High School Sports-related Concussion and the Effect of a Jugular Vein Compression Collar: A Prospective Longitudinal Investigation of Neuroimaging and Neurofunctional Outcomes
Yuan W, Diekfuss JA, Barber Foss KD, Dudley J, Leach J, Narad ME, DiCesare CA, Bonnette S, Epstein J, Logan K, Altaye M, Myer GD. J Neurotrauma. 2021 Aug 10. doi:10.1089/neu.2021.0141.
High school soccer and football athletes that wore the jugular vein compression collar had smaller changes in their brain’s white matter microstructure than those without a collar.
Sport-related concussions can cause long-term consequences such as changes in the brain’s white matter microstructure. A treatment or prevention strategy to reduce these changes remains elusive because the underlying progression of these changes from pre- to post-injury is unknown. External prevention strategies, such as helmets, limit external injuries (e.g., fractures). Therefore, it seems feasible to try a device that would provide internal protection. A jugular compression neck collar mitigates brain “slosh” by inducing a small Queckenstedt’s maneuver that causes the veins to fill up and take up more volume in the cranium.
The authors performed a cohort study to determine whether wearing a jugular compression neck collar would mitigate the preseason to post-concussion alteration in neuroimaging, behavior, and cognitive outcomes.
The authors followed 488 high school athletes (football and female soccer). All athletes were allocated at the team level to non-collar (8 teams; 237 athletes) or collar teams (8 teams; 251 athletes). Athletes in the collar group wore the jugular compression neck collar for every game and practice. At preseason, the athletes completed the King-Devick Test, the near point of convergence test, the trail-making test, and the flanker test. The authors evaluated preseason to post-concussion changes microstructural changes in white matter based on Diffuse tensor imaging. The same clinical tests were assessed post-concussion. Researchers attended each game and practice for both groups and recorded an athlete’s attendance and collar compliance.
Out of the 488 high school athletes, 46 of these athletes suffered a concussion during the season. Six athletes were unable to undergo neuroimaging because of their braces; therefore, the authors evaluated 40 athletes (20 in each group). The authors found smaller white matter microstructure changes over time in the collar group than in the non-collar group. However, over time wearing a collar had a minimal-to-no relationship to any clinical tests.
The authors demonstrated that athletes wearing the collars experienced smaller changes in white matter microstructure than those without a collar. These findings support the authors’ theory that jugular compression could create an internal cushion that reduces sloshing and thus preventing structural changes. However, it is unclear if the differences in microstructural changes are clinically meaningful since none of the clinical tests showed differences between groups over time. Furthermore, it will be important to see if these findings can be confirmed in a double-blinded, randomized, sham-controlled clinical trial that is not funded by a company producing the collars. It will also be helpful in future trials to have a better sense of how well the athletes comply with wearing the collars.
This study suggests that a simple, low-risk device that provides a slight compression to keep blood in the cerebral veins may reduce microstructural changes to the brain after a concussion. Medical professionals should be aware of products like these on the market and be prepared to discuss the pros (e.g., low risk, possible effect on microstructural brain changes) and cons (e.g., lack of high-quality evidence) of using these devices.
Questions for Discussion
Have you had your athletes wear jugular vein compression collars? If not, would you try them out? Why or why not?
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- Assessing Concussions with Functional MR Imaging
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban