Background Cervical musculature function (strength, endurance, and proprioception) may be a modifiable risk factor for concussion in contact sports. The ability to enhance neck function and reduce concussive risk needs to be determined.

Objective To assess the efficacy of a training programme to enhance neck function and lower match concussion injury risk in rugby union players.

Design Repeated-measures intervention with control.

Setting Premiership rugby union players in Scotland during the 2018/19 season.

Patients (or Participants) Premiership players selected for Scotland Rugby academies (intervention group; INT; n = 30) or those with their clubs (control group; CON; n = 20).

Interventions (or Assessment of Risk Factors) A neck training programme was implemented twice per week during the 2018/19 season for INT, while CON performed no systematic neck training.

Main Outcome Measurements For both INT and CON neck strength (maximal voluntary contraction; MVC), endurance (exercise capacity; TTF) and proprioception pre- and post-season, and match concussion injury incidence were recorded.

Results Left and right cervical flexion MVC force and flexion TTF all significantly increased in the intervention group (p < 0.001), with no significant change in the control group. While there were increases in cervical flexion and extension MVC force in both groups from pre to post-season, there was a significantly greater increase amongst the intervention group (p < 0.05). Concussion incidence was lower in INT versus CON (INT: 7.7/1000 match hours; CON: 18.4/1000 match hours). However, this was not a significant alteration in risk (incidence rate ratio: 0.42; 95% CI: 0.08–2.1).

Conclusions The neck function programme increased cervical MVC force and flexion exercise capacity, beyond any changes induced by a season of rugby union. The intervention group also had a lower incidence of concussion across the season. This pilot study shows good promise and highlights the need for further investigation.