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Health & Exercise Forum

Concussions in Football: Part 2 of 2

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Aug 29, 2016
Victoria Wrightson, SPT

Victoria Wrightson, SPT

Concussions in Football: Part 2 of 2

Guest Contributor: Victoria Wrightson, SPT

There is a heightened awareness of concussions in football due to the recent discovery of a degenerative brain disease found during the autopsies of professional football players now known as chronic traumatic encephalopathy, or CTE. The Mayo Clinic defines CTE as brain degeneration caused by repeated head trauma. Symptoms include difficulty thinking, impulsive behavior, depression, emotional instability, and substance abuse, to name a few, but the full list of symptoms remains unknown. With football season quickly approaching, it is important for coaches and parents to consider the safety of their players while at practice and during competition. Although the topic of concussion isn’t new, I think it is important to remind readers of what a concussion are the potential long-term effects of concussion, and what actions can be taken to keep athletes safe. Last week, in “Concussion Part 1” we discussed the symptoms and classification of concussions. This week we will discuss prevention of concussions in football.

Given the serious potential consequences of concussions and head impact, actions should be taken to prevent them (Table 1 Prevention of Concussion). Advances in technology are leading to better and safer helmet designs. Earlier this year, a Seattle-based company, VICIS, released a state-of-the-art helmet designed to better absorb head impact forces. This model, the ZERO1, differs from standard helmets in a few key ways. First, the outer shell of the ZERO1 is not hard, but rather a flexible plastic that slightly gives upon impact, then returns to its original form. Second, the ZERO1 helmet’s core is layered in columns, designed to slow forces that come from any direction. Finally, the inner shell of the helmet is made of memory foam, which forms to each player’s unique head shape. These revolutionary helmets will be tested this year by the University of Washington Huskies.

Actions can also be taken by coaches and players without having to spend money on high-tech helmets. Proper tackling technique should be taught by coaches, especially in young athletes. Emphasis should be placed on tackling with the shoulders, rather than head-first.

Studies have shown that strengthening the neck muscles may reduce player’s risk of head injury. Researchers at the Colorado School of Public Health and Nationwide Children’s Hospital found that neck strength predicts concussion risk regardless of the athlete’s gender or sport. They found that players with the weakest neck muscles suffered from the greatest number of concussions. Strong neck muscles can help slow the acceleration of the head during impact, and therefore lower the risk of traumatic brain injury. Exercises that target the neck muscles can easily be incorporated into practice. (Table 2 – Isometric Neck Strengthening Exercises).

In addition to technology, tackling technique, and neck strengthening, there is one more important action that needs to be taken in order to prevent concussion in football- limiting the amount of contact during practice. Research demonstrates that limiting full-contact practices reduces the number of concussions in football. For example, in 2012 the NFL placed limits on the number of full-contact practices. That year, the number of concussions during practices declined. Recently, the Division I Ivy League Conference football coaches made an executive decision: full-contact hitting practices will not be permitted during the regular season. In a recent article in Bleacher Report, Adam Kramer wrote a very compelling and informative piece entitled, “The Future of Football Practice – What a “no – tackle practice” looks, feels and sounds like.” In his article he describes the techniques developed by Dartmouth football coach Buddy Teevens, as he turned the team around from 0-10 season to Ivy League Champions utilizing a “no-tackle practice” approach. The team uses a “Mobile Virtual Player” (MVP) designed by Elliot Kastner, a Dartmouth engineering student and former football player. The virtual tackling dummy is controlled remotely by the coach to simulate and actual player. The team reduced their missed tackle rate by more than 50%. For more information, view the video, “The Dartmouth Way,” on YouTube.

THE BURNING QUESTION: If NCAA teams can do it, why can’t youth and high school football teams follow this example?

In conclusion, concussions are not only a serious problem in the short term, but they can also lead to adverse long-term consequences. With research showing that repetitive head trauma poses significant risk, one needs to take action to prevent concussions from happening.  Coaches, athletic trainers, athletic directors, school boards, parents and players would be well advised to incorporate a mandatory concussion prevention program such as the one described in part I and II of this column in order to prevent concussions in all athletes, especially football players. Prevention includes; purchasing proper equipment, teaching proper tackling techniques, implementing adequate fitness programs such as neck strengthening exercises and limiting full-contact sessions such as the program adopted by the College Football Division I Ivy League Conference. Let us begin the discussion on this important topic to raise the level of awareness toward change …you may be saving someone’s future!

Table 1: Prevention of Concussions

  • Equipment – ZERO1 Helmets made by the Seattle based company VICIS
  • Technique – Teach blocking and tackling techniques that promote using the shoulder instead of the head
  • Fitness/Training - Include exercises specifically targeted for the head and neck to improve neck size to protect the head (See Table 2 – Isometric Neck Exercises)
  • Limit Contact – Follow the lead of College Football Division 1 Ivy League Conference which limits full contact to game day. No full contact at practice one the season begins…Good enough for college – good enough for junior football and high school!


Table 2: Isometric Neck Strengthening Exercises

  • Shoulder Shrugs – Photo A: Stand with your arms at your side. Raise your shoulders upward towards your ears. (with or without weights)
  • Isometric Neck Flexion – Photo B: Place your fingers on your forehead. Gently press your forehead into your fingers without moving your neck.
  • Isometric Neck Extension – Photo C: Place your fingers on the back of your head. Gently press your head back into your fingers without moving your neck.
  • Isometric Side Bend – Photo D: Place your fingers on the side of your head. Gently tilt your head to the side, into your fingers without moving your neck. Do this on both sides.
  • Isometric Rotation – Photo E: Place your fingers on the temple of your head. Gently turn your head to one side, into your fingers without moving your head. Do this on both sides.


Guest Contributor: Victoria Wrightson, SPT, Temple University, Doctor of Physical Therapy Student 2018.  Victoria, a native of Scranton, PA, is an intern at Mackarey & Mackarey Physical Therapy Consultants, LLC.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.