Guest Post: Is “Preventing Concussions” False Advertising?
Necessity is the mother of invention. Is it necessary to try and prevent concussions in sports? Absolutely! Recent events have made it more necessary than ever. So then let’s invent something to prevent them, right? Well many people have tried to do just that. We are now seeing a wave of products, new technologies, safety equipment and supplements all specifically designed and marketed to prevent, reduce or cure concussions. But while these ideas are all well-intentioned, are these claims really valid? Let’s take a look.
Let’s start with the definition of concussion. Here it is as defined by the Summary Agreement Statement of the 1st International Symposium on Concussion in Sport (2001):
“Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathological and biomechanical injury constructs that may be used in defining the nature of a concussive head injury include: 1) Caused either by a direct blow to the head, face, neck, or elsewhere on the body with an “impulsive” force transmitted to the head. 2) Typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. 3) May result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury. 4) Results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. 5) Typically associated with grossly normal structural neuroimaging studies.”
Ok, it’s a long-winded definition but let’s take a look at feature #1. It can be caused by a direct blow to the head OR elsewhere on the body with an impulsive force transmitted to the head. What does that tell us? It tells us that it is not trauma to the skull that causes a concussion. What causes the concussion is the transmitted force to the brain. It could be transmitted via the skull, but it could also be transmitted from the face, neck, chest, etc because of the “whiplash” effect to the brain. This means that you could make the best helmet in the world with all kinds of high tech materials and air cushion systems but it still won’t prevent a concussion because the force comes from somewhere other than what the helmet is protecting. For example, take the boxer who gets hit by an uppercut under the jaw and gets knocked out. Would wearing a helmet have made a difference? No because nothing ever hit the boxer’s head. So what then is the helmet actually protecting? It’s protecting the skull. It’s reducing the risk of skull fractures and other skull injuries. So how does it protect the brain? Let’s look at some other analogies to better understand this.
If you take an egg and shake it around, what happens to the yolk inside? You may not damage the shell by shaking the egg but the yolk moves around freely due to the acceleration and deceleration forces from the shaking. This motion of the yolk within the shell damages the yoke as it bangs up against the shell. You could put a little helmet on the egg but the yolk still isn’t protected. The same thing occurs in the brain. The brain moves within the skull due to acceleration and deceleration forces. This can cause shearing of blood vessels and it can cause damage to brain cells. You can also think about it in terms of a car accident. If you are driving along at 60mph and hit another car, what is it that protects the passengers? Is it the hard steel frame of the car or is it the seatbelt and airbags inside of the car? Without the seatbelt and airbags the passengers would move around inside of the car and be injured even if the outer steel frame wasn’t significantly damaged. So then what we really need to prevent concussions are seatbelts and airbags for our brains inside of our skulls. Here’s one more example to make it clear. Shaken baby syndrome is caused by shaking a screaming baby back and forth to make them stop crying. Even though their head never hits anything, the shaking leads to brain damage. Would wearing a baby helmet have helped? Of course not. So how can a helmet possibly eliminate concussions in football. It can’t. Any protective device that claims to prevent concussions in a contact sport is false advertising and may be giving athletes a false sense of security. How can athletes be well informed of the risks they are taking when the advertising by equipment manufacturers minimizes the risks? The only way to prevent concussions is not to step on the field in the first place.
How about the claims to reduce concussion risks? The idea is that the helmets reduce the forces that are transmitted to the brain during a direct hit to the head and therefore reduce the risk of concussion. Is this true? Well in order to answer that we would first have to know what the forces are that cause concussions and how they do so. Is there a threshold of G-force that is required to cause a concussion? Are longitudinal force, axial force and rotational force all equivalent or is one worse than the others? Is there a certain area of the brain that is more susceptible to lower forces or different types of forces than another? Unfortunately we still don’t know the answers to these questions. Until we do, it is impossible to say with certainty that we can reduce concussion risks by using a certain type of helmet or other head, jaw or dental protection. We also can’t rely on a force sensor to tell us when a concussion has occurred because we don’t fully understand the correlation between all force types and concussions.
What about tackling technique? Can this prevent or reduce concussions? Certainly teaching athletes not to lead with their head can reduce certain direct head impacts. But as we learned above, even the impact to the chest or other part of the body can cause a concussion. Proper tackling technique also can’t stop the player being tackled from hitting their head against the ground and causing a concussion. Is proper tackling technique important? Of course it is. Will it prevent concussions? Of course not. Will it reduce the incidence of concussions? We hope so. Concussion rates in high school are about 20% compared to only about 10% in college and the NFL. We believe these differences are due to poor tackling technique in high school as well as smaller neck size and muscle mass so that there is less ability to absorb the transmitted force to the brain. Thus, we can hope that by improving tackling technique and proper conditioning, we might be able to lower the high school concussion rate so that it approximates college or the NFL. This 10% reduction could be significant, but it has yet to be seen.
Finally what about curing concussions? The only proven treatment is physical and cognitive rest to allow the brain to recover on its own. We are very hopeful that there may be interventions we can perform to assist the brain in recovering more quickly. Supplements such as omega 3 fatty acids may be of benefit to brain function and recovery. Increased oxygen availability (I.e. hyperbaric oxygen chamber) may also benefit the brain. However, as of yet we do not have any prospective randomized clinical studies to prove that these things work. Any supplement or treatment that is directly marketed to treat or cure concussions is misleading. Although there may be some benefits, we must be careful that we do not use these treatments in lieu of physical and cognitive rest and we do not return athletes to play before they are ready.
Necessity IS the mother of invention and we will now be seeing the market get flooded with inventions that are necessary to stem the tide of the concussion crisis in sports today. New technologies and new ideas will continue to develop and concussion prevention applications will take on avenues that we hadn’t even previously considered. We will see helmets made from all kinds of materials, with built in sensors and airbags to minimize impacts and indicators to warn us when we should evaluate an athlete for a concussion. Are these ideas all well intentioned? Of course they are. Are they going to help reduce head injuries? I hope so. Are they going to prevent concussions? Absolutely not. The devices are well-intentioned. The marketing is not.
Dr. Andrew Blecher is a Board Certified Sports Medicine physician at the Southern California Orthopedic Institute. He provides concussion management for both amateur and professional athletes including youth sports, high school and college, and he also has experience as a physician in the NFL as well as for the Los Angeles X-Games. He is a Certified ImPACT Consultant and has lectured extensively on concussions from hospital grand rounds to national conferences. By providing continuing education to other physicians, athletic trainers, coaches, parents and athletes, he strives to improve concussion awareness and prevention. Dr. Blecher is also the Director of the SCORE Concussion program which, in partnership with the Wells Fargo Play it Safe Program, provides comprehensive concussion insurance coverage for 10 Los Angeles area High Schools.
You can also follow him on Twitter for the latest concussion information: @the_jockdoc
If you have purchased sporting equipment that was marketed as a “concussion reduction device,” I would like to hear your story. Please email me at PaulD_Anderson@me.com
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