Helmets, Concussions and What's In Store
March 5, 2014
A frequently asked question I receive involve helmets, “Dr. what is the best helmet to prevent my child from having a concussion”. The standard answer is unsatisfying for most people, and to date, still holds true. Having a proper fitting helmet and mouthguard is still one of the most important elements in the athlete’s safety from severe head injury (goes for other sports but we are focusing on football). There is good news; research is actively ongoing in improving helmet technology discussed later in the article. The most common myth out there is that football helmets were designed to prevent concussions (known as mTBI or Mild Traumatic Brain Injury), although it goes without saying that they do prevent even more serious brain and skull injuries. A properly fitting helmet is very effective in reducing the more serious injuries such as skull fractures and internal bleeding and serves to prevent that catastrophe generally very well. It is doubtful however that any helmet alone will eliminate all concussions; the formula F=1/2MV^2 dictates that the force will distributed somewhere, mainly the head. In head to head collisions, the helmet functions to diffuse the energy of the impact preventing some catastrophic injuries, but not without consequences. It’s also critical to understand that concussions occur from the brain jolting in the free-floating fluid inside our skulls , and as you see in the CDC video you can appreciate the shearing forces which begin the concussion process. Most concussions come from rotational forces rather than straight on or linear forces as commonly thought, making those head turning hits a bigger culprit. Linear hits to the head with deceleration are causes of traumatic brain injury that we think of as happening in a head on car collision or a dive into a shallow body of water. More padding does help (if fitted well) but unless the energy sustained by blows to the front and especially side of the head can be distributed more to the neck and shoulders and limit the rotational forces which the brain suffers, they will are unlikely to be a sole solution to preventing concussions. There are several other preventative measures that seem more likely to be successful in primary concussion prevention, such as rule changes in the game, changes in playing techniques, neck strengthening and others.
That being said, there is a phenomenal amount of exciting research being done towards understanding the disease process, prevention and treatment. In the case of helmets there are many manufacturers and academic researchers exploring innovative ways to improve helmet functionality through use of technology. One such technology is the use of accelerometers inside helmets on crash test dummies to measure the G-forces observed with different helmets at varying levels of G-Forces and rotational acceleration. Some pioneering institutions use (different) wireless accelerometers inside their players helmets and necks and mouthpieces to both study the helmet technology and more importantly to alert the training staff to check up on the athlete for possible concussion. Several colleges utilize these now. (I will discuss some emerging technologies and therapeutics in some detail later on in late spring or summer).
As with all new technologies and research, there are in the early stages many disagreements that only time and research can settle as the picture becomes clearer. I do not endorse any particular helmet but here are some links: Three Riddell helmets received the highest ratings(note:Adults). In another study to be presented at the American Academy of Neurology this spring, simulated crash studies revealed that the Adams a2000 was the best for preventing a simulated concussion yet the worst in terms of preventing more serious closed head injuries. Note that the Virginia Tech ratings give the Adams a2000 a non-recommended rating. Please use this information as you see fit. Until we have definitive data, and I think it will be forthcoming soon, the recommendation stands that a properly inspected fitting helmet and mouthguard is the best advice as far as helmets goes.