Molly Fownes-Walpole

This qualitative study aimed to co-design and explore the feasibility, barriers, and facilitators of a neck-exercise training intervention aiming to reduce head acceleration events (HAEs) in men’s academy rugby league. A steering group of researchers and practitioners from five academy rugby league teams co-designed a neck-training programme (NExT-TaCKLE programme). The NExT-TaCKLE programme was designed to: give performance and medical practitioners exercises catering to different equipment availability; target neck musculature across flexion, extension, bilateral flexion and rotation; and progress from movement competency to perturbation focused training blocks. The NExT-TacCKLE programme was trialled for a six-week period in three teams. Semi-structured interviews were completed with a practitioner and player from each team to determine the feasibility of NExT-TacCKLE, including barriers and facilitators to implementation. Reflexive thematic analysis was used to analyse the interview data and generate themes. Data were then revisited and mapped to feasibility areas of interest and the capability, opportunity, motivation model for behaviour change (COM-B). Eight themes were generated during the reflexive thematic analysis. The programme showed good acceptability and demand, however, the implementation, integration and practicality were feasibility areas where the programme could be improved. Key barriers (e.g., equipment, coach-to-athlete ratio, practitioner experience) and facilitators (e.g., belief in the intervention effectiveness, perceived simple integration into existing setups) were identified. Working with practitioners, the NExT-TaCKLE programme was developed for implementation with academy rugby league players. This study can help inform future development of the NExT-TaCKLE and other neck-training programmes, as well as other injury prevention and implementation strategies. Future research is needed to evaluate the effectiveness of the programme to reduce HAEs.

Head acceleration events (HAEs) can potentially have adverse consequences for athlete brain health. In sports, in which head injuries have the highest incidence, identifying strategies to reduce HAE frequency and magnitude is a priority. Neck training is a potential strategy to mitigate against the magnitude of HAEs. This two-part study aimed to (1) systematically review the literature of neck training interventions in sport and (2) undertake an expert Delphi consensus on the best practices for neck training implementation to reduce HAEs in sport. Part I: a systematic search of four databases was undertaken from the earliest records to September 2024. The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines were followed, and a quality assessment was completed using a modified Downs and Black assessment tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation). Papers were eligible if they both (1) implemented a reproducible exercise intervention targeting the neck within collision, combat or motor sport, and (2) assessed outcomes relating to either: the physical profile of the neck; head/neck injury incidence; and/or HAEs. Part II: 18 international experts, with experience in research and/or applied practice of neck exercise training, concussion and/or HAEs, reviewed the part I findings before completing a three-round Delphi consensus process. Part I included 21 papers, highlighting the heterogeneity of existing interventions. Part II resulted in 57 statements coded into five categories: contextual factors (n=17), neck training periodisation (n=12), training adaptations (n=10), neck training content (n=15) and athlete adherence (n=3). This study presents recommendations for neck exercise training aiming to reduce HAEs in sport, supporting both practice and future research.

Neck strength is hypothesised to mitigate head/neck injury and head acceleration events. Studies often only assess maximal isometric neck strength in flexion, extension, and lateral flexion and few consider the criterion and ecological validity of the devices and protocols used. This study aimed to (1): evaluate the validity and reliability of a novel strength‐testing device (LINK), and (2) determine the reliability of a practical six‐way (flexion, extension, lateral flexion, rotation) neck‐testing protocol for peak force (PF) and rate of force development (RFD). LINK validity and reliability were assessed in two parts: (A) criterion validity and inter‐/intra‐LINK reliability for PF against Kistler force platforms; and (B) criterion validity for PF and RFD during an isometric mid‐thigh pull compared with the force platforms. Intra‐tester inter‐session reliability of the neck testing protocol was determined across two sessions. Reliability was assessed using intraclass correlation coefficients (ICC). All LINKs demonstrated excellent intra‐LINK reliability. Two LINKs showed agreement with the force platforms up to 606.8 N (mean bias: 10.6 [2.8–18.4] N and 10.7 [0.6–20.8] N) and excellent inter‐LINK reliability (ICC lower bound > 0.99). One LINK was removed from further analysis due to higher mean bias (23.7 [9.6–37.8] N). The six‐way protocol demonstrated moderate‐to‐excellent reliability for PF (ICC 0.83–0.95; 95% CI between 0.53–0.99), but not for RFD (ICC 0.41–0.94; −0.30 to 0.99). Meaningful detectable changes in neck strength ranged from 38.9 to 58.0 N. This study presents a valid, reliable method for assessing neck PF across six directions.