UW-Madison study finds no difference in rate of concussions across helmets
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Helmet technology is similar among all brands, and a helmet’s brand, age and reconditioned status has no impact on how many concussions a football player sustains, say UW-Madison researchers who have studied Wisconsin high school football players.
Like all injuries, concussions are multifactorial events, said Tim McGuine, a sports medicine researcher at UW-Madison and co-author of the study.
“It’s not just one thing that causes or can protect somebody from those injury occurrences,” he said.
It’s easy to point a finger and say, “Just put a different helmet on and we can prevent all this,” but that’s just not the case, he said.
Do helmets work?
“I think they work very, very well,” he said, pointing to a bicycle helmet, which is built to take only one blow. A football helmet sustains thousands of hits without needing to be discarded. It is ultimately designed to prevent skull fractures, and in McGuine’s 30 years around high school football, he has never seen such an injury.
With all the myths surrounding helmets, it’s unrealistic for a concerned parent to demand a school spend more when no evidence exists to say it will be more effective, he said.
“I don’t blame parents,” said McGuine, who still works the sidelines during fall football practice. He knows from personal experience that parents want what is best for their kids.
But better helmets can result in elevated risk taking, said Dr. Darin Rutherford, a sports medicine physician at Mercy Sports Medicine and Rehabilitation Center.
“If you have a helmet on your head that you perceive to be decreasing your risk of concussion, you’ll tend to have higher-risk behavior, which negates that. Then you’re at just the same or higher risk of concussion,” he said.
Study background
Misconceptions about helmets were a big part of why McGuine and his colleagues tackled the helmet study. Much of their research in the last decade has focused on practical questions such as, “Should kids wear ankle braces or not? Do they work?”
“I know we were getting a lot of questions from coaches and some parents,” McGuine said. “Is it worth it to buy new helmets when new brands come out?”
Some helmets marketed to parents range from $400 to $500—well beyond what schools can afford. One coach wondered if he should spend money on 25 standard helmets or 10 new helmets with big claims.
Findings
The study involved 2,081 football players at 34 Wisconsin high schools during the 2012 and/or 2013 football seasons. Players completed pre-season demographics and injury questionnaires, and athletic trainers recorded the incidence and severity of concussions throughout the years.
Of the 2,081 players, 9 percent, or 206 players, sustained a total of 211 sports-related concussions.
Findings included:
-- No difference in the rate of concussions across helmet brands, helmet age or helmet recondition status.
-- Custom-fitted mouth guards increased concussion risk by 60 percent, compared to generic guards.
McGuine said the mouth-guard statistic was an outlier in their findings, and he couldn’t really explain it. A student who had a previous concussion, and thus was more at risk for another, might use custom-fitted mouth guards, he said.
McGuine said he’s still a big believer in custom mouth guards as protection against dental injuries. If a player is struck in the jaw, a mouth guard can reduce some of the force that can cause a concussion, but its main purpose is not to prevent concussion injuries.
-- The rate of concussions was nearly seven times higher during competition than practice, and it was four times higher during full-contact practice than no-contact practice.
-- Age, body mass index, grade in school or competition level were not associated with an increased risk of concussion. More years of previous tackle football experience was not associated with a decreased risk of concussion.
-- Players who sustained concussions during the previous 12 months were almost twice as likely to have a second one compared to players with no concussion history.
No industry funding was used for the study.
Star ratings
Virginia Tech has become a go-to place for its five-star rating system on adult football helmets. The ratings are the culmination of more than 10 years of research on head impacts in sports, and they identify which helmets best reduce concussion risk, according to the online site.
The ratings are meant to help consumers make informed decisions when buying helmets. More stars equal better protection, and the site states, “We encourage athletes to get out of lowly rated helmets and into four- and five-star helmets.”
It notes no helmet is concussion-proof.
Researchers gave five-star ratings to 13 helmets, which ranged in price from $200 to $414. Eight helmets got four-star ratings, and they range from $149 to $398.
While some might question the Madison research findings in light of the ratings, McGuire said the Virginia Tech ratings are purely lab tests extrapolated out to say what researchers “think” will happen.
The Madison study was field research, McGuire said.
“I’m going to tell you what happened,” he said. “They’re projecting what might happen.”
Despite his research, McGuire says “go ahead” to somebody who wants to spend the extra money for a five-star helmet. His son played football for four years, and he would not have a problem with his son wearing any of the helmets on the market.
The right fit
The evolving design of football helmets has resulted in a bigger look. The distance from the outer shell to the skull is greater, with more padding, and the helmet now extends to cover the jaw line, unlike 10 to 15 years ago, McGuine said.
Some helmets also use much heavier materials.
Still, a player’s brain can bounce around in an expensive helmet that doesn’t fit right, Rutherford said.
“The helmet fit on the head is most important,” he said.
Weather can change the air pockets inside the helmet, so players need to make sure the pockets stay pumped up.
No helmet is concussion-proof, Rutherford noted, because “if there’s the right force in the right direction, things will bounce around inside just because your head is like a bowling ball on a stick.”
Not every kid needs a $400 helmet, he said. The most important thing is having one that fits the head correctly, meets the standards and has no other faults such as cracks, he said.
Years ago, some coaches would let kids pick out their helmets without checking the fit. A study then found helmets weren’t fitting properly, and a statewide education program for coaches helped solve the issue, McGuine said.
“The coaches in the state are really at the forefront in terms of safety,” he said.