Can helmet design reduce the risk of concussion in football?: Technical note
Rowson, S., Duma, S., Greenwald, R., Beckwith, J., Chu, J., Guskiewicz, K., Mihalik, J., Crisco, J., Wilcox, B., McAllister, T., Maerlender, A., Broglio, S., Schnebel, B., Anderson, S., Brolinson, P. J Neurosurg. 2014 Jan 31. [Epub ahead of print]
Take Home Message: When compared to the older Riddell VSR4 model helmet, college football players wearing the Riddell Revolution helmet may have a lower risk of concussion.
Currently, one of the hottest topics in sports medicine research is finding ways to reduce the risk of concussion in sports, particularly football. The recent guidelines by the International Conference on Concussion in Sport stated that there was no evidence that any particular helmet could reduce the risk of concussion. Additional preliminary research that compared different brands of helmets showed that no particular brand of helmet reduced the risk of concussion. Rowson et al. recently conducted a retrospective review of head impact exposure data collected over 5 years comparing rates of concussion among 1,833 NCAA division IA football players wearing either a Riddell VSR4 helmet or a Riddell Revolution helmet. Head impact exposures during games and practices were assessed with helmet-mounted accelerometers (HIT System). Certified athletic trainers or team physicians diagnosed all the concussions. Rate of concussion was recorded while controlling for head impact exposure. Over the course of the study, the medial staff diagnosed 64 concussion. Twenty-seven players wearing the VSR4 sustained a concussion at a rate of 8.4 concussions per 100,000 head impacts versus 37 concussions to players wearing the Riddell Revolution at a rate of 3.9 concussions per 100,000 head impacts. Players wearing the Riddell Revolution had more hits per season when compared to players wearing the Riddell VSR4 helmet, thus the lower rate despite the higher number of concussions. However, the players wearing the VSR4 helmet sustained high magnitude hits more often than players wearing the Riddell Revolution helmet.
The results of this study are interesting and encouraging in the fact that they show that newer helmet technology may help reduce the incidence of concussion in football. The authors state the results make logical sense from a biomechanical standpoint, given that the Riddell Revolution helmet was designed to reduce head acceleration experienced by a player during a game-related head impact. The authors argue that this reduction in head acceleration reduces the risk of concussion when compared with the older model VSR4 helmet. While these results are encouraging we must view them with caution for a number of reasons. First, the authors did not disclose if both helmets were used throughout the five year period (2005 to 2010) or if players switched helmets. The number of players that wore either type of helmet was also not disclosed. NCAA rule changes instituted in 2008 that discourage higher magnitude hits and could account for the lower rate of concussion in players wearing the newer model if the Revolution helmet was mostly tested after the rule changes. Improved awareness of the negative consequences of concussion may have also help lead to the lower rate of high magnitude impact among the Revolution players. Despite this limitation, a similar result of reduced incidence of concussion among players wearing the Revolution helmet was shown in high school athletes. This study also only compared one type of Riddell helmet to another of the same brand and did not include helmets of other popular brands in its analysis. Lastly, a number of authors of this study have financial interests in instruments (HIT System, Sideline Response System [Riddell]) used to collect the data presented in this study. Further independent analysis of different brands of helmets with similar study methods controlling for head impact exposure are necessary to truly understand if newer helmet technology can reduce the risk of concussion. Until further research clarifies if the Riddell Revolution can reduce the risk of concussion compared to other helmets, clinician should continue to emphasize tackling education, concussion education, and proper diagnosis and management of concussion.
Questions for Discussion: Have you seen differences in rates of concussion in athletes wearing newer helmet technology? How do you view the results of this study when compared to results of other studies that do not show risk reduction and the information reviewed by the 2012 Zurich consensus statement committee?
Written By: Stephen Stache, MD
Reviewed By: Jeffrey Driban
Rowson S, Duma SM, Greenwald RM, Beckwith JG, Chu JJ, Guskiewicz KM, Mihalik JP, Crisco JJ, Wilcox BJ, McAllister TW, Maerlender AC, Broglio SP, Schnebel B, Anderson S, & Brolinson PG (2014). Can helmet design reduce the risk of concussion in football? Journal of Neurosurgery PMID: 24484225