There are few better brains to pick on the subject of prep sports injuries than the one residing in Dawn Comstock's head. Eight years ago, the injury epidemiologist joined the faculty at Ohio State University and established as her first major research initiative the National High School Sports-Related Injury Surveillance System - an NFHS-endorsed online tool that hundreds of certified athletic trainers across the country use weekly to report injury exposure and incidents, logging up to 300 distinct variables for each injury in the process.

There are few better brains to pick on the subject of prep sports injuries than the one residing in Dawn Comstock's head. Eight years ago, the injury epidemiologist joined the faculty at Ohio State University and established as her first major research initiative the National High School Sports-Related Injury Surveillance System - an NFHS-endorsed online tool that hundreds of certified athletic trainers across the country use weekly to report injury exposure and incidents, logging up to 300 distinct variables for each injury in the process. It was the first and remains the only database of its kind. In February, Comstock presented findings from a subset of research that she calls an "exciting" first step in linking neck strength to concussion risk and, potentially, prevention. Data collected on 6,704 student-athletes in six sports (boys' and girls' soccer, basketball and lacrosse) indicates that for every single pound of improved neck strength, an individual reduces his or her concussion risk by 5 percent. Paul Steinbach asked Comstock, who settled into an associate professor position at the University of Colorado at Denver that same month, to explain her work and its head-turning results.

Q: Why are your research findings significant?
A: We're excited about this because very little of the money that has been going into concussion research has been going into concussion prevention. This represents one of the first primary prevention mechanisms identified that is completely within the student-athlete's control.

Q: Had no one made the head-neck connection before?
A: There have been a few people who said athletes with bobbleheads on long skinny necks are at increased risk of injury, but it hasn't really been formally tested. Within the national surveillance system, we have the opportunity to nest some sub-research studies now, and that's what we did with this. We enrolled a small sample of schools, about 50, and the athletic trainers took anthropometric measurements at the beginning of the sports season. They measured head circumference, neck circumference, neck length and neck strength in four different directions.

Q: How does neck strength protect the athlete?
A: Your neck acts like a shock absorber. As the head rocks back and forth, it's also twisting a little bit on the brain stem, and it's those accelerative and rotational forces as the brain is impacting inside the skull that are really what's causing these concussions. A stronger neck means you're reducing those accelerative and rotational forces. We know from our years of injury surveillance that the number-one mechanism for concussion injury is athlete-to-athlete contact. So we also ask the question, "Did the athlete see the blow coming?" And we find that for the athletes who saw the blow coming, the athletes who have a chance to activate their neck muscles, their concussions seem to be a little less severe.

Q: What strengthening methods do you recommend?
A: We need to do more research to find out what is the most effective way for athletes to strengthen their necks. I would rather see athletes doing self-plyometics, putting their own hand against their own head and providing their own resistance, just because there's less risk of injury than with partnered plyometrics or headforms with weights. Honestly, nothing is going to be the ultimate panacea to prevent all concussions. You could have the strongest neck in the world and it would never ensure 100 percent that you aren't going to get a concussion. That said, if we can reduce the risk with something so simple, why not do it?

Paul Steinbach is Senior Editor of Athletic Business.
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Jaw protection is also essential Boxers know the easiest way to knock out an opponent or in other words "give him a concussion" is to hit him on the jaw driving the jaw bone up into the TMJ and base of the Brain. The thinnest bone in the body known as the Glenoid fosa separates the end of the jaw bone and the brain. It's about the thickness of a potato chip and most athletes who have competed in contact sports have damage in this area. Boxers know the easiest way to knock out an opponent or in other words "give him a concussion" is to hit him on the jaw driving the jaw bone up into the TMJ and base of the Brain. The thinnest bone in the body known as the Glenoid fosa separates the end of the jaw bone and the brain. It's about the thickness of a potato chip and most athletes who have competed in contact sports have damage in this area.
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I would like to ask Dawn Comstock what she thinks about the HaloStrong device for training the neck in a rotational & functional pattern?
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I have dealt with concussions in pro hockey, football and soccer and am intrigued by the possibility of decreasing concussions and the severity with a stronger neck. In my experience, many concussions occur without contact to the head. Being able to decelerate the head better makes some sense. Some of the recent research has been pretty positive. Neck strengthening is nothing new, but the use of the Halo, I feel is much more functional than the old single plane exercises. We recently began using it and I look forward to seeing how our athletes do with it.
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Advancements in the development of EMG evaluation tools used to determine neuro path deficiencies in the head and neck have shown great results. Orthopedic imbalances of the head, neck, temporo mandibular joint and jaw are crucial in precise fitting these Tmd appliances. Each individual has their own physiological make up, particularly those with Temporal mandibular joint dysfunction often found in those who are post orthodontic. Store bought mouth guards, arbitrarily position the condyle in relation to the skull and could effect the trigeminal region adversely. While these subjects may not be suffering major concussions, the micro trauma recognized by the U.S. Army, is a major concern and may be linked to CTE. It, according to Cantu, in the medial temporal lobe, just millimeters from the Tmj. Creating a new category for this type of injury, micro trauma, will be key in moving forward in helping diagnose these specific symptoms in athletes. One Harvard expert states, these issues may be the cause of large neck muscle Asymmetry, creating a greater chance of whiplash. Upper extremity asymmetry can be easily screened for in preseason evaluations and should be part of any program. Whiplash, lower brain stem trauma are completely different injuries than cou contra cou or classic concussion. Until these injuries, all with different symptoms and physiological markers are broken into separate categories, the concussion conundrum will remain a malaise, because that is what we have now.