As fall sports begin in earnest this weekend, I am often asked if head protection can prevent a concussion while engaged in play. Since most fall sports head protection-related questions are directed at football and soccer, we will deal primarily with these two sports.
According to the recent Team Physician’s Consensus Statement on Concussion (TPCC) and the National Federation of State High School Associations (NFHS), there is no football helmet, or mouth guard for that matter, that can prevent a concussion. Helmets have been designed to prevent skull fractures, cerebral bleeding, and other head trauma. Mouth guards have been developed to protect teeth and against oral injuries.
Helmets in fact, when fit inappropriately, can increase the incidence of concussion. Helmets can also increase the incidence of a concussion when used for illegal means in football such as spearing. Schools generally provide the helmets that are worn by their football players, and these are usually refurbished helmets that have been used by previous players. Helmets used in schools should meet the standards for reconditioning set forth by NOCSAE (The National Operating Committee on Standards for Athletic Equipment) to be sure they are appropriate for wear.
New helmets raise even bigger questions. There are several companies at present who are advertising for concussion-proof helmets. Based on current research, however, there is no concussion-proof helmet in existence. The STAR System, developed at Virginia Tech, has looked at several of the new “concussion proof” helmets and have ranked them according to safety per the STAR guidelines which can give coaches and parents some objective data concerning these newer helmets. These rankings can be found on the Virginia Tech Website.
While we are on the topic of head protection, I am often asked about my opinion about concussion prevention using headbands/head gear in soccer. Their use is the source of much controversy and debate in the medical profession. The data that has been done independently has shown that head bands/headgear in soccer does prevent lacerations and other soft tissue trauma, but they not do much to protect against concussions. In fact, more concerning is that some data has shown that use of these devices has actually increased head injuries as it leads to more aggressive play as the athlete feels he or she is more protected due to the use of these devices.
NFHS has recommended that parents, coaches and athletes evaluate the use of these devices individually but none have been endorsed by this organization. The NFHS website contains some recommendations of soccer headgear that has passed the testing of the American Society for Testing and Materials (ASTM) standards for use in soccer. However, no physicians group or the NFHS itself has endorsed these devices. Their use continues to be controversial. I would like to wish the best of luck to all of our coaches, athletes and parents as they begin the 2013-14 athletic year.