Efficacy of exercise interventions on prevention of sport-related concussion and related outcomes: a systematic review and meta-analysis.

Concussion in sport remains a serious concern, and researchers have been looking for ways to reduce risk through exercise, whether by strengthening the neck or by using warm-up drills designed to improve movement control. This systematic review and meta-analysis pooled evidence from 26 studies to ask whether such exercise programmes actually reduce concussion occurrence, lessen the forces the head experiences during impact, or improve neck strength. The clearest finding was that resistance training increased isometric neck strength, with a large effect size and evidence rated as high quality. But whether stronger necks translate into fewer concussions was not tested in any of the included studies.

Neuromuscular warm-up programmes showed no statistically significant effect on concussion incidence, and resistance training showed no significant effect on the linear or rotational forces the head experiences, though this evidence was rated low to very low quality. Reporting of the exercise programmes themselves was often incomplete, limiting how confidently these programmes could be reproduced or compared.

If you or someone you care about plays a contact sport, you may have heard that neck-strengthening or warm-up exercises could help prevent concussions. This review pooled findings from 26 studies to see whether that idea holds up, looking at actual concussion rates, the forces the head absorbs during impact, and neck strength itself. The strongest result was that resistance training programmes made necks measurably stronger.

However, no study in this review actually tested whether that stronger neck led to fewer concussions, so that link remains unknown. Separately, programmes involving movement and warm-up drills did not show a statistically significant reduction in concussion rates, and neck-strengthening exercises did not significantly change the forces on the head during impact, though this evidence was considered weaker. Overall, the exercises studied clearly work on strength, but there isn't yet solid evidence connecting that strength gain to actual concussion prevention.

The studies also weren't always described in enough detail to know exactly what was done, which makes it harder to draw firm conclusions.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This review pooled 26 randomised, cluster-randomised, or quasi-experimental trials assessing exercise interventions against concussion incidence, linear and rotational head acceleration, and isometric neck strength. Resistance training produced a large, statistically significant increase in isometric neck strength (SMD 0.85, 95% CI 0.57 to 1.13), with this evidence rated high quality, the strongest finding in the review. However, no included study evaluated whether resistance training's neck-strength gains translated into reduced concussion incidence, leaving that causal chain unestablished.

Neuromuscular warm-up programmes showed a non-significant risk ratio for concussion incidence (0.69, 95% CI 0.39 to 1.23), rated low quality, and resistance training showed non-significant effects on linear head acceleration (SMD -0.43, 95% CI -1.26 to 0.40, very low quality) and rotational acceleration (SMD 0.08, 95% CI -0.61 to 0.77, low quality). CERT scores for intervention reporting ranged from 4 to 16 out of 19 (median 11.5, IQR 9-13), indicating substantial variability and generally insufficient detail for replication. Given the certainty ratings and absence of direct incidence data for resistance training, clinicians should interpret these findings as demonstrating a biomechanical strength effect without established downstream injury-prevention benefit.