Caroline Helwick

October 31, 2013

ORLANDO, Florida — No one brand of helmet is better than another for reducing the risk of football-related concussions, despite many manufacturer claims, according to a study of different helmet brands used by more than 1300 high-school football players. The study also found that generic mouth guards are more protective than custom-fitted devices.

"Lower risk and severity of sports-related concussions were not associated with any specific helmet brand," said Margaret Alison Brooks, MD, from the University of Wisconsin at Madison. If it doesn't reduce concussion risk, newer and more expensive equipment might not be worth the extra cost to families and schools, she suggested.

Dr. Brooks presented the findings here at the American Academy of Pediatrics 2013 National Conference and Exhibition.

Each year, approximately 40,000 sport-related concussions occur in high schools in the United States. According to Dr. Brooks, equipment manufacturers often cite so-called laboratory research suggesting that their helmet is superior to competitors' helmets in lessening impact forces.

The suggestion is that "current helmets are heavier, larger, and designed to absorb and dissipate impact forces more than earlier models, and this provides better protection than older, reconditioned helmets," she explained. "Schools and parents, therefore, are encouraged to purchase newer, more expensive equipment."

This study is very revealing because it identifies a need for better sports equipment that can protect the brain from trauma.

Dr. Brooks and her team conducted a study to test newer and older football helmets made by different manufacturers and various mouth-guard brands, including custom-fit mouth guards, for their ability to prevent sport-related concussions.

The study involved football players in grades 9 to 12 during the 2012 football season from 36 high schools. Median age was 16 years. Players completed a preseason demographic and injury questionnaire, and athletic trainers recorded the incidence and severity of sports-related concussions throughout the year.

Helmets in the study were manufactured by Riddell, Schutt, or Xenith, and were purchased from 2002 to 2012. Mouth guards included generic models provided by schools (61%) and specialized mouth guards (39%) custom-fitted by dental professionals or specifically marketed to reduce sport-related concussions.

A total of 115 players (8.5%) sustained 116 sport-related concussions. Of these, 78 occurred during competition and 38 occurred during practice. There was no difference in age or body mass index between players who sustained a concussion and those who did not. The incidence of concussion was also similar across high school grade and competition levels.

The study found no difference in the concussion rate based on type of helmet worn or year the helmet was purchased. The severity of the concussion, based on number of playing days lost, was also no different for players wearing the different helmet brands, Dr. Brooks reported.

Table. Rate of Concussion Based on Helmet Type

Helmet Manufacturer or Year Purchased Sport-Related Concussion (%) Median Playing Days Lost
Riddell 9.5 13.5
Schutt 8.1 13.0
Xenith 6.7 13.5
2002–2008 8.8
2009–2010 7.9
2011–2012 9.3


The concussion rate was actually significantly higher for players who wore a specialized or custom-fitted mouth guard than for those who wore a generic mouth guard (12.7% vs 6.4%), with a relative risk of 1.9 (< .001).

Asked by Medscape Medical News to comment on the study, Tanzid Shams, MD, a pediatric neurologist who is director of sports neurology at the Floating Hospital for Children at Tufts Medical Center in Boston, said that "with all of the controversy surrounding sports concussion, this study is very revealing because it identifies a need for better sports equipment that can protect the brain from trauma."

He pointed out that "contact sports are built into the ethos of American life. Going forward, I believe there is a strong need for further research in the area of athletic gear that provides better head protection. The National Football League recently announced a $10 million fund to stimulate innovation in helmet technology. With such a growing demand, we are bound to see newer technology in the marketplace."

According to Dr. Shams, one of the new heavily marketed technologies are impact sensors, which manufacturers claim can track the frequency and severity of hits. Some of the entry-level sensors cost about $150.

"By mid-season, this year's NFL teams are already going to gear up with impact sensors that send data from their helmet and mouth guard to a handheld tablet," Dr. Sham explained.

If the NFL and collegiate teams adopt the technology, high schools will most likely follow suit, he said.

"The more interesting question," he added, "is how to analyze these data to come up with specific guidelines or rules of play. The next step will be to determine whether there is a correlation between impact frequency and severity and clinical symptoms of concussion."

Dr. Brooks and Dr. Shams have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition. Presented October 28, 2013.


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