Helmet Safety – Do we know the truth? – Carl W. Nissen, MD

Participation in sports at all levels carries with it an inherent risk of injury.  Over the last decade, the issue of head trauma has expanded tremendously as the risk of and long-term effects of head trauma and concussions has become better understood and recognized.  The issue of head trauma and the use of helmets is not new and is not limited to football.  Football helmets were initially implemented to reduce the risk of skull fractures and lacerations.  Even as helmets have become better engineered and manufactured, their ability to do more than protect from skull fractures has not been established.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) was established in 1970 and along with other organizations perform helmet testing on new and reconditioned helmets yearly.   The Safety Equipment Institute (SEI) is the independent certifying body that provides third-party certification on helmets to determine if each helmet meets the NOCSAE standard.  At this time, NOCSAE certifies and recertifies helmets used in football, baseball, softball, ice hockey, and lacrosse.  The NOCSAE testing for football helmets is a bit more extensive and defined.  Testing for these helmets consists of twin-wire testing which uses gravity to accelerate helmets to test impact absorption at different speeds and temperatures.  In 2016 testing, has expanded to utilize a pneumatic ram impactor that allows impacts to be delivered in locations and directions that the previous testing protocols did not allow.

The testing has led to the inevitable ranking of helmets.  One of the first of these rank-lists that gained traction was published by researchers at Virginia Tech.  Since then many other organizations have created rankings as well including the NFL.  These rank lists are based on valid testing conditions and protocols.  The intuitive implications of the rank-list are that the top-ranked helmet will protect an athlete better than the others is not correct. Traditional football helmet testing evaluates linear or straight-line impact onto the helmet.  However, the majority of concussions are caused by rotational forces.  A helmet’s ability to absorb rotational forces are related to helmet fit as well as the helmet material.  Typically, the rotational forces leading to concussions occur at lower forces/speeds which are better absorbed by helmets with more give.  Not the typical high-impact helmet materials currently in use.  So while the improvement in testing that the pneumatic ram impactor provides, testing still cannot assure prevention or determine the absolute difference in the protection of one helmet versus another.

The real-life protection that a helmet provides an athlete is determined by many factors the most important of which is helmet fit.  It is imperative that athletes, parents, coaches, and equipment personnel make sure all protective equipment and in particular helmets are properly fit and worn.  Specifics and education on this can be found at:

The concerns regarding head trauma and specifically concussions are valid and are continuing to drive prevention research on many levels.  Rule changes, enforcement of the rules, and reducing exposures along with improved helmet safety are important avenues to pursue.  Positive steps have been made over the last decade but there is still more we need to understand.  Among the issues is an important realization that helmets are not able to prevent concussions.  Certainly, while we all hope that might one day be possible it does not appear to be likely.

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