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Out with the old, in with the new

Study Showing Helmet Design Can Reduce Concussion Risk Leaves Many Questions Unanswered

Newer helmet reduced risk by 54% compared to helmet with older design

 

NOCSAE: hard to draw conclusions

Mike Oliver, Executive Director of the National Operating Committee on Standards for Athletic Equipment (NOCSAE), the non-profit group that sets standards for football helmets, said in an email that NOCSAE was "still reviewing the study and its conclusions." "It is hard to tell at this point whether the conclusion is that the Riddell Revolution helmet model is better than the Riddell VSR 4 model, or whether that conclusion also applies to other helmet brands and models," Oliver said, "because the two helmets are based on different design concepts, with the main difference being that the Revolution model has a larger shell with more padding on the inside.

He noted that "this type of design difference also exists in almost all other brand helmet models introduced since 2000 when the Revolution was first made available," but that, despite the fact that this new design type has replaced the older style helmets over time, "we [are] see[ing] an increase in concussions, which is not consistent with the study findings. So there are lots of questions and information that the study does not address."

"Until the data behind the study is made available for review and analysis, it is very difficult to evaluate the study. Impact and concussion data has been collected by the Riddell/SIMBEX owned HITS system from collegiate players beginning in 2003 through 2013 but the study only evaluated data between 2005 and 2010. Almost all of the original data collected by Virginia Tech in 2003 and 2004 was done in the VSR4 helmet, but was not included in the study. Additionally the data collected at Virginia Tech after 2010 was done with the Revolution helmet and did not involve any VSR 4 helmets, but that data was not included in this study [either]."

Echoing a criticism made by Schutt's Erb, Oliver said, "We also know that SIMBEX filters the impact data using an internal and propriety algorithm that culls out a percentage of the impacts before being used in the various published studies, and the current study does not address how many of those filtered and excluded impacts involved Revolution helmets."

NOCSAE, which has been sharply critical of the STAR ratings system in the past, has itself been criticized for failing to move more quickly to update its standards to reflect the ability of football helmets to attenuate rotational acceleration, believed by many concussion experts to contribute more to causing concussions than straight-line or linear acceleration. NOCSAE  recently announced plans to unveil a new helmet standard in June 2014.

[For an article setting out Brooke de Lench's full interview with NOCSAE's Oliver, click here.]  

Back to square one?

In the final analysis, one thing seems clear: while the football helmets on the market today and manufactured in the recent past likely reduce concussion risk to some degree better than older helmets utilizing a different design and less padding, there is, and may never be, a helmet design which prevents all concussions, and whether there is an appreciable difference between different brands of helmets being sold today, has yet to be established.  In fact, more important, many experts say, than the helmet brand may be helmet fit. As not every helmet is going to fit every player, selecting a helmet that fits correctly - snugly almost to the point of being uncomfortable - will allow the helmet - whatever the brand - to perform at its best in protecting the player from injury, which includes staying on the player's head and not coming off during play. 

If the finding by McGuine and his colleagues at the University of Wisconsin that brand new helmets are not appreciably more protective against concussion than used and properly reconditioned helmets manufactured within the last five or six years is borne out in future studies, the best advice for parents may be, as he says, "not to become alarmed" if their kid is asked to wear a helmet that is three years old, and, likewise, for administrators "not to be worried about purchasing the most expensive and/or newest helmets."

On the other hand, if future studies extend the findings of the Rowson study to show a measurable and statistically significant difference in concussion risk reduction between, not just a new helmet and an old helmet, but between two or more of the new helmets currently on the market, the company with the helmet found to reduce risk the most will likely reap substantial gains in market share in the highly competitive football helmet market,     Regardless of whether one helmet is better than another in reducing the risk of concussion, the  best path to making football safer from a head injury standpoint is still to take a multi-pronged, all-the-above approach, such as set forth in MomsTEAM's Six Pillars, which, beyond equipping players with properly fitting helmets, includes:  

  • better enforcement of rules against helmet-to-helmet contact (such as the new rule passed just this week by the NFHS banning "targeting" and hits on "defenseless players");
  • encouraging players to strengthen their neck and shoulder muscles so as to better withstand the rotational forces that are primarily responsible for concussions;
  • taking common sense steps to reduce the number of sub-concussive hits players sustain;
  • doing more to educate players, coaches, and parents about the signs and symptoms of concussion and the dangers posed by continuing to play with symptoms;
  • working to overcome the "culture of resistance" to reporting concussions by creating a safe reporting environment;
  • ensuring that athletic trainers are on the sideline at every game and practice to identify potentially concussed athletes as quickly as possible and removing them from play for a sideline assessment and barring their return if concussion is suspected;
  • more conservative management of concussion (including a period of near-strict cognitive and physical rest in the first few days after concussIon); by
  • gradually returning concussed athletes to the classroom and to sports; and 
  • recommending retirement when the risks of long-term injury outweigh the benefits of continued participation.  

Citations

Collins M, Lovell MR, Iverson GL, Ide T, Maroon J: Examining concussion rates and return to play in high school football players wearing newer helmet technology: a three-year prospective cohort study. Neurosurgery 2006;58:275-286

McGuine T, Brooks A, Hetzel S, Rasmussen J, McCrea M. "The Association of the Type of Football Helmet and Mouth Guard With the Incidence of Sport-Related Concussion in High School Football Players." Presentation Paper AOSSM, July 13, 2013.

Rowson S, Duma SM. The Virginia Tech response. Ann Biomed Eng 2012;40:2512-2518 (Letter)

Rowson S, Duma SM, Greenwald RM, Beckwith JG, et al. Can Helmet Design Reduce the Risk of Concussion in Football? J Neurosurg. 2014; 10.3171/2014.1.JNS13916 (published online ahead of print January 31, 2014).

Photo courtesy of Virginia Tech - Wake Forest

 

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