Sports Medicine Research: In the Lab & In the Field: Helmet to Helmet: Type of Helmet Does Not Reduce Risk of Concussion in High School Football (Sports Med Res)
Tuesday, October 29, 2013

Helmet to Helmet: Type of Helmet Does Not Reduce Risk of Concussion in High School Football

The Association of the Type of Football Helmet and Mouth Guard With the Incidence of Sport Related Concussion in High School Football Players

McGuine, T.  Brooks, A. Hetzel, S. Rasmussen, J. McCrea, M. Orthopaedic Journal of Sports Medicine 2013 1:4 DOI: 10.1177/2325967113S00027 (AOSSM 2013 Annual Meeting Abstract)

Take Home Message: Preliminary results suggest that no particular brand of helmet reduces the risk of sustaining a sports-related concussion or reducing the severity of sports-related concussion symptoms compared with other brands. Furthermore, mouth guards that are marketed to reduce the risk of concussion may not reduce the risk of concussion.

With increased public awareness of sports-related concussions, different football helmet and mouthguard manufacturing companies have begun advertising campaigns claiming their model reduces head impact forces and thus reduces the risk of sports-related concussions.  To determine the accuracy of these claims, the authors of this abstract conducted a prospective study of 36 Wisconsin high schools during the 2012 football season to determine if any particular brand of helmet or mouthguard may be associated with a reduced risk of sports-related concussion or symptom severity. The athletes completed pre-season demographic surveys detailing the type of helmet and mouth piece they would wear. School athletic trainer reported incidence and severity of concussion.  The authors defined severity of concussion as the number of participation days lost. Overall, 115 athletes sustained 116 sports-related concussions. The breakdown of helmet manufactures in the study were Riddell (52%), Schutt (35%), and Xenith (13%) purchased in 2011-2012 (39%), 2009-2010 (33%), 2002-2008 (28%). Mouth guards were either generic models (61%) or customized mouth guards (39%) that were custom fitted by a dental professional or specifically marketed to reduce the risk of concussion.  The results showed no difference in rates or severity of sports-related concussion by type of helmet or year of purchase. Interestingly, the rate of concussion for players who wore a generic mouthguard was lower than the rate for those who wore a specialized or custom-fitted mouthguard.

The preliminary results of this study are noteworthy because they contradict claims by helmet manufacturing companies that products now exist that can reduce the risk of sports-related concussion. The results also importantly show that using an older helmet does not lead to increased risk of sports-related concussion. The results went one step further to challenge the claims of mouthguard companies who market specialized products that are reported to reduce the risk of concussion. In a market where parents are trying to find any way to help protect their children, knowledge is power.  Additionally, these results support the statements by the most recent
International Conference on Concussion in Sport that there is no evidence that any particular helmet or additional type of padding can reduce the risk of concussion. This doesn’t take away from the fact that helmets are designed to reduce impact forces and the risk of skull injuries while mouth guards reduce the risk of oral and dental trauma.  A parent can make better educated decisions about his/her child’s participation and protection in football by understanding that the risk of concussion is inherent to the game and that no particular helmet or product has been shown to reduce the risk of concussion,. If this study is reported in a full-length article it will certainly be discussed again on Sports Med Res since the full-length article will likely provide a better understanding of these findings.

Questions for Discussion: Have you found any particular brand of helmet or mouthguard that possibly reduces the risk of concussion? Do you think there should be more strict marketing requirements that regulate the claims sports equipment manufacturers can make with regards to injury risk reduction?

Written By: Stephen Stache, MD
Reviewed By: Jeffrey Driban

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14 comments:

Liz said...

I agree that knowledge is power. Parents want to make the best decision in protecting their children during sports. When you go to the store there are so many different choices of mouth guards all touting how great they are. Each brand comes with a different price tag with the ones claiming they are better usually being the more expensive ones. I think there should be truth behind the marketing and that truth should be backed by research. These are required safety products for many contact sports and people rely on helmets and mouth guards to protect them from harm during sport participation. Shouldn't we hold manufacturing companies responsible for the products they put out? Shouldn't the companies that say their product reduces risk of concussion or reduces severity of concussion be held liable if an athlete sustains a concussion while properly using that company's equipment?

Stephen Stache said...

Liz,

Thanks for your comment. Your points are very valid. In no way am I an equipment compliance officer nor a marketing expert so while I agree that equipment companies should be responsible for the validity of their claims, I am quite certain there are equipment experts and compliance officers that do supervise what the companies advertise to assure legal responsibility.


