How Measuring Neck Strength Prevents Concussions

What We Need to Grow, Episode 012: Measuring the Unmeasured. A Founder Talk conversation with Kim Brouzes, CEO of Kinmetrix. Cleaned for readability; the words are the speakers' own.

Caleb Pedosiuk: Kim, very nice to meet you. Tell us a bit about yourself, what you're building, and let's go for it.

Kim Brouzes: Sure. My name is Kim Brouzes. I'm an athletic therapist here in Sudbury, Ontario. I've been here for 26 years now, where I opened my first clinic 26 years ago. I've always had a passion to understand more about concussions. Working as a sports therapist in the industry, it's always that little bit of a mysterious injury. The ACLs we understood, the ankle ligaments we understood, the shoulder injuries, okay, we've got this. But concussions were always this injury with a mysterious undertone, where you had some pre-existing issues that caused problems like anxiety and depression, and then you take a hit and you don't know what you're supposed to do. It's six different silos. You can have anything from mood disruptions to sleep disruptions, headaches, migraines, visual disturbances. For the last almost three decades, I've been trying to dive into how we get to a place where we not only understand concussions, but understand how to manage them, and maybe even know how to prevent them.

Fast forward 26 years of working with thousands of athletes and thousands of concussions, and I'm now the CEO of a company called Kinmetrix. It's a marriage of software, firmware, and hardware, the world's first digital resistance system that can assess neck strength. Research tells us it takes about 4.5 Gs of force to sustain a neck injury, a cervicogenic injury, and anywhere from 77 to 118 Gs to sustain a concussion. So it's safe to say every concussion has some involvement around the neck, whether it's a neck injury itself or the neck playing a role in the concussion. There's no normative pool of data anywhere in the world that tells us what a strong neck actually is. Does Sidney Crosby have a strong neck? We don't know. Did George Foreman have a strong neck? We don't know. Look at UFC fighters, fighter pilots, gymnasts, skaters, anyone with a reputation for having the strongest neck. Max Verstappen's neck is just about as wide as his head, but is it strong? We don't know.

This device can test isometric and isokinetic strength across all 360 degrees of movement. Most of the time we assess in eight cardinal directions: flexion, 45 degrees to each side, extension, and posterior, which covers the majority of the neck muscles, from the scalenes to the deep flexors, the sternocleidomastoid, the traps. Those are the muscles that, if you take an impact, are there to support you. We take that information and our software builds a program, whether that's a light program, a strength program, or an elite performance program. What we're looking for essentially is symmetry. If I look at your head and I look at the graph, are you symmetrical, or is there a place where you're not as strong? I tested a hockey player this morning who's heading to the OHL. He had a lack of strength side to side, great in front, great in back, very little strength laterally. So I know that if he takes a hit in either direction laterally, he's likely to get at least a neck injury, if not a concussion. Over the next six to eight weeks we'll work with him to build symmetry. The other piece is expanding that whole octagon outward, so every time an athlete comes in, whether weekly or every two weeks, each of those eight points gets stronger. How strong? We don't know yet, but stronger.

Along with that we see things like angiogenesis, an increase in blood vessel formation. Anecdotally, we're seeing changes in spatial awareness and vestibular function. Athletes have reported feeling better with migraines. We've seen TMJ dysfunction (the jaw) improve. Anything that depends on blood flow tends to get better with use of the device.

Right now we have devices with the UFC, with a performance coach in Formula One, with an NFL team (I can't say which one, NDA), at a performance center in Toronto, and one going to Texas Christian University, which is a particularly interesting fit because they have an athlete engineering program. Every athlete there is part of that program, and TCU collects data from head to toe. Before Kinmetrix, we were building monsters from the shoulders down: HRV, sleep-wake cycles, mid-thigh pulls, sprint speed, vertical jump. We forgot about one of the most important parts of the body, the neck. Not that we forgot exactly, we just didn't have a way to solve the problem. Now we're part of TCU's Athlete Engineering program, adding symmetry, peak force, and strength to those metrics. TCU also works with the Department of Defense, so fighter pilots in the US, RCMP in Canada, tactical forces anywhere in the world, all of whom need to be stronger and reduce their risk of injury to the neck and brain.

