As the popularity of contact sports continues to grow, concussion prevention is becoming a hot topic. With millions of youth athletes in the U.S. reporting concussions each year, it’s a significant concern for families, sports organizations, and schools looking to enhance safety in high-risk sports. Headgear is often required or highly recommended in sports, where collisions are just part of the game.

With advancements in technology, education, and safety standards, new protective gear is constantly hitting the market. For example, the NFL recently introduced the “guardian cap” helmet cover to help reduce concussion risk and related injuries. 

But the big question remains: 

• “Do helmets and headgear really prevent concussions?”

In this article, we’ll dive into the latest evidence on how concussions occur, breaking down the science to make understanding what works in prevention easier. Once we know the mechanism of a concussion, we can better explore the role of helmets and headgear and evaluate their effectiveness. Finally, we’ll look at emerging strategies and innovative approaches to help reduce the risk of concussions. 

So, let’s explore the current evidence and see what the science says!

What Causes a Concussion?

Structural overview

To understand concussions better, it’s helpful to know a bit about the brain’s anatomy. Our brains are made up of brain cells called neurons, which relay nerve impulses by way of exchanging molecules from the outside to the inside through gated channels to help us do everything—from thinking to moving. Each neuron has two main parts: the cell body (gray matter) and the axon (white matter). The axon is wrapped in fatty cells, like electrical tape around a wire, helping signals travel faster. Here’s the key: gray matter and white matter have different densities, and this difference plays a significant role in what happens during a concussion.(1)   

Mechanism of a Concussion 

A concussion happens when the brain experiences a force of around 70-120 G-forces. (2) While a direct hit to the head can cause this, it’s essential to know that a blow to the body can also result in a concussion. That’s right, you don’t have to be hit in the head to get one!

A concussion occurs when the brain rapidly accelerates and decelerates inside the skull. This sudden change in movement causes a shearing effect between the brain’s gray and white matter (which have different densities, as discussed earlier). This shearing doesn’t tear or structurally damage the cells but does open gated channels throughout them, causing a massive exchange of molecules. This results in millions of nerve impulses firing simultaneously, known as the “excitatory phase” of acute concussion, which explains the immediate symptoms like confusion, dizziness, headache, or even loss of consciousness. (1,3)

This newer understanding of concussions replaces the older “coup-contrecoup” theory, which suggests that the brain simply bounces off the skull, causing bruising and cell damage. Current evidence supports that the real cause is the rapid acceleration and deceleration of the brain, not the impact itself.

Do Helmets and Headgear Prevent Concussions?

So, do helmets or headgear prevent concussions? 

• The short answer is “no.” 

Helmets and headgear are great for absorbing very high impact and preventing skull injuries, but they can’t control the brain’s acceleration and deceleration, which leads to a concussion. Said differently, while they do protect the skull from fractures and more serious traumatic brain injuries, helmets don’t stop the brain from moving rapidly inside the skull – which is the primary mechanism of a concussion. 

A perfect example of this is when athletes suffer a concussion resulting from a body hit – not just a direct blow to the head. For example, a body check in ice hockey can generate enough force to cause a concussion even without direct head trauma, as the brain may still experience rapid movement within the skull.

The acceleration-deceleration mechanism is crucial because it explains why helmets and headgear are consistently ineffective at preventing concussion injuries in the research data.   

Soccer and rugby? What about American Football? 

A 2023 systematic review and meta-analysis on concussion prevention strategies used to inform the most recent Amsterdam Concussion Consensus found benefits for helmets in concussion prevention for American Football. (7) These authors found that:

• Helmets with complete facial protection were associated with significantly lower sport-related concussion rates in lacrosse. 
• Proper helmet fit may reduce concussion symptom severity and duration, as well as mitigate sport-related concussion odds in American football and ice hockey. 
• Some studies have also reported a lower rate of sport-related concussions with thicker helmet padding in American football, but these findings are not consistent across all studies.  

Despite these numbers, American football remains a “top 5” sport for concussion rates across nearly all epidemiological data (9-13). So, how do we effectively prevent concussions? 

