Both the NFL and the NHL are in the midst of a concussion crisis, highlighted by the suffering of long retired players, as well as those that have recently left their sports. However, despite increased awareness over the past several years, current generations of athletes from traditional stick and ball games may also have a frightening future of chronic traumatic encephalopathy (CTE) ahead of them.

And the danger isn’t just in sports like football and hockey. Centuries of boxers have also suffered short and long term consequences from blows to he head. When it comes to MMA (and the UFC’s viability as a mainstream sport franchise) the concussion-question is a ticking time bomb.

One man hoping to get ahead of an MMA concussion crisis – by increasing fighters’ abilities to reduce concussive blows – is Dr. Beau Hightower, Director of Sports Medicine for Jackson-Wink MMA Academy in Albuquerque, NM. He’s a doctor of naprapathic and chiropractic medicine with a Masters in exercise science and Bachelors in biology, anatomy, and health and wellness.

Dr. Hightower describes himself as the ‘gateway’ to all kinds of medical care for Jackson-Wink’s star-studded roster of fighters; which includes Jon Jones, Holly Holm, Alistair Overeem, Carlos Condit, Diego Sanchez, Andrei Arlovski, and Donald Cerrone, to name a few. Dr. Hightower’s team includes physical therapists, chiropractors, napropatic doctors, strength and conditioning coaches, and a house nutritionist.

“We just basically try and get ahead of everything in MMA to try and make it a one stop shop here,” Dr. Hightower told Bloody Elbow.

In trying to stay ‘ahead of the game’ Dr. Hightower and his team are always on the look out for new information that can be applied to improve the wellbeing of the dozens of fighters they are responsible for. In December Dr. Hightower read What Makes an Iron Chin? on BloodyElbow.com.

That article featured an interview with highly respected neurosurgeon Dr. Charles Tator, head of the Canadian Concussion Centre at Toronto Western Hospital. When speaking to Bloody Elbow, Dr. Tator explained some of the science of concussions and ran through the various factors which can affect an individual’s susceptibility to being knocked unconscious through impact to the head.

According to Dr. Tator, not all brains are created equal. Some are hardier than others and can withstand greater impacts before suffering a concussion. Science is yet to discover why this is the case. But, along with this invisible physiological factor, Dr. Tator did identify something else that could greatly affect an individual’s chances of receiving a concussion: neck muscles.

Much more important than the density of a skull or shape of a jaw, strong neck muscles are extremely powerful weapons against concussions. Strong muscles in the neck – tensed appropriately prior to impact (tucking the chin) – make it less likely for an individual’s head to be sent into violent motion as the result of a blow. The movement of a person’s head after a punch, kick, etc. is what causes the brain to jiggle within the skull, which in turns creates a concussion. That jiggling is known as ‘rotational acceleration’ and is accompanied by both long, short, or tiny lapses of consciousness. The process also releases a protein known as p-Tau. It’s the build up of p-Tau that leads to long-term symptoms of CTE such as depression, dementia, and suicidality.

On reading the interview with Dr. Tator, Dr. Hightower – who knows concussions all too well from five years of playing college football – decided he and his team needed to create a program to strengthen their clients’ necks with hopes of limiting head trauma. “Dr. Carlos Gamero, who is one of our physical therapists, came up with the meat and the potatoes of program. Dr. Gamero and Chad Smith, who is the wrestling coach here, have been implementing the program. Just making sure that people are doing what they're supposed to as far as protecting their neck and just keeping the neck as strong as they can.”

Dr. Hightower also explained that, in addition to preventing concussions, strengthening athletes’ necks has a number of benefits. “The neck muscles obviously protect a lot of important structures,” he said. “Not only the skull itself, but the spinal canal, the esophagus, the larynx, so if we don't have any stability in the cervical spine we're at risk for hemiplegia, quadriplegia, all sorts of spinal cord injuries and neurological injuries as well.

“So if your neck isn't strong enough and you're getting grappled and you're put in a Thai clinch, the odds of herniating a disc are much higher if your muscles aren't capable of resisting that force. Once the force gets past the muscles, it goes onto the ligaments, and the disks. A herniated disk can lead to neurological damage, lack of hand strength, and severe pain which can often lead to surgery.”

Part of Dr. Hightower’s neck protection program is fostering good habits in training. Many fighters, coaches, and camps are decreasing the amount of hard sparring they do. Dr. Hightower says Jackson-Wink is no different, with an increased focus on bigger gloves being a particular desire of gym co-founder Mike Winkeljohn. However, not all concussions (or neck injuries) happen in sparring. And Dr. Hightower argues that some of the worst head/neck injuries can actually occur on the wrestling mat.

