No good evidence that helmets prevent concussion

Helmets can help prevent other injuries, but not concussion, researchers say.
Helmets can help prevent other injuries, but not concussion, researchers say. © Mike Bain

Mouthguards and helmets can help ward off other serious head and facial injuries, but there is no reliable evidence that they can help prevent concussion, experts say.

Paradoxically, such protective equipment may even encourage wearers to take greater risks, they warn.

That is precisely why it is important to recognise and treat symptoms of concussion promptly, according to the latest Consensus Statement on Concussion in Sport, published in the British Journal of Sports Medicine.

The statement is the fourth revision of recommendations first developed in 2001 in Vienna, in a bid to offer some practical and evidence based guidance to healthcare professionals on the on-field assessment of the condition, and one of the most important aspects of its treatment – the timing of the return of participants.

In high profile sports, team doctors are under pressure to get players back into competition as quickly as possible, but safe return to play after concussion is a key issue across all sports, irrespective of whether they are played at elite level.

This latest version of the statement, which has the backing of the International Olympic Committee, the FEI, football’s world governing body FIFA, and the International Rugby Board, was drawn up after a two-day meeting in Zurich, Switzerland, last November.

Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilised in defining the nature of a concussive head injury include:

  1. Concussion may be 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. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.
  3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
  4. Concussion results in a graded set of clinical symptoms that may or may not involve loss of consciousness.

Resolution of the clinical and cognitive symptoms typically follows a sequential course. However, it is important to note that in some cases symptoms may be prolonged.

Over the course of the two days, researchers from around the world were invited to present the latest findings on this common type of brain injury, which has the potential to cause long-term neurological damage if not dealt with appropriately, particularly in sports such as football, rugby, ice hockey, horse riding, skiing, and boxing, where the risk of concussion is high.

A panel of 32 international experts then distilled the research – details of which are published in the current Injury Prevention and Health Protection issue of the British Journal of Sports Medicine – until complete agreement was reached.

The consensus has been designed to raise awareness of concussion among the public, so for the first time includes a concussion recognition tool (CRT).

It clarifies the definition of concussion to emphasise that a person does not have to lose consciousness before being considered concussed and therefore removed from a sporting event. Symptoms of concussion can range from headache and memory loss to irritability, slowed reaction times, and sleep disturbance, it says.

It contains a new focus on the assessment and management of concussion in children, who should not be returned to play the same day and who may require longer to heal than adults, it says.

It also provides a useful question and answer section, a handy pocket symptom checker and assessment tool, as well as advice on medico-legal considerations and injury prevention.

It makes clear that mouthguards and helmets have a role in minimising injuries and are to be recommended, but emphasises: “There is no good clinical evidence that currently available protective equipment will prevent concussion.”

It continues: “An important consideration in the use of protective equipment is the concept of risk compensation … where the use of [this] equipment results in behavioural change, such as the adoption of more dangerous playing techniques, which can result in a paradoxical increase in injury rates.”

While the competitive/aggressive elements of some sports make them fun to play and watch, “sporting organisations should be encouraged to address violence that may increase concussion risk”, it recommends.


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