It seems with two days in full swing it has been harder than expected to get this post written and a week has passed too quickly. Shortly before my last post, Dustin Fink of the concussion blog posted a great resource that he had found regarding the myths of TBIs written by Don Brady and Flo Brady that include a lot of other false ideas commonly perpetuated about TBIs. All of these myths are compiled into one pdf file for easy reading.
However, I believe that there is one myth that was left out of the document. The idea that a better designed helmet will prevent all concussions is one that continues to be thrown around at an irritating rate. This is the myth that has even driven many in Congress to pass laws to require better headgear for football and other sports. A waste of time on Congress's part, to be sure. Of course helmet manufacturers are going to continue to pursue better helmets. If they want to remain in business, the competition amongst the manufacturers is going to drive this without any government interference.
The problem isn't looking for the ideal helmet. The problem exists in the anatomy of the human head. The brain is not fixed to the inside of the skull, but instead, it is suspended in cerebral spinal fluid. It is floating inside the skull in fluid. Sudden accelerations and decelerations of the head will cause the brain to shift inside the skull and collide with its interior wall.
The best analogy that I've seen for this is the comparison to a raw egg. It doesn't matter how much padding I add to the exterior of the egg to prevent the shell from cracking. If I shake the egg hard enough, the yolk will collide with the interior of the shell and eventually become beaten inside the shell.
The truth of the matter is that helmets were originally designed to reduce the incidence of skull fractures, not TBIs. When in 1905, the Chicago Tribune ran the headline "18 FOOTBALL PLAYERS DEAD AND 159 SERIOUSLY INJURED!" President Theodore Roosevelt proclaimed that football needed to change the rules or be banned. This led to the changes requiring helmets be used. Unfortunately, as helmet technology improved, players began to develop a false sense of security and started using their helmets as weapons. This included three kinds of hits. Butt blocking (leading with the head and making initial contact with the facemask to anybody except the ball carrier), face tackling (a butt block to the ball carrier), and spearing (leading with the crown of the helmet to make contact rather than the facemask) were all made illegal in 1976 due to the rapidly increasing number of neck fractures and head injuries. Spearing has been called consistently since that time, however butt blocking and face tackling have not. Further compounding the problem is the ESPN highlight reel that glorifies those hits from Saturday and Sunday games. This has quickly filtered down to lower level games as well and we see kids from elementary school to high school trying to make the same "highlight reel hits". This is what has led to the recent, rapid rise in mTBIs in the football and other collision sports.
This is not to say that creating a better helmet is a futile effort and should be abandoned. Any helmet improvements that can reduce the risk should be pursued and implemented. However, we need to realize that the risk is still present in football and other sports and that there is no "concussion-proof helmet." The effort to reduce these injuries in football have to be from many angles including rules enforcement and sportsmanship as well as improving helmet design.
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