Ways to Prevent Concussion.

Awareness 

The best way to prevent a concussion is to avoid the impact altogether. 

Solved. Right?

That’s not always easy, or even possible, in high-impact sports. However, there are specific strategies that can help. 

Techniques like heads-up tackling, proprioceptive training, and visual tracking/spatial awareness training teach athletes to see a hit coming and avoid it. For example, in 2014, Dr. Joe Clark at the University of Cincinnati demonstrated reduced concussion rates through vision training, which may have contributed to athlete preparedness for contact. (14) 

Related to preparedness, a key factor closely linked to concussion prevention is an athlete’s ability to stiffen their neck muscles at the appropriate time. Increased neck stiffness is the most effective way to prevent the rapid acceleration of the head, which is a significant mechanism in concussions. When an athlete braces for impact by tightening their neck muscles, it reduces the brain’s movement inside the skull. Since most concussions occur when a hit isn’t anticipated, training to improve awareness and reaction time can significantly lower the risk.

This concept is demonstrated in a 2018 study by Kerr et al. Among hockey players who reported concussions, 36.2% were injured from being checked, while only 5% were from delivering a check. This highlights that when athletes have time to brace and stiffen their neck muscles, they can reduce head acceleration and lower the risk of concussion. (5)

Training Strategies

Warm-ups also play a crucial role in prevention. For instance, Neuromuscular Training (NMT) warm-ups have been shown to lower concussion rates among rugby players of all ages by 32-60%, with just three sessions per week. (6)

Personal Protective Equipment

Early emerging evidence suggests some gear can also help reduce the risk. A study by Eliason P et al. (2022) found that using mouthguards led to a 28% reduction in concussion injuries among child and adolescent hockey players. More research is needed to determine if mouthpieces directly cause this prevention reduction. (7) 

Policy or Rule Changes

Policy and rule changes are another direct way to prevent concussions among sporting youth athletes. Again, Eliason P et al. (2022) found that a policy change of disallowing body checking in youth hockey prevented concussion by 58%. They also found that contact practice time and restricting the intensity of a contact in practice reduced practice-related concussions by 64% in American Football. (7)

Concussion Management 

Another key to preventing concussions is the proper management of diagnosed or suspected cases. The appropriate steps can help prevent further injury if a concussion is suspected. 

Effective management includes immediately removing the athlete from play, requiring medical clearance from a healthcare professional before returning to the field, and educating coaches, parents, and athletes on the signs and symptoms of concussions. 

Better detection and education can significantly reduce the risk of repeat injuries.

One of the most dangerous mistakes in concussion care is rushing an athlete back into play before they’ve fully healed. Tools like the sideline SCAT6 and pre-season baseline testing are essential for healthcare providers to assess (i.e., SCAT6) and establish when an athlete fully recovers (i.e., repeating baseline testing), ensuring a safer return to play.

Conclusion.

While helmets and headgear are essential for protecting against skull fractures and serious injuries, they do not prevent all concussion injuries. This is because concussions result from the brain rapidly accelerating and decelerating within the skull, a process that can be triggered even by impacts that don’t directly hit the head.

However, there are effective ways to reduce the risk of concussions. Incorporating body awareness training and warm-up strategies, using protective gear like mouthguards, and implementing safer policy changes can all play a significant role in concussion prevention. By combining these strategies, you can help keep athletes safe and continue enjoying sporting events.

Getting a preseason baseline at a Complete Concussions Clinic gives us a snapshot of an athlete’s healthy state, which is invaluable when deciding if they’re ready to return to play. Knowing what “normal” looks like for an athlete helps healthcare providers make safer, more informed decisions about when it’s okay to get back in the game.

If a concussion does occur, it’s crucial to visit a certified concussion clinic as soon as possible. Studies show that the sooner a trained concussion specialist evaluates an injured athlete, the quicker their recovery can be! And always remember the golden rule: if a concussion is suspected, “When in doubt, sit out.”