Helmets, mouthguards: Is there 'concussion-proof' equipment for fall sports?

As the fall sport seasons begin to get underway, my colleagues and I often asked if head protection can prevent a concussion while engaged in play. Since most head protection-related questions around fall sports are directed at football and soccer, this piece will deal primarily with those two sports. 

Let’s dive right in.

Do Helmets Prevent Concussions?

The simple answer is no. Though there have been significant advances made in the technology and science surrounding football safety, there is no helmet on the market that is 100% concussion proof.

However, helmets obviously have safety value in sports. A quality helmet protects a player’s head from feeling force directly on their brain, which is key in preventing neurologically-significant injuries. That’s because the hard outer shell of the equipment is designed to stop anything from actually hitting the skull, which in turn helps the athlete stay healthy - as long as it’s properly fitted for the player wearing it.

When fit poorly, helmets have been shown to increase the incidence of concussion. A helmet that is too tight on the skull can cause headaches, which hinders the ability to focus on the game and can have longer term impacts on the brain. Conversely, a helmet that is too loose fails to do its job at protecting the brain as it can come off or become tilted at an awkward angle mid-play and lead to a severe injury. Loose helmets are tied to the highest rates of concussion symptoms among young athletes – their concussions were shown to last longer and be more severe. 

How Do I Know a Helmet Is Safe To Use?

Schools generally provide the helmets that are worn by their football players, especially in public-funded school systems, which make up about 90% of the student body across the country. And due to an increased lack of funding across school districts across the country, most end up using refurbished helmets that have been worn by previous players and can be upwards of 10-15 years old in many states.

The CDC has ruled that 10 years is the maximum length of time that a helmet should be used from the date of manufacture. Helmets used in middle and high schools are required 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. 

But while some states are beginning to impose more strict rules around football helmets and the lengths they go to refurbish them (Texas prevents schools from using helmets that are more than 16 years old, regardless of reconditioning), many states lack real regulation or even data around this type of safety. 

For parents or players looking for clear distinction between a quality helmet and one with only marginal differences in safety, the STAR System, developed at Virginia Tech, has looked at several of the new “concussion proof” helmets and have ranked them according to safety. These guidelines can give coaches and parents some objective data concerning these newer helmets. Rankings can be found on the Virginia Tech Website. 

Does Soccer Headgear Prevent Concussions?

While we are on the topic of head protection, my colleagues and I are often asked about our opinion on soft helmets/head gear in soccer as they relate to concussion prevention.

Their use is a source of controversy and debate in the medical profession. Data that has been studied independently has shown that head bands and headgear in soccer does prevent lacerations and other soft tissue trauma, but they do not do much to protect against concussions. In fact, possibly even 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 - the athlete feels he or she is more protected due to the use of these devices, and therefore is more likely to put themselves in harm’s way.

The National Federation of State High School Associations (NHFS) 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. 

Do Mouthguards Prevent Concussions?

No, mouthguards do not prevent concussions. However some athletes, both amateur and professional, believe that they do, which may be adding to swell of folks who share the same beliefs as it pertains to contact sports.

The truth is that back in 2009, top neurological experts disproved the notion that mouthguards help prevent the occurrence of concussions, pointing out that no credible research demonstrates the claim to be true. Regardless, many athletes hold firm beliefs that wearing a mouthguard functions as a shock-absorber against strong impact around their head. For example, Jamie Lundmark, a center for the Calgary Flames, has said "I think it helps concussion injuries, biting down on [a mouthguard] takes pressure off the jaw and the shock to the brain."

So although disproven, the myth itself still serves to put tens of thousands of athletes at risk of unknowingly putting themselves in danger by being miseducated on the safety benefits that come with wearing a mouthpiece. 

We recommend all players and athletes do their research before engaging in contact sports and take all necessary precautions to protect their head from serious injury.

Robert Franks, D.O., F.A.O.A.S.M. is a board certified, family practice physician with a certificate of added qualification in Sports Medicine at Rothman Orthopaedic Institute. He specializes in medical orthopaedics, sports medicine, and is one of the nation’s leaders in sports-related concussion management.

Dr. Franks serves as an Associate Professor at Thomas Jefferson University as well as a Clinical Associate Professor at Rowan University School of Osteopathic Medicine.