‘stiff’, may be ineffective due to locally spasmed muscles restricting joint articulation/movement at a joint. These joint tension needs to be addressed first otherwise exercise won’t be as effective. This 'stiffness' can be eliminated by many means; with the utilisation of two methods used at the CombatSportChiro clinic. The first includes techniques from the Watsons Headache Approach whereby specific low-dose massage and mobilisation is applied to this ‘sub occipital’ muscle group. This treatment approach is useful in early stages of whiplash or concussion management where the body is still in a relatively high fight or flight state or academically known as ‘high sympathetic tone’ [12].
Alternatively, if the tension remains, and all contra-indications have been eliminated, and psychologically the patient is comfortable with the idea of manipulation and joint tightness is still present an adjustment/manipulation emerges as an appropriate treatment type. Whilst not as gentle as the Watsons approach, a manipulation of the neck is one of the highest biomechanical doses of tension-relieving-force that can affect this ‘stiff’ point through localised stretch and relief. This can return normal proprioception, reduce pain and is safe within the guidelines proposed by the grade 1 and grade 2 neck pain scores by Chaibi etal, 2019 [13]. Over the course of treatment these approaches, provided consent is consistent, often alternates with eventual bias placed on the exercise therapies.
It should be mentioned, if any contraindications or red flags are identified in the history and physical exam a referral to appropriate specialist is organised immediately. If any treatment is sort, ensure it is conducted by a qualified professional.
If you have any questions on the neck don’t hesitate to contact myself at alex@combatsportschiro.com.
Cheers,
Alex
1. Elliott J, Heron N, Versteegh T, Gilchrist IA, Webb M, Archbold P, Hart ND, Peek K. Injury reduction programs for reducing the incidence of sport-related head and neck injuries including concussion: A systematic review. Sports Medicine. 2021;51(11):2373-88.
2. Daly E, Pearce AJ, Ryan L. 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? Journal of Functional Morphology and Kinesiology. 2021;6(1):8.
3. Dezman ZD, Ledet EH, Kerr HA. Neck strength imbalance correlates with increased head acceleration in soccer heading. Sports Health. 2013;5(4):320-6.
4. Zabihhosseinian M, Holmes MW, Ferguson B, Murphy B. Neck muscle fatigue alters the cervical flexion relaxation ratio insub-clinical neck pain patients. Clinical Biomechanics. 2015;30(5):397-404.
5. Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, Cantu RC. Neck strength: a protective factor reducing risk for concussion in high school sports. The Journal of Primary Prevention.2014;35(5):309-19.
6. Woodhouse A, Vasseljen O. Altered motor control patterns in whiplash and chronic neck pain. BioMed Central Musculoskeletal Disorders.2008;9(1):1-0.
7. Honda J, Chang SH, Kim K. The effects of vision training, neck musculature strength, and reaction time on concussions in an athletic population. Journal of Exercise Rehabilitation. 2018;14(5):706.
8. Meisingset I, Stensdotter AK, Woodhouse A, Vasseljen O. Neck motion, motor control, pain and disability: A longitudinal study of associations in neck pain patients in physiotherapy treatment. Manual therapy. 2016;22:94-100.
9. Bexander CS, Hodges PW. Cervical rotator muscle activity with eye movement at different speeds is distorted in whiplash. Physical Medicine and Rehabilitation Journal. 2019;11(9):944-53.
10. Sung YH. Upper cervical spine dysfunction and dizziness. Journal of Exercise Rehabilitation. 2020;16(5):385.
11. Anderst WJ, Donaldson III WF, Lee JY, Kang JD. Cervical motion segment contributions to head motion during flexion\extension, lateral bending, and axial rotation. The Spine Journal. 2015;15(12):2538-43.
12. Pertab JL, Merkley TL, Cramond AJ, Cramond K, Paxton H, Wu T. Concussion and the autonomic nervous system: An introduction to the field and the results of a systematic review. NeuroRehabilitation.2018;42(4):397-427.
13. Chaibi A, Russell MB. A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Annals of Medicine. 2019;51(2):118-27.
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This touches on some of the key questions around sleep. What is it? how much do I need? What are the benefits of good sleep hygiene. Join us as we delve into the key concepts of health.
Based in Sydney Australia, my goal is to provide high quality information about boxing injuries, chiropractic, and academia to the boxing and wider sporting communities.