There's a lot happening. It's great to have the logos, great to be in all these places gathering data. But ideally this device makes its way into clinics like mine, high schools across the US, high schools and performance centers in Canada, so we start mitigating risk at 11, 12, 13 years old, as kids begin taking hits and giving hits in sports, and for everyday people too.

Caleb: That's wild. It's truly the definition of the weakest link. Pull your lower back and you're in trouble, but the neck, how much more so. I'm curious where the conversation starts, because in a way you're creating a category. No one walks in saying, "we need this hybrid of robotics and physiotherapy." So where have you found the conversation starting?

Kim: The device was actually invented by a chiropractor in Eastern Canada, and the conversation started for him the way it does for most practitioners: the neck is a very hard spot to strengthen. We've used our hands, we've used bands, and for decades we've tried our best to creatively and carefully strengthen the neck. In my world, and in his, the problem was that I couldn't quantify whether someone was ready for the pitch, ready for the ice, ready for work. That return-to-play or return-to-work decision after a cervicogenic injury is really a guess at best. The patient feels better? Fine, subjectively that's a check. Objectively I have a few tools in the toolbox that can give me a partial answer, but it's one of the hardest calls to make with any certainty. That's where the story started for me. Look at WSIB, car accident insurance, even the legal side of these cases: the neck is the one part of the body we can't give you data on. What happens when a patient says, "I've been denied my claim, apparently my neck is fine," and I know it's far from fine? Now I can say, here's your proof, it's far from fine. Most of these conversations already exist because we're all struggling with the same lack of information. It was a hard problem to solve. This company has been around for nine years, it started in Eastern Canada, and we've since moved it to Sudbury, Ontario, where I have a great group with me, from physicians to IT people, all building this device together. Brains and necks, you have to be careful. This is not a Class II medical device, it's a strengthening device that happens to assess as well. We're probably working toward a Class II medical device one day. But right now we need people using it so we can build this pool of data and know where the conversation leads next.

Caleb: Think about the cost of a neck injury, depending on the industry: a professional athlete, a hockey player, a football player. What's the cost for someone in college, in terms of the trajectory of what school they attend or what work they do afterward? I'm curious how much of the conversation comes from the pain point. Are people perking up when they hear "half a million dollars, this UFC fighter's neck is out for six months of their prime," versus the cost of putting one of these devices in a trainer's clinic? Is the pain point where people are paying the most attention?

Kim: Yes. Look at the average hockey player in the NHL. A lot of people don't realize that if they're not playing, they're not getting paid. They carry an insurance policy just like the rest of us do for work. A neck injury or concussion that takes you out for eight, nine, twelve weeks probably costs somewhere in the $200,000 to $400,000 range, and that number climbs in UFC and Formula One. So we know this is a problem everyone is looking to solve. Go further down and look at an NCAA player who might have an NIL deal, getting paid a little to play while waiting to be drafted. They can lose that opportunity because some of these concussions are career-ending and life-changing. Same with neck injuries. I spoke with someone from the Department of Defense in the US: a fighter pilot lasts about four years before their neck is bad enough that they have to retire. But they're not retiring into a $200,000-a-year job flying commercial for Delta. Too often they end up addicted to narcotics, or on workman's comp, or on disability, because the neck problem follows them. You want to solve it and prevent it, but you also want to lessen it enough that people can move into a second career instead of ending up on disability. And I always come back to the brain, which is much worse than the neck. I've seen some of the worst concussions, and it's life-changing. Look at Brett Favre. Look at CTE. Look at how many football players, and now hockey players, have died by suicide. It's that drastic. It's not just "will I have a sore neck for a couple of weeks," it's "how does this change my life from this moment on." Those are the conversations that have driven us.

