These days, more and more means are being deployed to prevent sports injuries. In field hockey, several strategies were successful, while others failed to deliver the expected results. Among the misses are various pieces of equipment designed to reduce the risk of concussion. As seen in a previous article, many companies claim to offer “concussion-proof” helmets to their customers when in fact they are not. Even mouthguards have a questionable impact on concussion prevention (5-6-7-8). The mixed effect of these two tools is perhaps due to the fact that they do not directly prevent the movement of the brain within the skull. At least, that’s what Q30 Innovation intends to do with their new product, the Q-Collar.
The idea behind this new technology is that there is a 30% lower risk of concussion when sport is practiced at altitude (1). The increase in intracranial pressure at altitude is thought to lead to a reduction in intracranial space, thus reducing the force and speed at which the brain comes into contact with the skull walls during impact.
The C-shaped collar is designed to apply gentle pressure on the external jugular veins of the neck to increase blood volume in the skull and reduce empty spaces. In this way, during impacts, the movement of the brain in the skull could be reduced. What’s more, as the collar applies a constant low pressure, the athlete would have this extra protection whether or not he was ready to receive a blow.
Two recent studies point to interesting results for the Q-Collar. One was field hockey (4), while the other was soccer (3). In both cases, the comparison of a group wearing the Q-collar with a control group playing at the same level suggests that wearing the collar reduces the impact of repeated hits on the brain. Diffusion magnetic resonance (DTI) was used in pre-season and post-season to demonstrate differences in white matter diffusions in the brains of players who had not worn the collar compared with players who had. This innovative imaging technique has the potential to identify concussions, but would also be useful for measuring the impact of sub-concussive blows on the brain’s white matter (9-10).
While these preliminary results are interesting, we must remain cautious about the real impact of this technology on the incidence of concussions and the long-term repercussions that repeated insults to the brain can have. The involvement of David Smith, the inventor of the Q-Collar, in both research projects raises its share of questions. He and other employees have a financial interest in the product. In fact, Mr. Smith was also at the head of the study into the reduced incidence of concussions at altitude, which formed the basis of the theory behind his invention. However, the only systematic review on the subject indicates that this difference in concussion incidence is not significant (2). In short, it would be desirable for other groups of researchers to look into the matter to validate the product’s benefits.
It should be noted that in both Q-collar studies, some participants refused to wear the necklace for a variety of reasons. Some athletes claimed that the collar irritated their neck, caused pressure in the head, mild nausea and made it difficult to turn their head. The complaints seemed few and far between, but they’re not surprising considering that many field hockey players are bothered by a simple neck protector.
All in all, it’s an interesting concept that needs to be explored further. The theory behind the product is interesting, and it suggests a solution from a different angle. Despite very promising results, caution is called for regarding the direct impact of its use on reducing the incidence of concussions and the long-term repercussions of repeated impacts on the brain. The positive impact that this tool could have in no way replaces the importance of education, the adoption of behaviours that promote good sportsmanship, and concussion prevention regulations in sport.
Written by Maxime Provencher, M. Physiotherapy
References :
1. Smith, D.W. & al. Altitude Modulates Concussion Incidence; Implications for Optimizing Brain Compliance to Prevent Brain Injury in Athletes. The Orthopaedic Journal of Sports Medicine, 2013, 1(6).
2. Zavorksy, G.S. & Smoliga, S.M. Risk of Concussion for Athletes in Contact Sports at Higher Altitude vs at Sea Level: A Meta-analysis. JAMA Neurology Published online September 6, 2016.
3. Myer GD, Yuan W, Barber Foss KD, & al.. 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 soccer. Br J Sports Med Published Online First: [15 juin 2016].
4. Myer GD, Yuan W, Barber Foss KD, Smith D, Altaye M, Reches A, Leach J, Kiefer AW, Khoury JC, Weiss M, Thomas S, Dicesare C, Adams J, Gubanich PJ, Geva A, Clark JF, Meehan WP III, Mihalik JP and Krueger D (2016) The Effects of External Jugular Compression Applied during Head Impact Exposure on Longitudinal Changes in Brain Neuroanatomical and Neurophysiological Biomarkers: A Preliminary Investigation. Front. Neurol. 7:74.
5. Cusimano MD, Nassiri F, Chang Y. The effectiveness of interventions to reduce neurological injuries in rugby union: a systematic review. Neurosurgery. 2010;67(5):1404-18.
6. Benson BW, Hamilton GM, Meeuwisse WH, McCrory P, Dvorak J. Is protective equipment useful in preventing concussion? A systematic review of the literature. Br J Sports Med. 2009;43: 56-67.
7. Knapik JJ, Marshall SW, Lee RB, Darakjy SS, Jones SB, Mitchener TA, et al. Mouthguards in sport activities: history, physical properties and injury prevention effectiveness. Sports Med. 2007;37(2):117-44.
8. Winters J, DeMont R. Role of mouthguards in reducing mild traumatic brain injury/concussion incidence in high school soccer athletes. Gen Dent. 2014;62(3):34-8.
9.Bahrami & al. Subconcussive Head Impact Exposure and White Matter Tract Changes over a Single Season of YouthFootball. Radiology. 2016 Dec;281(3):919-926.
10. Murugavel M & al. A Longitudinal Diffusion Tensor Imaging Study Assessing White Matter Fiber Tracts after Sports-Related Concussion Journal of Neurotrauma. November 2014, 31(22): 1860-1871.
