jugular vein compression collars cover

jugular vein compression collars

introduction

Sports-related concussion (SRC) can exert serious acute and long-term consequences on brain microstructure, function, and behavioral outcomes.  Many unanswered questions remain in the treatment of sport related concussion and many studies are ongoing in attempts to find the best preventative tools.  The University of Virginia Tech has done extensive research on helmets.  Luke Kuechly, a former all pro linebacker for the Carolina Panthers, became one of the first advocates for a jugular vein compression device.  Today, you may notice many athletes with these “collars.”

Initial studies were performed on rats and the basis of the studies was to try and reduce “slosh.”  The skull and spinal canal contains only nervous tissue, connective tissue, and fat cells and their interstitium, blood, and cerebrospinal fluid. These fluid contents do not completely fill the rigid container delimited by the skull and bony spinal canal, leaving a “reserve volume.” The change in volume inside a container for a given change in pressure is called compliance. Increases in volume of the contents of the skull and bony spinal canal, within the range of reserve volume, occur at low container pressures [9].

 In the presence of reserve volume, as seen in a normal physiological state, acceleration to the skull can result in a differential acceleration between the skull and its contents. As a consequence, the brain and fluids collide with the inside of the skull. Considering the semisolid properties of the mammalian brain, this effect is referred to as “slosh” [9].

In the initial animal model, applying the collar increased intracranial volume, as indicated by an increase in ICP and IOP by 30% and 31%, respectively [9]. In humans, safe, gentle compression of IJVs dates back to 1918 when Quenkenstedt developed a simple test to prove patency of the spinal column. In this maneuver, a spinal needle was placed in the lumbar subdural space and then the internal jugular veins (IJVs) are compressed, causing a rise in spinal pressure. Compression of the IJV may also occur on placement of tight-fitting neck stabilization collars and has been shown to increase intracranial pressure (ICP), whereas wearing shirts with tight collars or neckties has also been shown to increase intraocular pressure (IOP).

Neuroimaging studies of mTBI, including SRC, have revealed alterations in widespread white matter (WM) regions.  Diffusion tensor imaging (DTI) measures can differentiate concussed from non-concussed subjects by quantifying differences in WM regions throughout the brain; however, findings have been inconsistent in the diffuse location of affected regions and their associations with neuropsychological functioning [1-2].

Image 1.  Luke Kuechly was one of the first to publicly wear and advocate for the jugular vein compression collar.  He suffered at least three concussions during his time in the NFL. 

In humans, recent research supports the claim that wearing IJV compression collars can effectively confer a protective benefit against concussions or measured effects of multiple head impacts. There are a few football studies performed in the last ten years.  One was a prospective longitudinal trial in 62 individuals followed through a football season.  Another had 284 athletes separated into two groups with a collar and non-collar group [6].  Each has shown  that a JVC neck collar can provide a mechanistic response to the diffusion and anisotropic properties of brain white matter (WM) following the highly diverse exposure to repetitive head impacts in American tackle football [10].

A similar study was performed in seventeen hockey players.  The study concluded that “ sport-related alterations in white matter microstructure were ameliorated by application of jugular compression during head impact exposure. [11]”  An additional study was also performed on soccer players.  One involved seventy-five female soccer players that studies brain MRI changes before and after the season.  This concluded that “microstructural changes in WM occurred during a season of female high school soccer among athletes who did not wear the collar device. In comparison, there were no changes in players who wore the collar, suggesting a potential prophylactic effect of the collar device in preventing changes associated with repetitive head impacts. In those without collar use, the microstructural changes showed a reversal towards normal over time in the off-season follow-up period. [12]”

Image 2.  Jugular compression device used for some studies.  Adopted from [15].

Two other relevant studies were performed on non athletes looking at prevention of changes.  One study with twenty three SWAT personnel evaluated functional brain MRI changes after blast exposure for a day.   This provided initial evidence of the impact of low-level blast on working memory and auditory network connectivity as well as the protective effect of the JVC collar on brain function following blast exposure.  An additional study was performed and evaluated EEG changes after two days of breach training in twenty-three individuals and showed a possible amelioration of changes in the group that wore the JVC collar [14].

Critics of this work have challenged the use of DTI as markers of brain injury [13]. A systematic review was performed including 86 studies.  It was concluded that results suggested widespread but inconsistent differences in white matter diffusion metrics following mTBI/concussion. The review states there was significant overlap in white matter abnormalities reported in mTBI with those commonly affected by socioeconomic status factors or the presence of MDD and ADHD. We conclude that DTI is sensitive to a wide range of group differences in diffusion metrics, but that it currently lacks the specificity necessary for meaningful clinical application [13]. 

Image 3.  Internal jugular vein area changes with JVC collar .  Adopted from [15].

There are other public skeptics that have claimed individuals would take more risk if they feel they wouldn’t get injured.  Others do not think the “slosh” theory is validated.  The FDA has approved the most popular device called the Q-collar.  However, it does state that a link between the changes the studies revealed and actual brain injuries has not been “validated.”  FDA experts have cited a strong need currently for the prevention of traumatic brain injury and the potential benefit outweighs the risk involved.

