Sports-related concussions (SRC) occur due to biomechanical forces to the head or neck that can result in pathophysiological changes in the brain. The musculature of the cervical spine has been identified as one potential factor in reducing SRC risk as well as underlying sex differences in SRC rates. Recent research has demonstrated that linear and rotational head acceleration, as well as the magnitude of force, upon impact is influenced by cervical spine biomechanics. Increased neck strength and girth is associated with reduced linear and rotational head acceleration during impact. Past work has also shown that overall neck strength and girth are lower in athletes with SRC. Additionally, differences in cervical spine biomechanics are hypothesized as a critical factor underlying sex differences in SRC rates. Specifically, compared to males, females tend to have less neck strength and girth which is associated with increased linear and rotational head acceleration. Although our ability to detect SRC has greatly improved, our ability to prevent SRCs from occurring and decrease the severity of clinical outcomes post-injury is limited. However, we suggest, along with others, that cervical spine biomechanics is a modifiable factor in reducing SRC risk. We review the role of the cervical spine in reducing SRC risk, and how this differs dependent on sex. We discuss clinical considerations for the examination of the cervical spine and the potential clinical relevance for SRC prevention. Additionally, we provide suggestions for future research examining cervical spine properties as modifiable factors in reducing SRC risk.
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