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Analysis of head impact exposure and brain microstructure response in a season-long application of a jugular vein compression collar: a prospective, neuroimaging investigation in American football
  1. Gregory D Myer1,2,3,4,5,6,
  2. Weihong Yuan7,8,
  3. Kim D Barber Foss1,2,9,10,
  4. Staci Thomas1,2,
  5. David Smith1,
  6. James Leach11,
  7. Adam W Kiefer1,2,3,12,
  8. Chris Dicesare1,2,
  9. Janet Adams11,
  10. Paul J Gubanich1,3,
  11. Katie Kitchen1,2,
  12. Daniel K Schneider1,2,13,
  13. Daniel Braswell1,2,
  14. Darcy Krueger14,
  15. Mekibib Altaye15
  1. 1Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2Division of Sports Medicine, The SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
  4. 4Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  6. 6Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
  7. 7Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  8. 8College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  9. 9Division of Health Sciences, Department of Athletic Training, Mount St. Joseph University, Cincinnati, Ohio, USA
  10. 10Rocky Mountain University of Health Professions, Provo, Utah, USA
  11. 11Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  12. 12Department of Psychology, Center for Cognition, Action and Perception, University of Cincinnati, Cincinnati, Ohio, USA
  13. 13College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  14. 14Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  15. 15Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Gregory D Myer, Cincinnati Children's Hospital, 3333 Burnet Avenue; MLC 10001, Cincinnati, OH 45229, USA; Greg.Myer{at}


Background Historical approaches to protect the brain from outside the skull (eg, helmets and mouthpieces) have been ineffective in reducing internal injury to the brain that arises from energy absorption during sports-related collisions. We aimed to evaluate the effects of a neck collar, which applies gentle bilateral jugular vein compression, resulting in cerebral venous engorgement to reduce head impact energy absorption during collision. Specifically, we investigated the effect of collar wearing during head impact exposure on brain microstructure integrity following a competitive high school American football season.

Methods A prospective longitudinal controlled trial was employed to evaluate the effects of collar wearing (n=32) relative to controls (CTRL; n=30) during one competitive football season (age: 17.04±0.67 years). Impact exposure was collected using helmet sensors and white matter (WM) integrity was quantified based on diffusion tensor imaging (DTI) serving as the primary outcome.

Results With similar overall g-forces and total head impact exposure experienced in the two study groups during the season (p>0.05), significant preseason to postseason changes in mean diffusivity, axial diffusivity and radial diffusivity in the WM integrity were noted in the CTRL group (corrected p<0.05) but not in the collar group (p>0.05). The CTRL group demonstrated significantly larger preseason to postseason DTI change in multiple WM regions compared with the collar group (corrected p<0.05).

Discussion Reduced WM diffusivity alteration was noted in participants wearing a neck collar after a season of competitive football. Collar wearing may have provided a protective effect against brain microstructural changes after repetitive head impacts.

Trial registration number NCT02696200.

  • Concussion
  • Brain
  • Injury prevention
  • Blood
  • MRI

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