Good Football Helmet Fit Key to Preventing Brain Injuries
FRIDAY, Feb. 17 -- While football helmets don't prevent concussions, good helmet fit might help reduce loss of consciousness that can follow a blow to the head, a new study finds.
Expensive, high-tech helmets with air-lining systems aren't much better than vintage "leatherheads" for preventing concussions, the researchers said.
"The occurrence of concussion has been constant for the past 30 years: whether it was a leather helmet, whether it was a plastic helmet with web suspension, whether it was a plastic helmet with foam, or one with the new combination air cells and padding," said study author Dr. Joseph Torg, an adjunct professor of orthopedic surgery at Temple University in Philadelphia.
The researchers looked at data from the U.S. National High School Sports-Related Injury Surveillance System from 2005 to 2009. Of the nearly 1,400 kids who sustained a concussion, 44 lost consciousness and 267 experienced amnesia.
Injury reports addressed helmet fit, type of inner-helmet padding and whether the helmet was new or reconditioned.
"Youngsters who had a concussion, if the helmet fit, they had 82 percent less chance of loss of consciousness," Torg said. "Helmets -- and advanced helmet technology -- do not prevent against concussions or the severe intracranial injuries of hemorrhage [bleeding] and brain swelling."
The researchers also analyzed previous studies comparing types of helmets.
Older, reconditioned helmets did as well as new helmets. But unpublished data suggested that helmets with air-bladder linings might be a risk factor, because they tend to leak and can deflate if not maintained properly.
Wendy Norris, head athletic trainer at DeMatha Catholic High School in Hyattsville, Md., said her responsibility for player health includes gear safety, and it's standard practice to inspect helmets before each game.
"We have helmets certified every year, and the day before games we always check them to make sure they're fitting well," said Norris, a certified athletic trainer. "It's an ongoing process. Sometimes I'll see somebody on the field and say, 'Hmm, I don't like how that looks.' And we adjust it."
Higher-tech helmets with improved air-cell systems cost about $250 to $350 each, Norris said. An advantage is that company representatives come out to the schools and educate trainers and coaches on proper fit.
Torg said the big question is, beyond helmets, what sets apart the four to six football players who suffer catastrophic injuries from concussion each year?
"Our thesis: there's a combination of factors that predisposes those small numbers of youngsters," he said. The factors are mostly unidentified, he added, noting they could be congenital, anatomic, or even related to air temperature.
"A kid who has a severe concussion has a number of predisposing factors, one of which is probably a helmet that doesn't fit," Torg said. "If you remove that component, then maybe the problem is solved."
Torg's study was presented at this month's annual meeting of the American Orthopaedic Society for Sports Medicine in San Francisco.
Athletic trainer Norris suggested some "easy landmarks that parents can look for," with helmet fit:
- Players' eyes should be visible.
- Helmet ear holes should line up with players' ears.
- Cheek pads should sit next to the skin, without a big gap.
- The back of the skull should be covered.
- Mouth guards shouldn't be chewed up and hanging out of players' mouths. They should fit past the second molar on both sides. Molded is better because that helps absorb the shock when players get hit in the head.
- The helmet shouldn't shake or rattle. If you grab the facemask and the chin strap is tightened up all the way, you should not be able to move the facemask left or right. It should stay neutral.
- Find out if helmets are recertified every year. "They should be," Norris said. "But a lot of schools can't afford that." One way you can tell: there should be a sticker at the back of the helmet with the year.
If you think something's wrong, ask the trainer or the coach, she advised.
Players also have a role, the trainer stressed.
"We tell them for sure not to customize the helmet in any way," Norris said. "A lot of them want to cut the forehead pads or cut the cheek pads to make them thinner. We definitely discourage that."
And, she added, "they should also have their coaches check their helmets at least every week or two weeks, just to make sure everything's good."
The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.
Visit the U.S. Centers for Disease Control and Prevention to learn about concussion in sports.
Posted: February 2012
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