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10/19/2015

Helmets and the illusion of safety

Concussions & Sports–Legal & Ethical Review: Part 9
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Equipment manufacturers claim that their gear reduces the risk of brain injury without proof


The authors of the youth sports and public health section of The Journal of Law, Medicine & Ethics' sports issue 25 note that, despite a lack of evidence, hockey helmet manufacturers continue to tout safety claims that they cannot back up with evidence. “Kevin Walter of the American Academy of Pediatrics’ Council on Sports Medicine and Fitness recently stated, ‘At this time, no protective equipment can prevent concussion.’” Still, makers state that their products defend against mild Traumatic Brain Injury (mTBI). This creates a dangerous false sense of security among parents purchasing this equipment for their youth hockey player.

Equipment safety claims, rule changes, and new guidelines can often have a perilous side effect. They promise a perceived increase in safety even in cases where that increase isn’t supported by science. But the perception is often enough of a motivator for a parent to allow a child to participate in activities for which there is a real risk of mTBI.

This (il)logic falls under the umbrella of “risk frame,” in which The lack of real evidence to support this impression tends to fall into the background for a child or parent sufficiently motivated to participate in a dangerous pastime. In the words of the authors, “The current reliance on helmets, rule changes and return-to-play guidelines as mTBI prevention strategies reflect the view that these risks, even if inherent, can be mitigated to an acceptable level.”

A Virginia Tech University research study of hockey helmets found that one in four are not reducing concussion risk at an acceptable level.26 Football helmets fared better in the study.

The Cleveland Clinic makes a clear statement on a helmet’s ability to protect against concussion. “Helmets don’t prevent concussions,” says ATC Bob Gray of the Cleveland Clinic. “The best protection is proper hitting, tackling and blocking technique.”27 That said, the Clinic notes that a properly fit and conditioned helmet can mitigate other injuries, such as skull and facial fractures.

The helmet issue has unveiled some odd practices that, in retrospect, seem absurd. As an example, Florida requires boys lacrosse players to wear helmets. According to the governing agency for youth lacrosse, US Lacrosse, girls are not permitted to wear the same style of hard helmet as the boys.28

Dr. Patrick A. Caruso, who is spearheading a movement to change this rule, said, “My colleagues and I are seeing an increasing number of head injuries in all amateur sports, with women’s lacrosse making up a significant proportion of these incidents.”

Dr. Caruso put forth an argument that illustrates the absurdity of the lacrosse authority’s position. “The excuse put forth by US Lacrosse is that if helmets are required the game will become more aggressive. That is not only a sexist viewpoint, it is like saying putting vests on our police officers will cause the criminals to shoot at them more.”

To prove the point, he pointed to a 2007 study in the Journal of Athletic Training that found a majority of neck injuries in women’s lacrosse result from stick contact.

At least one helmet manufacturer has chosen to err on the side of open and honest disclosure about the role helmets play in concussion safety. “No helmet system can prevent concussions or eliminate the risk of serious head or neck injuries while playing football,” reads the pop-up window one encounters at the homepage of Schutt football helmets.29 “No helmet system can protect you from serious brain and/or neck injuries including paralysis or death. To avoid these risks, do not engage in the sport of football.”

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25Kathleen E. Bachynski, M.P.H., M.Phil., and Daniel S. Goldberg, J.D., Ph.D., “Youth Sports & Public Health ,” The Journal of Law, Medicine & Ethics, 42:3 (2014): 323 - 333.
26Why You Should Take A Second Look At Your Child’s Hockey Helmet Today,” last modified March 31, 2015, http://www.huffingtonpost.com/2015/03/30/hockey-helmets-safety-study_n_6....
27“Choosing a Football Helmet: 6 Tips for Best Protection,” last modified May 20, 2015, http://health.clevelandclinic.org/2015/05/choosing-a-football-helmet-6-t....
28““Flanders pediatrician butts heads over helmets and girls lacrosse,” last modified May 1, 2015, http://www.newjerseyhills.com/mt_olive_chronicle/news/flanders-pediatric....
29www.schuttsports.com.

A Legal & Ethical Review of CONCUSSIONS & SPORTS
A Legal & Ethical Review of CONCUSSIONS & SPORTS
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