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NCAA committee clarifies headgear issue

Increase in ‘soft headgear’ does not mean decrease in concussion concern

By Brian Hendrickson

The Louisville men’s basketball team drew curious eyes last spring when they stepped onto the Superdome floor for the Final Four in New Orleans, looking prepared for boxing practice rather than a hoops shoot-around.

Several players wore helmets that covered the tops of their heads, wrapped around their forehead, and covered their ears. They’re typically used in Mixed Martial Arts, but the Cardinals were trying them out as a possible way to reduce their student-athletes’ risks of concussion.

The equipment drew the interest of the crowd and media as a unique practice safeguard. But in the months that followed, the use of soft headgear has expanded beyond practice precautions and into game situations, where some student-athletes and parents expect the equipment to protect against concussions.

Since that time, the NCAA has seen an increasing number of waiver requests from NCAA student-athletes competing in various sports in which headgear is either prohibited by playing rules or is not intended for the sport. The increased interest in wearing soft headgear across sports to prevent concussion raised questions about the use of products that medical researchers say offer little – if any – protection from a concussion.

“They just don’t do what people think they’re going to do,” said David Halstead, technical director of the Southern Impact Research Center. “It’s interesting: If you allow people to use them, then people ask why you don’t mandate them. But they’re not mandated because they don’t work.”

The issue became a topic of concern during the December meeting of the NCAA’s Committee on Competitive Safeguards and Medical Aspects of Sports (CSMAS). At that time, the committee approved the development of a policy statement to address misperceptions that the equipment provided protective benefits against concussions. The CSMAS also made clear that the NCAA would not provide medical waivers for the use of the equipment to prevent concussions in order to medically clear student-athletes for play.

“We are not rewriting the playing rules for the sports; they are the same as the beginning of the year,” said NCAA Director of Health and Safety David Klossner. “The committee wanted to clearly state that these devices should not be used to permit medical clearance of a student-athlete to play their sport for the prevention of concussions or if they would otherwise not be medically cleared to participate due to a concussion.”

In a position statement about the headgear's use the CSMAS pointed to the equipment’s inability to prevent the typical forces that cause concussions, such as the sudden acceleration or deceleration of the head that causes brain injury. That can be caused, in both helmeted and non-helmeted sports, by a collision with the playing surface or another athlete’s body, such as a head or elbow. Such forces that move the head back or forward, or even rotate it, can lead to a concussion.

Michael Oliver, the executive director and legal counsel for the National Operating Committee on Standards for Athletics Equipment (NOCSAE), said soft headgear can’t stop that whipping type of impact. He said the soft padding in the headgear – the most popular of which are the size of a large headband – doesn’t distribute the energy of a collision over a wide enough area to stop the direct impact, nor can it prevent the head from rotating.

“It can’t address it from a physics standpoint,” Oliver said. “We have a good understanding of what we’re trying to protect against. And when you know that, you understand that soft headgear does not address those forces that are likely to cause a concussion.”

Oliver said he understands why players seek to use the equipment, though. Recent media coverage of concussions has raised questions about the affects of the injury and raised fears about its long-term health risks. Those concerns can lead student-athletes and their parents to seek protection.

If they discover some popular headgear products, their description can build an impression of high-tech protection. Phrases that promise to guard against “concussive head impacts” using “cutting edge technology” with features like “ForceBloc Foam” can lend a sense of security. But there is no established standard for the use of soft headgear for the purpose of preventing concussion. And researchers say it’s mostly a creative sales pitch. For example, concussive head impacts aren’t the same as a concussion; and the cutting edge technology hasn’t been conclusively proven by scientific studies to reduce the risk for concussion.

“The wording on these things, it’s a work of genius,” said Steve Broglio, director of the Neurotrauma Research Laboratory. “Even if you have some background in this area and you read it, you go, ‘Oh yeah, this is going to do it.’ But you’ve really got to look at what you’re reading.”

There may also be additional psychological risk in using the equipment.

The CSMAS cited the potential for developing a false sense of security when athletes use the soft headgear, raising the potential that they might dive after balls – where their heads can make contact with the playing surface – or play more physically aggressive than they otherwise would. The CSMAS also expressed concern that the use of headgear may lead to a sense that the medical condition has been addressed, and place less importance on avoiding head impacts, or allowing the athlete to return to play before fully recovering.

Researchers said that concern, while largely anecdotal, has merit.

“Some protection, even though it may be minimal, tends to be misunderstood by the people who are getting the protection,” Oliver said. “There’s a sense of, ‘I’m safe. I’m protected.’ Once you have that mindset, you’re not doing things to prevent another concussion.”