Caleb: Once someone has decided this matters, once they've gone through enough of the technical information to understand the science and the functionality, how quickly can a clinic be set up and operational? Is training required? Does someone need to be licensed on the equipment? Or is there no bottleneck between it coming off your assembly line and being shipped, installed, and running the next Monday?

Kim: There isn't much of a bottleneck. If we have units available, we ship them and onboard quickly, often online. The device has some nuance to it. The user interface is very friendly, it's more about understanding how the device works: how do we calibrate it, how do we handle firmware updates, things like that. From "Kim, I need one" to delivery is probably about two to three weeks. For some places I onboard personally, like the NFL. But anyone with a kinesiology degree or higher can run it. The nice part, from a revenue or ROI perspective, is that once you've assessed someone and the device has built their program, you don't need to stand there anymore. They come in, log in, the program is waiting, and they exercise. It doesn't take manpower to run day to day. Onboarding itself is about an hour and a half. It's important to actually sit in the device and feel how it works. The interesting thing about the neck is we're fine with soreness after a hard leg day, but because most of us have never trained our neck, getting used to soreness as those muscles fatigue and strengthen takes some education. That piece is critical. But two to three weeks is about right to get to operational.

Caleb: Who is the decision-maker, typically? I know it varies by industry, but are you seeing more interest from the talent themselves, the F1 driver, the athlete, their parents, the coach, or from people with a physio background who are excited about the science?

Kim: When we go to the PFATs, the combine, all these events, we get a lot of interest from directors of player safety and from strength and conditioning coaches. When we placed our first device in the NFL, there was actually a bit of a tug of war between three groups. Strength and conditioning wanted it because they understood what strengthening the neck would do. Our sports med docs wanted to use it as a return-to-play decision-making tool. And the ATs, the trainers and therapists, wanted it in their own clinic. They're all coming at it from slightly different angles, so interest comes from all of them. Family members and parents are starting to notice too, asking where the devices are located and whether their son or daughter can get assessed. The group we've seen the least uptake from is coaches. We haven't had a lot of coaches say, "we need this." But think about what it costs a team. If the Toronto Maple Leafs lose Auston Matthews for three or four months, what does that actually cost Larry Tanenbaum and the organization? If it's going to cost millions, and the device costs $24,000 with a monthly subscription, like an iPhone plan, it's a no-brainer. If something out there gives you a risk assessment for every athlete on your roster, this one's good, this one's good, this one isn't, this one carries real risk and needs strengthening before they ever see contact, you've done everything in your power. Recruiting improves, your risk profile goes down, and everyone from the director of player safety to the athlete feels like there's one more layer of protection in place. So we get uptake from almost everyone. The one group we haven't seen much interest from yet is coaches.

Caleb: The world of robotics is really merging with strength and conditioning in an interesting way, because it's calibrated objectively, in a way that resistance bands, or an athlete's own sense of exerting at 80 or 90 percent, simply aren't. From an insurance standpoint it's interesting too, because it cuts both ways. There's the argument that it helps prove an injury is more extensive than someone is writing it off as. But there's also the flip side, where an insurer could look at the data and say, this is actually useful because it helps us understand the real extent of an injury, and flag when readings are far enough off that something needs closer attention. From some of the content you've put out, nutrition also plays a role in recovery, so there's a more holistic layer to this. From what I understand, the center of the dartboard is the device, the robotics, the interface, the custom programs, but you're also paying attention to nutrition and giving the body what it needs to properly recover.

Kim: Yeah, because these injuries aren't simple, and our bodies aren't simple. For a lot of high-level athletes, recovery is a full-time job. As we get older and further away from that pro world, we tend to do less and less for ourselves. Even though the device can tell you exactly what you're lacking in strength, it's not as simple as "just strengthen it." Where are your hormones? Where's your iron, your vitamin D, your B12, your NAD, and all the other things that factor in? The interesting thing about robotics is that a few years ago, Collins et al. published research showing that for every pound of neck strength you gain, concussion risk drops by about 5%. There have been a few other studies in the same vein, but when a meta-analysis put them all together, the methods behind those conclusions weren't consistent or accurate. Some of it came from machines built in a garage, some from a lever system and a few bands. When researchers analyzed it all, they couldn't conclusively say the measurements were reliable enough. As we bring in robotics, and AI, because no human can process the volume of data we're collecting, AI is going to be a big part of what we do going forward, analyzing this data. But without a consistent, accurate measurement in the first place, there's no way to know for sure. Going forward, our device will be used for research more consistently.

