Companies redesign football helmets to reduce concussions
Companies redesign football helmets to reduce concussions
(Dave Weaver - Associated Press)
By Jonathan Starkey
Special to The Washington Post
Tuesday, November 10, 2009
Blake Lawrence tried not to think about injuries when he was on the football field. But Lawrence, a junior who until recently played linebacker at the University of Nebraska, could have been forgiven for worrying about his head. In one 12-month span, from spring 2008 to spring 2009, three on-field blows left Lawrence with a trio of mind-numbing concussions.
Two were the result of helmet-to-helmet collisions with teammates in practice. The other he suffered while taking down a Kansas State running back last fall.
In all three instances, the blows, all near his left temple, left Lawrence in a &state of total confusion,& unable to comprehend plays or answer questions.
&My brain just got rattled,& Lawrence said.
With his football career -- not to mention his health -- in jeopardy, Lawrence looked for sturdier head protection before taking the field this fall. In consultation with his family and Nebraska's medical staff, he selected Xenith's X1, a helmet with an innovative design of air-cushioned shock absorbers that hit the market last November. A range of trainers, coaches, head injury experts and equipment gurus think that the new design holds promise but agree that only longtime use in real games will show how well it works.
&It's helped me this year not only be safer, but feel safer,& Lawrence said a few weeks ago. After a big hit during Nebraska's second game this fall, Lawrence said he &took inventory,& checking to see &if I got all my screws together up there. I ended up being okay. . . . I think it has protected me pretty well.&
Football helmet manufacturers face a unique design challenge. Whereas motorcycle helmets, for example, are meant to be discarded after one severe impact, football helmets must be soft enough to cushion routine blows, stiff enough to absorb the force of violent helmet-to-helmet collisions and durable enough to withstand week after week of intense punishment.
A far cry from the leather headgear of the early 1900s, most modern football helmets are stiff polycarbonate shells lined with dense foam padding. They're designed to protect players from such potentially deadly injuries as skull fractures and subdural hematomas and have been very effective at doing so. They are often unsuccessful, though, at preventing the concussions and other damage, often cumulative, that comes from less dramatic collisions.
Xenith seeks to provide protection against both routine and extreme blows by replacing the traditional foam with a &shock bonnet&: an adjustable cap housing 18 plastic shock absorbers shaped like small hockey pucks, each of them hollow with a tiny hole on top.
When a player wearing an X1 takes a relatively mild hit, the pressure forces air out of the pinholes, dispelling force by deflating the absorber until it's as flat as a saucer. When the pressure is removed, the absorbers reinflate quickly -- much as the bulb of a turkey baster pops open when you stop squeezing -- and the helmet is ready for the next impact.
During a more violent collision -- say, a high-speed, helmet-to-helmet blow on a kickoff -- the higher level of force tries to displace the air more quickly than the pinhole can accommodate, thereby increasing the air pressure inside the absorber. That pressure stiffens the disk, offering skull protection much as traditional helmets do. (Think of a bicycle-tire pump: Pump forcefully and the handle becomes increasingly hard to push down. Apply pressure slowly and you meet less resistance.)
It's during the milder, routine impacts that Xenith's forgiving cushion may offer a significant advantage, experts say. Gerard Gioia, a neuropsychologist who leads the concussion program at Children's National Medical Center, said the gradual expulsion of air would spread the force of impact over a longer period of time, lessening the force that reaches the brain.
&We want to have a helmet that responds differently in every impact,& said Dave Halstead, technical director at the , an independent group that certifies football helmets worn from the youth to professional levels.
Although he describes Xenith's approach as unique, he is not convinced that any manufacturer has solved the concussion problem. &Anyone who says to you that they have a helmet that eliminates concussions is lying to you,& Halstead said, because the most likely cause of most concussions is not the blunt linear force of impact, but the resulting rattling of a player's brain inside the skull. Consider that a player can sustain a concussion without so much as a visible bump on his head, Halstead said. It's like shaking a raw egg, he said: You can scramble the yolk inside without cracking it.
&Can helmets reduce or mitigate those rotational forces? . . . We don't know yet,& Gioia said. &We'll see how this goes with Xenith and with other companies that are trying to address this problem. It's not a simple process.&
The impact
The Centers for Disease Control and Prevention estimates that each year, 1.6 million to 3.8 million sports- and recreation-related concussions are sustained in the United States, many of them on football fields. Memory loss, confusion and nausea are among the immediate symptoms.
Scientists are studying the longer-term, cumulative effects. At Boston University, researchers studying the brains of several deceased professional football players with a history of head trauma found a degenerative brain disease linked to paranoia, aggression and progressive dementia. And a recent study commissioned by the National Football League found that former players ages 30 to 49 were many times more likely than their peers to have received diagnoses of dementia and other memory-related diseases.
All football helmet manufacturers (Riddell, Schutt Sports, Adams and Xenith being the ones that supply to the NFL) have been tweaking helmet designs in attempts to combat football's head injury problem. Adams lines its helmets with foam of varying degrees of density to moderate the force of both routine and more extreme blows. Riddell has marketed a helmet that sends a wireless alert to a team's training staff if a player sustains a potentially dangerous impact.