On a mat crowded with wrestlers, the chances of two or more men and women crashing into each other is ever-present. Think of the frightening collisions that happen in baseball when two outfielders try to catch the same ball and don’t see each other before it is too late. It’s why, as Dr. Hightower explained, making sure wrestlers have enough room on the mat is taken seriously at Jackson-Wink.

When it comes to maintaining healthy necks, wrestlers pose another problem for Dr. Hightower. According to him, people who have wrestled for a long time may have already done a great deal of damage to their necks. “The head is not designed to be a weight bearing surface,” he said - referring to how often wrestlers bridge, using their heads as fulcrums and pivot points.

“Cervical discs aren't designed to hold your whole body weight so when you put your head on the ground, it's not really a good thing. You're going to grind away the set joints, you're going to get arthritis, you're gonna see degeneration. And then you’re going to absorb more damage to the head.”

Outside of best training practices for fighters during sparring and wrestling, Dr. Hightower’s team has developed a range of “open ended neck exercises, both with and without resistance” to strengthen neck muscles. “So we are doing yesses and nos, and lateral bending, basically trying to get these guys to be ready to handle a double leg takedown or a thai clinch and hopefully, hypothetically, to be able to take a punch better as well.”

Yesses and nos are basic movements where you either nod your head up and down, or turn it side to side. “We're not using resistance with those movements,” cautioned Dr. Hightower, who advocates that fighters – or anyone else who wants a stronger neck – practice free and controlled head movements on a regular basis. “These are set joints in the neck and we don't want cause damage while we're trying to strengthen.”

Also in program are exercises that can utilize weights, resistance bands (namely TheraBand products), and some weighted headgear. However, Dr. Hightower cautioned against the use of weights tied to headgear. “I generally don't like those long leather variations because the force gets transferred to other places. I'd rather someone had more control over the weights.”

Dr. Hightower said that some of these neck exercises are accomplished by simply holding a weight in front of your head and then performing the movement (making sure not to give your head and neck total responsibility for the weight). Although, Dr. Hightower admitted that his most preferred type of exercises are isometric motions; where the athletes use their own hands for resistance. An example of an isometric neck exercise is nodding your head up and down while applying slight pressure to the forehead with your palms.

The exercises and movements described above are designed to make neck muscles bigger and stronger. Dr. Tator in Toronto has instituted similar programs with hockey players. However, Dr. Hightower stressed that there must be a balance between neck strength and flexibility. “We have to have strong neck muscles, but we have to have a mobile neck as well. We don't want our clients to not be able to move their head, so we have to try and balance that strengthening with some myofascial release.” Myofascial release therapy involves mostly hand-applied pressure targeted at connective tissue.

The importance of neck muscles when it comes to preventing injuries, and especially head trauma, may have come as a surprise to watchers of the sport. Dr. Hightower claimed the same was true for some of the fighters he and his team have been attending to. “Some of our fighters, I think stay ahead of the game. They read quite a bit, so a few of the guys already had their own programs in place for the neck, but it was a big surprise for some others.

“Some of the folks – who rely on the old school methods – they are surprised, but once we start talking about long term brain trauma, generally every single fighters' ears prick up because they understand the consequences,” continued Dr. Hightower. “They don't want to be vegetables when they grow old, so if we can give them any kind of way to cut that off at the pass, whether it's strengthening the neck muscles, or proper nutrition or sparring less, whatever else we can do to help them with that. Generally speaking, they are pretty receptive to it. You get some hard headed folks too who just want to go fight. Some of those folks we're just not getting through to, but there's a lot of people we are getting through to.”

According to Dr. Hightower, the fighters who have bought into the importance of neck training have given the team positive feedback about how they feel in training and in actual fights. “Whether it be psychosomatic or not, we've had a fairly positive reaction to it. I think generally speaking most of them understand that the stronger they are, the better they are going to be.”

Those reviews are welcomed by Dr. Hightower, who is hopeful that other MMA gyms will consider instituting their own programs designed to strengthen fighters’ necks. He’s also keen for fighters themselves to recognize the importance of neck muscles and what they could mean to both their immediate performance and their quality of life past their fighting days. “When it comes to the neck, it tends to be overlooked because fighters are doing so many other things within their strength and conditioning programs or jiu jitsu, or striking classes, or boxing or hitting pads. These guys and gals are working out three or four times a day - it's easy to neglect some small muscles like that, but it can also have a major impact on how the fight goes and as well as potential long term damage.”