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Introduction
Young people at heavy metal concerts often report being dazed and confused, possible symptoms of mild traumatic brain injury. Little formal injury research has been conducted on the world wide phenomenon of head banging, even though case reports indicate the inherent risks in this activity, especially in head and neck injury. Head banging is a violent activity associated with hard rock and various subgenres of heavy metal. Over the past five years hard rock and heavy metal have contributed to about 30% of all record sales in the United States 1 and, as of 2002, rock albums have outsold pop albums. 2 The second highest selling album of all time is AC/DC's Back in Black , which has sold about 42 million copies worldwide. 3 Two slightly more recent albums, Bon Jovi's Slippery When Wet and Guns N' Roses' Appetite for Destruction , have each sold about 28 million copies. 4 5 Though exposure to head banging is enormous, opportunities are present to control this risk-for example, encouraging bands such as AC/DC to play songs like "Moon River" as a substitute for "Highway to Hell"; public awareness campaigns with influential and youth focused musicians, such as Sir Cliff Richard; labelling of music packaging with anti-head banging warnings, like the strategies used with cigarettes; training; and personal protective equipment.
The head banging story begins in 1968 when Led Zeppelin was playing a set at the Boston Tea Party on their first US tour. The front rows of the audience were banging their heads on the stage in time to the music and the term "head banger" was born. 6 7 It now refers to violent and rhythmic movement of the head synchronous with music, most commonly heavy metal music. 8 It has etched its mark in popular culture with the likes of Beavis and Butt-head banging their heads instead of reviewing video clips for songs, with the first of these being "I Wanna Be Sedated" by The Ramones. 9 Head banging was popularised in the movie Wayne's World when Wayne, Garth, and friends started head banging to Queen's epic ballad "Bohemian Rhapsody." 10
There are many different styles of head banging such as the up-down, the circular swing, the full body, or the side-to-side. It...