Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players
Greenhill DA, Navo P, Zhao H, Torg J, Comstock RD, Boden BP. Sports Health. March 2016. doi:10.1177/1941738116639027.
Take Home Message: An athlete with a poorly fit helmet that sustains a concussion may have an increased risk of more severe symptoms and prolonged recovery.
There has been much discussion and research into the potential for protective equipment to alter the risk of sports-related concussion. However, there is insufficient evidence to suggest that any type of helmet or protective equipment used in football can reduce the risk of sustaining a sports-related concussion. Investigation into the effects of proper fit and concussion risk is currently limited. Thus, Greenhill, et al. sought to understand if an athlete with an improperly fit helmet at the time of an injury is more likely to have longer recovery and more severe symptoms after sustaining a concussion. For a nine-year period, data was collected from a sample of 100 high schools participating in a national surveillance system. A Certified Athletic Trainer determined if an athlete had an improperly fit helmet at the time of injury. Of the 4580 concussions that were sustained during this time period, 3172 had information regarding helmet fit. Among those concussions, athletic trainers determined that 102 helmets had an improperly fitted helmet. When compared to athletes with a properly fit helmet, concussed athletes with an improperly fitted helmet had averaged more symptoms during recovery and were more likely to have symptoms that persisted longer than 7 days (37% versus 31%). The 2012 NFHS helmet rule changeIndependent of fit, an athlete who wore a helmet with a gel or foam liner was more likely to lose consciousness after a concussion compared with an athlete with an air-filled liner helmet. However, there was no association between helmet liner type and symptom severity.
Very few medical professionals will argue the merits and necessity of the helmet in football. The results of this study are noteworthy because they bring to light a completely different issue with helmets, which seems obvious but unfortunately is still an issue: sports equipment should fit properly. Maintaining proper fit should be emphasized to athletes as a fundamental of the game, just as important as proper tackling and following the rules of play. Athletes on the professional and colligate level sometime set poor examples on proper equipment fit. Clinicians need to make emphasizing injury risk associated with poorly-fit equipment to the youth athlete a priority. While these results are interesting, they should be viewed carefully. Data was not cited for symptoms in a category beyond seven days. It is widely accepted that the majority of young adults will recover in 7–10 days, with youth athletes taking longer, so it is possible that the results of this study could normalize between the fit and poorly-fit helmet groups if the endpoints were more specific of time of recovery. Additionally, as the authors mention, this study lacked uniformity for method of helmet fit assessment. Further research is necessary to determine reproducibility and clarify assessment protocol. Perhaps a simple real-time method to assess helmet fit on the side line could become an important risk reduction tool for an easily modifiable risk factor. In the meantime, clinicians need to educate their athletes about the risk associated with poorly-fit helmets and that it could lead to them missing more time after a concussion.
Questions for Discussion: Do you think there is an easy way to quickly and effectively assess helmet fit on the sideline? Do you think protective equipment will ever evolve enough to reduce concussion rates or severity in sports that require a helmet?
Written By: Stephen Stache, MD
Reviewed By: Jeffrey Driban
Helmet to Helmet II: Full Data Set Show Helmet Type Does Not Reduce Risk of Concussion in High School Football