The effects of a concussion, perhaps contrary to popular belief, are brought on more by a disruption of the inner workings of the brain than by physical damage to the organ.
When the brain moves inside the skull, neurons become twisted and stretched, and subsequent chemical reactions inhibit the brain from running at full capacity.
Concussion experts at UPMC refer to this as an "energy crisis," where the brain needs more energy than usual to carry out tasks but receives less blood flow.
So it doesn't necessarily take a crushing hit to the head to lead to an injury -- any blow to the body that transfers force to the head and jiggles the brain can lead to a concussion.
With this knowledge in mind and new research in the field, the UPMC Center for Sports Medicine and Community College of Allegheny County campuses have opened their doors to dozens of local youth hockey players to get them on the latest trend in concussion reduction: neck strengthening regimens.
"It doesn't necessarily have to be a hit to the head, it's just that shaking, that movement of the brain inside the skull," said Cara Troutman-Enseki, co-coordinator of exertion training at UPMC who works solely with concussion patients. "And that's where the neck strength comes into play; it's going to limit the forces that cause that shaking. It's not going to be as intense, so you might not get the concussion."
Through Heads Up Pittsburgh and the Pittsburgh Penguins Foundation, the athletes in the program are provided free neurocognitive baseline testing and a neck strengthening kit.
Most parents and athletes who participated in the first event understood the basics: Baseline testing is a measure of cognitive function taken when the athlete is healthy to be used as a reference point if a brain injury is ever suspected. Neck strengthening means stronger muscles, which equal more resistance, which can mean less jarring of the head.
Skeptics were reassured by trainers at the event who offered data from a study presented in February at the Youth Sports Safety Summit, which found that the odds of concussion fell by 5 percent with every pound of neck strength increase.
Testing began June 17 for local hockey players ages 10-14 and will open to all athletes July 15. Athletes of other ages can take a test for $25, and neck strengthening kits will be distributed until they're gone.
Worth a try
Trainers at UPMC were concerned when they received calls from professional teams asking if attaching a dumbbell to a player's head was the best way to strengthen neck muscles.
Concerned about the compressive forces that could put on the neck, UPMC looked for a better alternative. The kits given to young athletes at the event utilize resistance bands that can be connected to a head strap, which is provided.
The neck strengthening regimen is an eight-week process that is completed at home. The exercises, broken into three phases, begin with basic extension, flexion and rotation movements and get progressively more complex.
All it takes to do the exercises is the kit and a door. Wearing the head strap, the child clips the resistance bands into a ring on the strap and closes the band's handle into a door.
With the anchor in place, the child is ready to do a set of exercises. The head strap can be put on in any direction to target whichever muscles the regimen calls for.
Most parents said their children didn't give them a hard time about coming. Some have been scared straight.
"My older son had three concussions. He had to leave the sport because he had too many concussions in a short period of time," said Bob Silverman, who brought his younger son, Jonah, a peewee player in the Mt. Lebanon Hornets organization.
"So for my younger son -- much to my wife's concern, and mine too, for that matter -- we figure at least we can do everything we can to make darn sure we're educated and that we have a good baseline.
"He watched his brother go through it," Silverman added. "So it was sort of, 'If you want to play hockey, this is what you're going to do.' "
Marianne Kinsey said her son, Robert, who plays for the Pittsburgh Huskies Under-16 team, has had two concussions playing hockey. So going to UPMC this week wasn't a fight.
"Oh no, he wants to come," Kinsey said. "He knows. His grades, his health are important."
Evolving field of study
The brain is separated from the skull by a three-layered tissue called the meninges, which is not more than a few millimeters thick. It cushions the brain in daily activity but can only do so much in collisions.
"Because there is that layer of meninges, what happens is the brain moves like an egg yolk in an eggshell would," UPMC neuropsychologist Jonathan French said. "That causes the neurons inside the brain to stretch out just a tiny bit."
That stretching of the neurons is what leads to the chemical reactions, he said.
"When they do, potassium starts to leak out of the cell, calcium starts to leak inside the cell, and when that happens, it causes this 'neurometabolic storm,' we say. What that really leads to is an energy crisis. The brain needs more energy to do things ... [but] the brain is starving of energy.
"So concussions are more neurometabolic rather than structural. Structural would be a big bleed inside the brain ... this is more of the neurons stretching out causing the brain not to function as efficiently."
So while the neck strengthening exercises do all they can to help keep those neurons in place after collisions and falls, one question that remains at UPMC is how far the program can go in concussion prevention. If the risk of concussion is decreased by 5 percent by every pound of neck strength added, there must be a point of diminishing return somewhere.
But it is not yet known where that point is. The young athletes in the program had their neck strengths tested before receiving the kits and will have the opportunity to be tested again at the conclusion. UPMC will look at the data to see what can be learned in the continually evolving field of concussion study.
But until then, parents of youth hockey players are glad to be on the leading edge of research and safety for their children.
"We owe a big thank you to the Penguins and UPMC," Silverman said. "I really don't think too many cities offer this. It's pretty remarkable."
Nick Veronica: email@example.com and Twitter @NickVeronica.