Lowell, Mass.-based Xenith, founded by Vin Ferrara, a former Harvard quarterback, won certification from the standards committee in 2007 for the X1 helmet. The company gave away 2,000 helmets in 2008 and has sold about 15,000 in the past year, according to company spokesman Chris Clark. The majority are being used at more than 600 high schools across the country, including, in the Washington area, Walt Whitman, Landon, Broad Run and Oakton. It's also in use at Princeton University, North Carolina State University and the University of Illinois.
NFL players who are trying it include Ryan Fitzpatrick and Xavier Omon of the Buffalo Bills, the Indianapolis Colts' Dallas Clark and the Baltimore Ravens' Matt Birk. (Birk, a center, is one of three professional players who recently pledged to donate their brains after death to Boston University's Center for the Study of Traumatic Encephalopathy for the study of head injuries.)
&I think the shock-absorption system is the best out there,& said Charlie Thompson, the head athletic trainer at Princeton, where 20 football players wear Xenith helmets. Thompson said Princeton players sustained 12 concussions last fall and six
so far this fall, with just one involving a player wearing a Xenith. &I am very pleased with the protection it's provided.&
At Nebraska, where Lawrence has been the only player wearing the X1, Mark Mayer, the head football trainer, sees potential but remains skeptical.
&It's something I'm going to keep my eye on,& said Mayer, a former assistant trainer for the NFL's Oakland Raiders. &If there's anything out there that's going to protect our players . . . we're going to explore it. It's such a young product. Is it better than what's out there right now? We just don't know yet. But it does hold promise.&
Like Halstead, some experts suspect helmets, however advanced, cannot prevent the cause of most concussive incidents. They suggest the best defense against concussions might just be simple education and prevention. Players should not put such trust in their helmets that they use their heads as battering rams, for example. And if they feel abnormal after a big hit, they should resist the urge to shake it off and keep playing.
Despite his hopes for the X1, Lawrence has come to a similar conclusion. While wearing the new helmet in a recent tackling drill, he was left confused and anxious after another blow near his left temple. &I knew my head wasn't working right,& Lawrence said. &For the rest of practice, I spent a lot of time staring at the ground in front of me, trying not to focus on faces. I was just out of it.&
It was his fourth concussion in less than two years. &I put no blame on the helmet at all,& he said. &My head is just more prone to being rattled.&
But after giving it some thought, Lawrence took a major step: He decided to quit football.
&My brain works pretty well,& he said. &As long as I'm not taking continuous hits to the head, it will stay that way.&Statistics - Prevacus
Concussions 101 /StatisticsConcussion rate doubled in decadeThere are between an estimated 1.6 and 3.8 million sports-related concussions in the United States every year,1,2 leading The Centers for Disease Control (C.D.C.) to conclude that sports concussions in the United States have reached an epidemic level.High school athletes sustain an estimated 300,000 concussions per year.10A 8 of U.S. high schools with at least one certified athletic trainer (AT) on staff found that concussions accounted for nearly 15% of all sports-related injuries reported to ATs and which resulted in a loss of at least one day of play.Another 2011 study4 reported that, for all athletes, concussion rates in high school athletics have increased by 16% annually from the
academic years, possibly resulting from an increase in injury or diagnosis.A 2012 paper presented to the American Academy of Pediatrics’ annual meeting19 suggests that high schools with ATs have concussion rates much higher than those that don’t (8 times higher in girl’s soccer and 4.5 times higher in girls’ basketball). Again, the reason for such higher concussion rates may be due to the fact that
to spot the often subtle signs of concussions.A 2012 study10 of 20 high school sports reported that 13.2% of all injuries in the sports studied were concussions, two thirds (66.6%) in competition and one-third (33.4%) during practice.According to the ,12 during , an estimated 2.7 million children aged ≤19 years were treated annually in emergency departments (EDs) for sports and recreation-related injuries. Approximately 6.5%, or 173,285, of these injuries, were traumatic brain injuries (TBIs), including concussion.During the same period, the estimated number of sports and recreation-related TBI visits to EDs increased 62%, from 153,375 to 248,418, with the highest rates among males aged 10-19 years. The rate of TBI visits also increased 57% from 153,375 to 248,418 during . The authors of the C.D.C. report speculated that the increases were likely due to increased awareness of the importance of early diagnosis of TBI.For young people ages 15 to 24 years, sports are the second leading cause of traumatic brain injury behind only motor vehicle crashes.3,13
[Editor’s note: the study on which this statistic is based is 17 years old and based on data from 1991, so it may be outdated].High school football is consistently shown in studies to be the sport with the greatest proportion of concussions (47.1%) and the highest concussion rate (6.4 concussions per 10,000 athletic exposures).At least one player sustains a mild concussion in nearly every American football game.There are approximately 67,000 diagnosed concussions in high school football every year.9According to research by The New York Times, at least 50 youth football players (high school or younger) from 20 different states have died or sustained serious head injuries on the field since 1997.Anecdotal evidence from athletic trainers suggests that only about 5% of high school players suffer a concussion each season, but formal studies surveying players suggest the number is much higher, with close to 50% saying they have experienced concussion symptoms and fully one-third reporting two or more concussions in a