If you currently visit Schutt's (one of the helmet companies mentioned in the prelim study) website at: http://www.schuttsports.com the following warning pops up before you can even access the site:

" Scientists have not reached agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.

NO HELMET SYSTEM CAN PREVENT CONCUSSIONS OR ELIMINATE THE RISK OF SERIOUS HEAD OR NECK INJURIES WHILE PLAYING FOOTBALL.


NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL."

Clearly the companies are aware of this new research and are taking steps to make sure we know they aren't making false claims.

More research will certainly be on the horizon. Until we know more, promoting education of parents, coaches, and players is paramount to an effective concussion management and prevention strategy implemented on any level.

Lauren said...

Perhaps these helmet companies are putting up these disclaimers stating that concussion research is ongoing, however, many of them still advertise and market protection from concussion. This study stating that this simply isn't true is quite shocking to me. Perhaps we should stop looking for the latest and greatest right now in terms of equipment. Many football programs that aren't pro or in a prominent Division I league are struggling to make financial decisions. Perhaps forking out extra money for the latest helmets is not the way to go until we know more about concussions. I think the best thing for most of us to do is simply keep our current helmets in great condition, get them refurbished often and make sure all of the parts are in good working order as well as maintaining a great rapport with the equipment staff.

What is even more shocking to me, however, is the fact that customized mouth guards actually saw more concussions than the standard generic ones. This was a really thought provoking moment for me as the football program I work at currently has suffered only 4 concussions this year with our worst concussion being a quarterback who uses a custom mouthguard. This study does not necessarily delve into specific symptoms and longevity of concussion damage, but it really made me wonder if the custom mouth guards are worth the time, money, and trouble to use. Sure, our quarterbacks can talk in them, but are we actually putting them at risk by having them use the custom mouth guards?

Granted, mouth guards and helmet type are not the only determining factors in concussion incidence or severity, but this article has definitely given me food for thought.

Stephen Stache said...

Lauren, thanks for your comment. I agree that the best way to protect athletes is to make sure all equipment is in proper working order and well maintained. I would take things one step further and add that it is also important to educate athletes with regards to proper equipment use and maintenance and to highlight finding such as the those in this study so athletes have a better understanding of what their equipment is designed for and more importantly, what it cannot prevent.

Regarding the mouth guards, I agree that the finding are interesting, but I would like emphasize the importance of the principle of correlation does not equal causation, meaning one cannot infer from these results that wearing a custom mouth guard puts athletes at greater risk for concussion. The opposite may be true in the sense that wearing a generic mouth guard may be protective, but until another study shows that wearing a custom mouth guard can increase the risk of sustaining a concussion, the best thing any sports medicine provider can do is inform athletes and their parents that custom mouth guards marketed to reduce concussion do not have the medical research to back up manufacturers' claim.

Tim Gribbin said...

I think this article is great for the high school athletes who may have more say in the equipment that they purchase on their own. When I was in high school, one of my teammates on the football team was told to purchase a specific helmet after he suffered a concussion. I think it may have been his third in three years of high school football, but I can't remember exactly.
While most companies disclaim that no helmet can prevent head injury etc, I think the marketing strategies towards coaches and parents need to be addressed. What the companies say are completely different than what parents and coaches may hear when making equipment decisions.

About the mouth guards, I completely agree with Stephen. It is very important to remember that correlation does not mean causation. Unless there is evidence that the force causing the concussion was transferred through the jaw, and that certain mouth guards better attenuate that force and reduce what is sent to the brain, I don't think it is fair to say that an athlete is more prone to concussions with a certain mouth guard.

Kaitlyn Johnson said...

This article gives good information and helps athletes and athletic trainers realize that helmets and mouth guards do not protects athletes from concussions 100% of the time. I feel that helmet companies should not display any false advertisement. However, it was stated that companies advertise that they help reduce concussions, which might be true. With the research that was done it was stated that 115 athletes sustained concussions, but it does not say how may did not receive a concussion. I feel like that part might be important as well. Do you think this plays a role in why the company’s advisement's say that their models reduce concussions?

Jason Shermer said...

I do not understand how a mouth guard company could even try to convince anyone that a mouth guard reduces a risk of a concussion. I wonder what the severity of the injuries were of the ones reported for this study. Could the results per type of helmet not really matter because injuries occurred during employment of one of the helmet types have not been as serious?

Stephen Stache said...

Kaitlyn and Jason,

Thank you for your comments.

