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

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

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

Related Posts:

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