single season.One study estimates that the likelihood of an athlete in a contact sport experiencing a concussion is as high as 20% per season.According to the National Center for Catastrophic Sport Injury Research, there were 5 catastrophic spinal cord injuries in high school football in % of all catastrophic injuries in football since 1977 are from tackling.According to a study reported in the July 2007 issue of The American Journal of Sports Medicine:Football players suffer the most brain iAn unacceptably high percentage (39%) of high school and collegiate football players suffering catastrophic head injuries (death, nonfatal but causing permanent neurologic functional disability, and serious injury but leaving no permanent functional disability) during the period 1989 to 2002 were still playing with neurologic symptoms at the time of the catastrophic event.Girls more prone to concussion?Some studies suggest that girls have higher concussion rates than boys and that concussions represent a greater proportion of all injuries in girls than in boys, but the trend in peer-reviewed studies appears to be towards finding no significant gender differences.A
published in the Winter
Journal of Athletic Training3 suggested that girls were much more susceptible to concussions in sports like soccer and basketball than boys,Two more recent studies suggested that, while the concussion rate for girls in soccer was higher (33.0 per 100,000 AEs versus 19.2 per 100,000 AES in the
school year),8
the concussion rate for basketball was actually higher for boys (21.2) than girls (18.6).A more recent study of high school sports10 found that the concussion rate for girls’ basketball (21) was higher than that in boys’ basketball (16) and soccer (34 versus 19).Whether female high school athletes are more likely than male athletes for have symptoms that persist longer than 7 days is also unclear.
While a 2011 study8 found such a gender gap,
a 5, reported no gender difference in the time symptoms took to clear or in the time athletes took to return to play.
A study conducted by researchers at Vanderbilt published in late 201214 found that girls did not appear to be worse off after sports-related concussion than boys, either in terms of concussion symptoms or on
measuring reaction time and visual memory. The only significant gender-related difference the study identified was that female high school soccer players reported a greater number of , although their total symptom score, when the symptoms were ranked on a 6-point scale for severity, were not statistically different from those of the male athletes.The reason for the higher concussion rate for girls, if one exists at all, are unknown, although some have theorized that female athletes have
and a small head mass than male athletes5,10,17,18 or that male athletes are
concussions for fear of being removed from competition, which may result in the well-documented underestimation of the incidence of concussion among boys,6,15,16,17, 18
and that female athletes may be generally more honest about reporting injuries than male athletes, a reporting bias resulting in a greater proportion of boys’ concussions going undiagnosed than girls’, thereby misrepresenting girls as having higher concussion rates.10,17,18 A third explanation for gender differences in concussion may be possible hormonal factors, such as the protective effect of estrogen in males.17,18Multiple concussionsThe percentage of high school athletes sustaining a concussion who had previously sustained a sports-related concussion either that season or in a previous season is holding steady at about 11%:in two studies released in 2011, the 4 covering the 11-year period from 1997 to 2008 at high schools in one large suburban school district, each with an athletic trainer, and the second8 covering the
school year for a representative sample of U.S. high schools with athletic trainers, both found that 11% of concussions in the high school sports studied werthe most recent study of concussions in high school sports10 reported that 11.5% of concussions were of the recurrent variety.almost 20% of concussions in boys’ wrestling were recurrent concussions.10Once an athlete has suffered an initial concussion, his or her chances of a second one are 3 to 6 times greater than an athlete who has never sustained a concussion.Slightly more than a third of high school players in one recent survey who reported two or more concussions within the same school year.8High school athletes who suffer 3 or more concussions are at increased risk of experiencing loss of consciousness (8-fold greater risk), anterograde/post-traumatic amnesia/PTA (reduced ability to form new memories after a brain injury) (5.5-fold greater risk), and confusion (5.1-fold greater risk) after a subsequent concussion.Children who are seen in a hospital emergency room for a head injury, concussion, skull fracture or intracranial injury) are more than twice as likely to sustain a subsequent head injury of similar type within 12 months as are children seeking care for an injury not related to the head, regardless of their age.Recovery time variesA 2007 study found that:post-concussion symptoms resolved in 3 days or less in more than 50% of the high school athletes in sports other than girls’ basThe same study found that more than 50% of athletes returned to play in 9From 30 to 80 percent of those athletes who have sustained concussions still had post-concussion signs and symptoms (e.g. are symptomatic) three months about one in seven were still symptomatic after one year.The most recent study of U.S. high school athletes covering the
period showed that in more than 40% of athletes in 18 of the 20 sports studied (all but girls’ swimming and girls’ track) concussion symptoms resolved in 3 days or less, but that, although approximately one-fourth of all athletes studied had concussion symptoms resolve within a day, 2% returned to play the same day, a practice in clear violation of the current consensus statement on sports-related concussion,11 which recommends that no adolescent athlete who sustains a concussion should return to play on the day of injury.
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