NeckCentric

Publications

Does Reduced Ball Inflation Pressure in Association Football Decrease Head Impact Kinematics? (England et al., 2025)¹

Abstract

Purpose

Apparent degeneration in brain health due to heading the football is amongst the most pressing and contentious health-related questions in sport (Keogh F, Pirks N (2024) “Pain was sickening”—Ex-players on heading fears. In: BBC). The purpose of this study was to thoroughly explore the effectiveness of reduced inflation pressure as an intervention to reduce head kinematics from a ball to head impact. The influence of impact location, head orientation, neck flexion angle and ball type on the intervention were experimentally investigated.

Method

A Hybrid III head and neck was impacted in frontal and oblique locations with two modern footballs that were projected using a bespoke launch device. Peak linear acceleration, peak angular velocity, peak angular acceleration and DAMAGE metrics were calculated for a total of 34 permutations of impact variables at two inflation pressures.

Results

Magnitude was decreased (82%) or unchanged (8%) for 90% of impacts with average magnitude changes between − 2 and − 12% across the four metrics. Findings indicated that decreased inflation pressure was a positive intervention towards decreasing kinematic magnitudes in most cases. This was especially true for linear acceleration, angular velocity and angular acceleration, where 100, 97 and 100% of impacts were reduced or unchanged, respectively.

Conclusions

Reduced inflation pressure was overall an effective mitigation to reduce the kinematic magnitude of heading in football based upon these four kinematic metrics despite 10% of impacts exhibiting an increase in kinematic magnitude. The DAMAGE predictor of MPS exhibited 12 out of 13 cases where magnitude increased demonstrating the capacity for decreased inflation pressure to result in increased kinematics for an angular response derived metric, indicating that reducing inflation pressure is not a universal solution. Nonetheless DAMAGE still saw a net decrease in magnitude across all impacts. Metric magnitude was found to be sensitive to head orientation, impact location and ball type, demonstrating the importance of the sensitivity analysis in this study. Two impacts were recommended to represent the worst-case ball to head impact, one in each nominal orientation. These locations contrasted with those commonly used in literature, a finding pertinent to future experimental design in football heading research

UEFA Medical Conference 2025 (Scholer et al., 2025)

Does body position influence isometric neck strength?

Background: Neck strength has been suggested as a possible modifiable risk factor for brain health during impacts. Higher neck strength values have been shown to reduce head accelerations during purposeful heading in football (Peek et al., 2022), but to date, there is no consensus on how to measure neck strength (Fownes-Walpole et al., 2025). The purpose of this study was to establish the influence of body position on isometric neck strength values.

Methods: A convenience sample of male (n=5) participants (20 – 27 years) were included in this pilot-based, observational cross-sectional study. Participants performed three maximal isometric contractions for flexion, extension, left-side flexion (LSF) and right-side flexion (RSF) in five testing positions (Quadruped, Lying, Seated hands holding onto a chair, Standing, Seated with arms across chest) conducted over two testing sessions on the Humac Norm (Cybex) isokinetic dynamometer. The highest peak torque values (in Newton-meter) for each test position and movement direction were collected and analysed using descriptive and percentage statistics.

Results: The quadruped position produced the highest mean peak torque values for flexion (102 Nm) and extension (141 Nm). Flexion in quadruped was 45% higher than in standing (56 Nm), and 16% higher than in lying (86 Nm). Extension in quadruped was 57% higher than in standing (60 Nm), and 50% higher compared to seated with arms across the chest (70 Nm). The smallest difference (20%) was found with extension in the seated with hands holding position (113 Nm). The mean peak torque value for LSF (115 Nm) was highest in the lying position. The greatest discrepancy (41%) was in LSF in seated with arms across the chest (68 Nm), followed by standing (39%, 70 Nm). The smallest difference (3%) was with the seated hands holding position (111 Nm). Mean peak torque for LSF and RSF were similar in lying (115 Nm and 110 Nm) and seated with hands holding (111 Nm and 117 Nm). Seated with hands holding produced the highest RSF mean peak torque (117 Nm) across all positions. The overall lowest mean peak torque values were found to occur in standing position, followed by seated with arms across chest. The latter displayed the most similar values across all movement directions.

Conclusion: The preliminary findings suggest that position may influence the ability to generate force at the neck with the least stable positions producing the lowest force values the significance of these findings is still to be determined. This has potential implications for the future recommendations for the analysis of neck strength. Further research is needed to understand how position impacts the activation of muscles within the cervical spine.

Between-Session Reliability of Field-Based Assessments of Isometric Neck Strength.(Oxford et al., 2024)

The reliability of the fixed-frame dynamometer for measuring isometric neck strength is established, but with limited field-based applications. This study aimed to establish the inter- and intra-session reliability of the peak force for neck flexors, extensors, and side flexors using the VALD ForceFrame and DynaMo and the force–time characteristics in the quadruped position (ForceFrame). Twenty-seven recreationally active males performed three repetitions of isometric neck flexion, extension, and side flexion over two sessions in random order using the VALD ForceFrame and DynaMo. Both devices demonstrated acceptable reliability, with the Forceframe ICC > 0.8 and CV% < 13.8% and the DynaMo ICC > 0.76 and CV% < 13.8%. No systematic or proportional differences were found using the Passing–Bablock procedure, and Bland–Altman analysis confirmed agreement across measures. Reliability was shown for right-side (ICC > 0.76) and left-side (ICC > 0.79) flexion and flexion (ICC > 0.75) across 50, 100, 150, and 200 ms. Statistical parametric mapping indicated no differences in ForceFrame-generated isometric force–time curves between sessions, though the CV was highest in the force development phase. The findings suggest that both tools can reliably assess neck strength, supporting their use in sports and clinical settings. However, assessment methods are not interchangeable, emphasising the need for standardised neck strength assessment approaches. 

Intra and Inter-Rater Reliability of a Novel Isometric Test of Neck Strength. (McBride et al., 2022)

There is no single, universally accepted method of measuring isometric neck strength to inform exercise prescription and injury risk prediction. This study aimed to establish the inter- and intra-rater reliability of a commercially available fixed frame dynamometer in measuring peak isometric neck strength. A convenience sample of male (n = 16) and female (n = 20) university students performed maximal isometric contractions for flexion (Flex), extension (Ext), left- (LSF) and right-side flexion (RSF) in a quadruped position over three sessions. The intra-rater reliability results were good-to-excellent for both males (ICC = 0.83–0.90) and females (ICC = 0.86–0.94) and acceptable (CV < 15%) across all directions for both males and females. The inter-rater reliability results were excellent (ICC = 0.96–0.97) and acceptable (CV < 11.1%) across all directions. Findings demonstrated a significant effect for sex (p ≤ 0.05): males were stronger in all four directions, and a significant effect for direction (p ≤ 0.05): Ext tested stronger (193 N) than Flex (176 N), LSF (130 N) and RSF (125 N). The findings show that the VALD fixed frame dynamometer can reliably assess isometric neck strength and can provides reference values for healthy males and females. 

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