Caleb: I'm curious about the content you're creating, because it's so niche: case studies with real depth, the science, the nuance, the objective, quantifiable improvements. You mentioned AI. So much of what we do right now is building and creating content for clients aimed at the machine layer. It's one of the big paradigm shifts for us. After about 12 years, this is our 14th year now, there was such a shift happening with the tools, with AI, that we realized better serving the human being on the other end actually means changing how we interface with these systems. We're using AI tools to filter, asking "what's the best option, how do I solve this problem," and the brands and companies preparing content to serve that machine layer, giving it what it needs to be confident, consistent, and clear in its messaging, are the ones AI can confidently suggest as the solution. So it's interesting that you're producing material AI systems can actually pick up on, when the average person searching wouldn't have the time or capacity to read through the papers, the case studies, the technical detail.

Kim: Yeah, and we hope it helps PhDs write more papers too. We all need to understand more about how to reduce this. I'll go back to CTE, because that's the scary one. Chris Nowinski's institution in Boston is the one collecting brains right now and trying to figure this out. I believe the youngest confirmed case of CTE, someone who didn't die of it but died with it, was 15 years old. The current numbers say that if you take impacts for 25 years, say a hockey player who started getting hit at 11 and played for 25 years, retiring at 36, the chance they'll have, not necessarily die of, but have CTE is essentially 100%. So we need the research, the robotics, the AI, and the PhDs, everybody saying, we have real epidemics here. ACLs have now been called an epidemic in the NFL. We need to get everyone together. Maybe that means FIFA saying no heading the ball until age 18. Maybe it's decision-makers and policymakers changing how we play sports. Maybe it's flag football, maybe the NFL keeps evolving. The NFL is doing good work with guardian caps and different helmet types, but there's more to the causes, and more to the solutions, than that. The more people who come together to do research, the better solutions we get. We're hoping to be part of that.

Caleb: As the tools change, as we have more information and more data, and the ability to actually act on that data instead of carrying on as if it doesn't exist, all of the industries you've mentioned, whether they realize it yet or not, are being offered a real advantage, whether that's UFC or high school football. So, one final question. As the visionary behind this, where do you see it a year out, five years out? In every clinic? In high schools? Is the goal to scale distribution fast, or is it more about deep research and white papers first?

Kim: I'd say all of the above, at different points. When we first started, we focused on getting the logos, because the logos gave us credibility and access. Now we're moving sideways into research. We need groups like TCU, and hopefully Charles Tator at UHN, saying, keep working with us, do as much research as you can over the next year. We built kind of an inverted pyramid, starting with the biggest logos and the teams with the most publicly visible problems because they're in the media. But our end goal is the roughly 30,000 high schools in the US. We want to be in high schools. I don't think we need to go any younger than that, as long as kids have access to neck assessments. In the US, we're hoping to work with a congressman who believes every high school student should get a full physical, and that physical should include a neck assessment. If we can get that passed, it's something we can bring to Canada too. If the device is in schools, in chiropractic clinics, in physio clinics, all someone needs to do is search "Kinmetrix, where's the closest one to me" and go get assessed. That's where we want to end up. In short, I want all of it. I want to be everywhere it matters, and I want to keep running research while still going after the big logos.

Caleb: Kim, thank you so much. Kinmetrix, K-I-N-M-E-T-R-I-X dot com, is the website to find out more. What you're doing is genuinely game-changing, for the game and for the athletes. I keep thinking about how many athletes are out there, and the ability to prevent injuries like this and change their lives in a meaningful way. It's exciting to see products doing that. Thank you very much, I appreciate you making the time.