Summary

In conclusion, more studies are needed to evaluate the clinical value of the jugular vein compression collar.  There are many similar studies that show there are possible positive changes on diffusion tensor imaging (DTI) of the brain and the “Q-collar” has been FDA approved.  These have gained some traction in the professional sports area and are becoming increasingly popular.  

– More on Wiki Sports Medicinehttps://wikism.org/Jugular_Vein_Compression_Collar

References

 

  1.  Hulkower, M.B., Poliak, D.B., Rosenbaum, S.B., Zimmerman, M.E., and Lipton, M.L. (2013). A decade of DTI in traumatic brain injury: 10 years and 100 articles later. A.J.N.R. Am. J. Neuroradiol. 34, 2064–2074
  2. Levine, B., Kovacevic, N., Nica, E.I., Schwartz, M.L., Gao, F., and Black, S.E. (2013). Quantified MRI and cognition in TBI with diffuse and focal damage. Neuroimage Clin. 2, 534–541.
  3. Gilland, O., Chin, F., Anderson, W.B., and Nelson, J.R. (1969). A cinemyelographic study of cerebrospinal fluid dynamics. Am. J. Roentgenol. Radium. Ther. Nucl. Med. 106, 369–375.
  4. Smith, D.W., Myer, G.D., Currie, D.W., Comstock, R.D., Clark, J.F., and Bailes, J.E. (2013). Altitude modulates concussion incidence implications for 2820 YUAN ET AL. Downloaded by Emory University e-package from www.liebertpub.com at 01/05/22. For personal use only. optimizing brain compliance to prevent brain injury in athletes. Orthop. J. Sports Med. 1, 2325967113511588. 
  5. Turner, R.C., Naser, Z.J., Bailes, J.E., Smith, D.W., Fisher, J.A., and Rosen, C.L. (2012). Effect of slosh mitigation on histologic markers of traumatic brain injury: laboratory investigation. J. Neurosurg. 117, 1110–1118.
  6. Myer, G.D., Yuan, W., Barber Foss, K.D., Thomas, S., Smith, D., Leach, J., Kiefer, A.W., Dicesare, C., Adams, J., Gubanich, P.J., Kitchen, K., Schneider, D.K., Braswell, D., Krueger, D., and Altaye, M. (2016). 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 football. Br. J. Sports Med. 50, 1276–1285. 
  7. Yuan, W., Dudley, J., Barber Foss, K.D., Ellis, J.D., Thomas, S., Galloway, R.T., DiCesare, C.A., Leach, J.L., Adams, J., Maloney, T., Gadd, B., Smith, D., Epstein, J.N., Grooms, D.R., Logan, K., Howell, D.R., Altaye, M., and Myer, G.D. (2018). Mild jugular compression collar ameliorated changes in brain activation of working memory after one soccer season in female high school athletes. J. Neurotrauma 35, 1248–1259. 
  8. Yuan, W., Barber Foss, K.D., Thomas, S., DiCesare, C.A., Dudley, J.A., Kitchen, K., Gadd, B., Leach, J.L., Smith, D., Altaye, M., Gubanich, P., Galloway, R.T., McCrory, P., Bailes, J.E., Mannix, R., Meehan, W.P., 3rd, and Myer, G.D. (2018). White matter alterations over the course of two consecutive high-school football seasons and the effect of a jugular compression collar: A preliminary longitudinal diffusion tensor imaging study. Hum. Brain Mapp. 39, 491–508.
  9. Smith, David W., et al. “Internal jugular vein compression mitigates traumatic axonal injury in a rat model by reducing the intracranial slosh effect.” Neurosurgery 70.3 (2012): 740-746.
  10.  Diekfuss JA , Yuan W , Barber Foss KD , et al  The effects of internal jugular vein compression for modulating and preserving white matter following a season of American tackle football: a prospective longitudinal evaluation of differential head impact exposure. J Neurosci Res 2021;99:423–45
  11. Myer, Gregory D., et al. “The effects of external jugular compression applied during head impact exposure on longitudinal changes in brain neuroanatomical and neurophysiological biomarkers: a preliminary investigation.” Frontiers in neurology (2016): 74.
  12. Myer GD, Barber Foss K, Thomas S, et alAltered brain microstructure in association with repetitive subconcussive head impacts and the potential protective effect of jugular vein compression: a longitudinal study of female soccer athletesBritish Journal of Sports Medicine 2019;53:1539-1551.
  13.  Asken BM , DeKosky ST , Clugston JR , et al. Diffusion tensor imaging (DTI) findings in adult civilian, military, and sport-related mild traumatic brain injury (mTBI): a systematic critical review. Brain Imaging Behav 2018;12:585–612
  14. Bonnette, Scott, et al. “A jugular vein compression collar prevents alterations of endogenous electrocortical dynamics following blast exposure during special weapons and tactical (SWAT) breacher training.” Experimental brain research 236 (2018): 2691-2701.
  15. Dinsmore M, Hajat Z, Brenna CT, et alEffect of a neck collar on brain turgor: a potential role in preventing concussions?British Journal of Sports Medicine 2022;56:605-607.