Protective Equipment and Player Characteristics Associated With the Incidence of Sport-Related Concussion in High School Football Players: A Multifactorial Prospective Study
McGuine A., Hetzel T., McCrea M., Brooks, M. Am J Sports Med. 2014; ahead of print.
Take Home Message: No particular brand of helmet reduces the risk of sustaining a sports-related concussion among high school football athletes. Athletes who wore custom fitted mouth guards and had a history of concussions had a higher rate of concussion.
In September of 2013, preliminary findings from a concussion surveillance program found that contrary to recent equipment manufacturers’ claims there were no associations with a specific helmet brand and a reduction in the risk and severity of sports-related concussions (SRC) during a single football season. These finding were noteworthy because they were some of the first to comment on the risk of SRC in high school athletes who may be using newer helmet technology. In the current study, the same research group expands upon their data set by pooling data from the 2012 and 2013 football seasons. A total of 2,081 athletes were enrolled in the study and observed over 134,437 football exposures (21,525 in competition and 112,912 in practice). Two hundred and eleven SRCs were sustained at a rate of 1.56/1000 exposures. Riddell (51%), Schutt (30%) and Xenith (19%) accounted for the top 3 brands of helmets worn by athletes in the study. The top 3 models by brand were Riddell Revolution Speed, Schutt DNA Pro1, and Xenith X1. Similar to the preliminary study, the authors also looked at the type of mouth guards worn and almost two-thirds of the players wore a generic mouth guard provided by their school. The authors found similar rates of SRC across helmet brands, helmet age (determined by purchase year), or helmet recondition status. There were also no differences in competition days lost (average 15.5 days) across helmet brands, or when comparing generic, custom, and specialized mouth guards. However, wearing a custom-fitted mouth guard increased an athlete’s risk of sustaining a SRC by 60% when compared with those wearing generic mouth guards. Additionally, players with a reported history of SRC within the previous 12 months were almost twice as likely to sustain a SRC.
The results of this 2 year study reinforce the original preliminary findings from the single season that helmet type, age or recondition status do not appear to influence the risk of SRC. This study contradicts previously published data that claim the Riddell Revolution helmets reduced the risk of SRC when compared with other helmet brands within both the collegiate and high school levels. These contradictory findings are of great importance when viewing the data from the Riddell Revolution studies given that the results have been and continue to be under significant scrutiny. This new study’s prospective design, greater number of participants using a variety of helmets over multiple seasons, and control of multiple variables are all factors that add to the strength of these findings. Helmet manufacturers widely report that newer helmets perform better on laboratory testing and helmets should be replaced on a regular schedule; however, older age and recondition status of the helmet did not contribute to SRC risk. This study further challenges the notion that mouth guard technology can reduce the risk of SRC. Lastly, the results reinforce the well-established knowledge that athletes with a history of SRC are at increased risk of sustaining another concussion. This finding is strengthened due to the authors controlling for multiple factors including use of protective equipment, years of football experience, and player characteristics such as their grades in school and competition level. Therefore, athletes, parents, coaches, and schools should be cautioned against the use of newer helmet technology as well as customized mouth guards to reduce risk of SRC until further thorough scientific investigation.
Questions for Discussion: Based on currently published data, do you recommend a particular brand of helmet or type of mouth guard? Do you think advances in helmet technology will ever successfully reduce the incidence or risk of sports related concussion in football?
Written By: Stephen Stache, MD
Reviewed By: Jane McDevitt
Riddell Revolution Helmet and Concussion Risk Reduction?
Helmet to Helmet: Type of Helmet Does Not Reduce Risk of Concussion in High School Football
Rotational Head Kinematics in Football Impact: An Injury Threshold?
McGuine TA, Hetzel S, McCrea M, & Brooks MA (2014). Protective Equipment and Player Characteristics Associated With the Incidence of Sport-Related Concussion in High School Football Players: A Multifactorial Prospective Study. The American Journal of Sports Medicine PMID: 25060072
As an athletic trainer working in the high school setting, I think it is important to stay informed on this topic. Parents are always asking questions about new helmets and how to "prevent a concussion." Being cautious about the research published by the company who makes the product is always important. Just because the company claims something, doesn't make it true. These studies that are funded by specific companies can also have a certain level of bias. So with that being said, no I don't recommend a specific brand of helmet. Even with recommendations, athletes at the high school level many times just want what is new and well marketed which isn't necessarily the safest option. To answer your second question, no I don't think any increase in technology will truly prevent concussions just based on the human anatomy and the level of protection we have naturally. The brain essentially floats in fluid within the skull and when that is disrupted injury occurs. No helmet can protect against that internal disruption. In my opinion, the helmets and pads allow athletes to feel safe and as a result they take more risks. So getting rid of the helmets and pads might reduce their risk because athletes don't have that additional sense of protection, but this suggestion is pretty unrealistic for the game of football. In conclusion, I think one of the most important things we can do for our athletes/parents/coaches is to inform them of the risks and consequences of getting a concussion.