Kaitlyn, your point about the advertisements from the helmet companies and the "might be true" falls directly in line with why this study was done and why the results, while preliminary, are important. A "might be true" is not the standard of evidence in medical and scientific research, so looking at the numbers becomes important.

The total number of athletes that participated in the study was 1,332. With the 115 concussions that equals 8% of the study sample and the sub-sets of concussion rate was not significantly higher or lower for any one particular brand of helmet. In the end, an important consideration with regards to the companies' claims is that research for marketing is not the same as independent, unbiased research.

Jason, you highlight the importance of conceptual misunderstanding that can happen with safety products. Mouth guards are designed to reduce oral and dental trauma and the consensus statement emphasizes this point as part of the section on protective equipment.

And with regards to your question on the concussions not being as serious and therefore causing the results to not matter, one must be careful to avoid using labels like "serious" or "minor" when discussing a concussion. The current guidelines do not stratify a concussion into any category, but notes that:

"Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged."

The results of this prelim study also account for the "severity" of a concussion by totaling days lost from sport. Hence, "severity" of a SRC were not associated with a specific helmet brand.

Brittany Cavacloglou said...

This article provides great information and the most important take home message to me is the fact that helmets or mouth guards are never guaranteed to eliminate or reduce concussions. I believe that if companies want to advertise information about their helmets, they should advertise the fact that the helmet will help reduce impact forces and is essentially protecting the skull itself. The brain still has a chance to be injured with or without the helmet on. Do you feel as if there will ever be a helmet that can prevent concussions?

Morgan Hooven said...

Concussions are potentially life threatening injuries. I feel as if parents should research information about helmets and mouth guards if they want to help protect their children instead of depending on companies who relay false statements. I am also wondering like Brittany, do you ever think there will be a helmet made to prevent head injuries? Research studies are done all around the world to get a closer look at concussions and how we can help reduce them. Do you think changing the material in the helmets would help reduce severity and likeliness of concussions?

Stephen Stache said...

Brittany and Morgan, Thanks for your comments.

You both pose an interesting and important question. Before I answer, I would like to highlight that concussion is a brain inside the skull injury and that coup counter-coup impact (http://en.wikipedia.org/wiki/File:Contrecoup.svg) can still occur with extensive head and skull protection.

So, to answer the question of the possibility for future technology that could help reduce concussion, its certainly possible. However, as the results of this study highlight, any claims will need to be thoroughly researched and validated.

What I believe is a more important strategy to reduce concussion in sports are education initiatives and rule changes. Increasing player, coach and parental awareness of concussion is one of the most important components to any concussion management plan. And as much as athletes of all levels are complaining about rule changes in various sports, the knowledge that has been gained with new research into concussion warrants the rule changes. Allowing athletes to continue on as they have for years put undue risk into activities that are meant to be enjoyable and fun to those who play in addition to entertaining for those who watch.

"Those who have the privilege to know have the duty to act.” - Albert Einstein

Marisa Rizzo said...

This article shows great information that most people have no clue about. Most people think that the most expensive helmet has to work the best, and since this mouth guard says it protects against concussions then it does. This article is something that every parent should be given when their kid signs up for football or any contact sport for that matter.

Sylvia Thelemaque said...

Even though mouth guards do not completely protect you from developing a concussion and are more likely to protect your mouth and jaw, I find it kind of weird that the generic mouth guards showed lower results then the specialized pieces. Simply to the fact that the specialized mouth guards obviously more customized and adding a bit more stability. Even when some one gets in the mouth from a tackle or the helmet, if their is enough force to jaws that can cause a concussion.

I understand that teams reuse helmets for a few years because they are expensive... but say that older helmets doe not lead to an increased risk of a concussion is absurd. If these helmets are not reconditioned as often as they should by the NOCSAE like they should be, and something is faulty then a concussion is bound to happen sooner or later!

Alex Ruxton said...

This article was interesting and has a lot of good information. I think educating parents and coaches about concussions and concussion symptoms has a lot of value. No helmet or mouth guard right now reduces the risk of concussions. Helmets do reduce the risk of skull fractures and lacerations. Also, mouth guards do reduce the amount of dental and oral injuries. I find it interesting that generic brand mouth guards have a lower rate of concussions but I don't know how much that has to do with the mouth guard. I think it would be more surprising if generic mouth guards prevented more dental and oral injuries than customized mouth guards. I think rule changes are important right now in football to decrease the amount and risk of concussions. I also think there should be more strict marketing requirements of equipment companies and make them actually advertise what there equipment does.

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