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THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 11 - NOVEMBER 2000


Will New Helmet Features Reduce Football Injuries?

Football helmets have changed little in the past 25 years. However, two recent developments—a lighter-weight helmet and a new warning label—are sparking medical interest because of hopes that each might reduce the risk of catastrophic injuries.

Helmets and Injury Reduction

The annual number of catastrophic football injuries peaked in 1968 when 32 deaths were recorded (1). The increasing injury trend for football—and other sports—prompted the formation in 1969 of the National Operating Committee on Standards in Athletic Equipment (NOCSAE) to set research priorities on injury reduction.

The 1973 publication of the first NOCSAE testing standard led to changes in football helmet design that are partially credited, along with rule changes and coaching, for an 84% drop in head and neck injuries between 1959 and 1990.

Robert Cantu, MD, chief of the Neurosurgery Service at Emerson Hospital in Concord, Massachusetts, says though catastrophic head injuries in football are at an all-time low, the injury trend has flattened. On average, there are four to five football fatalities per year. "More efforts must be made to further reduce the number of catastrophic head and cervical spine injuries," he says.

An Enlightened Design

Reducing the already low number of catastrophic head injuries wasn't the original intent behind the design of a new lighter-weight helmet (figure 1: not shown) marketed by Bike Athletic Company, based in Knoxville, Tennessee, which is being used this year in its first full season. However, those close to football are hoping that it may assist in reducing the number of cervical spine injuries by promoting proper tackling technique (ie, keeping the head up). "The new helmet is one-third lighter than the other three on the market," says Cantu, who is an editorial board member of The Physician and Sportsmedicine. "The hope is that the athletes will like it better and do a better job of keeping their head up, assuming that fatigue from the weight of the conventional helmet is why some athletes put their heads down."

Ed Christman, ATC, Bike's marketing director for protective sports medicine, says the lighter weight was achieved by using a thinner polycarbonate shell than that of other helmets as well as lighter- weight component parts. Other new features of the helmet that are designed to make it more comfortable for players are multiple ventilation holes at the top of the helmet and a shape that more closely contours to the head. Christman says the new helmet is targeted to youth, junior high, and varsity players and can be distinguished from other helmets by a ridge at the occipital region.

Cantu says the thinner polycarbonate shell plus a thicker inner liner appears to have the same energy attenuation as thicker counterparts, but he wonders how well the thinner material will hold up over multiple hits. "I'm interested in seeing this unfold, but there's no reason to believe now that it won't hold up over time—but only time will tell," he says. Christman says the questions about the thinner shell are understandable. "Any new product certainly comes under a lot of scrutiny," he says, noting that helmet reconditioners anticipate the life expectancy of the new helmet to be similar to others on the market.

A Better Warning Label

Helmet manufacturers have for many years placed warning labels on helmets to warn players about the risk of injury associated with playing football. However, the labels have not prevented companies from making large payouts stemming from product liability lawsuits. For this reason, it is difficult—and even legally risky—for existing companies to alter their warning labels.

Adams USA, based in Cookeville, Tennessee, recently introduced a youth and varsity helmet that features a revised warning label (figure 2: not shown), along with a helmet-fitting instruction booklet that elaborates on the risks of playing football, raises awareness of postconcussion symptoms, and encourages players to use proper technique. The company's new helmet models also feature a nearly identical warning label and fitting- instruction booklet.

Richard A. Sawin, Jr, an attorney and partner at Michienzie & Sawin LLC in Boston, has represented sporting goods companies for about 13 years and has worked closely with Adams USA to develop its warning label. "I had the luxury of starting from scratch with the warning label. I took my experience defending cases and combined it with feedback that I received about labels as well as information made available from the medical and sports communities," Sawin says. Cantu says the new label and helmet-fitting booklet are the first to specifically warn players about the risk of catastrophic injury or death from return to play while still symptomatic after a head injury.

The label is designed to make a meaningful impression on players, not just to legally protect the company, Sawin says. Sawin worked with a human factors (warnings) expert, who talked about football safety issues with young people. One result was a graphic symbol that is designed to quickly demonstrate improper technique. "You can't use the term 'axial loading' with kids, so we developed a pictogram," Sawin says.

The helmet-fitting booklet lists postconcussion symptoms and the dangers of returning to play when symptomatic in terms that young people can understand, he says. "Kids still don't want to tell when they're dinged. They love the sport," Sawin says. "We need to let kids know they're making a life decision when they make these [return-to- play] decisions on their own."

Lisa Schnirring
Minneapolis

REFERENCE

1. National Operating Committee on Standards in Athletic Equipment Web site
(https://www.nocsae.org/nocsae/HistPur.htm). Accessed Sept 19, 2000


Field Notes

Physician Gun Owners: Better Counselors?
In a report that seems timed to coincide with hunting season, researchers from Mount Sinai School of Medicine in New York City take aim at physician attitudes toward firearm safety counseling. The report was published in the October issue of the American Journal of Public Health.

Between 30% and 50% of American households contain at least one firearm. Several medical specialties have recommended that physicians counsel patients about firearm safety, but most physicians (75% to 90%) do not discuss the subject with patients.

The survey of 915 physicians (457 internists and 458 surgeons) found that physicians who are gun owners—almost a third of all physicians surveyed—are less likely than nonowners to think that physicians should counsel patients about firearm safety. However, the gun owners were more likely than others to actually counsel patients on the subject.

Why the paradox? The researchers proposed that physician gun owners may view firearm safety counseling as an endorsement of firearm regulation. They may, however, be more likely to counsel because they are aware of the hazards involved with firearms and, because of their knowledge about guns, feel more comfortable discussing the topic with patients.

Exercise Prevents Impotence
In a study believed to be the first of its kind, researchers report that physical activity may reduce a man's risk of developing erectile dysfunction (ED). The exercise level found to be effective was 200 kcal/day, which is the equivalent of walking briskly for 2 miles. The study appeared in the August issue of Urology.

The study group consisted of about 600 men who had not reported ED. When looking at the effects of various lifestyle changes the men had made over 8 years, researchers found that smoking cessation and stopping drinking did not reduce the risk of ED. Men who were obese had an increased rate of developing ED, even if they lost weight. The men who remained active or began exercising at midstudy were at lowest risk for developing ED, and a dose-response relationship between exercise and a decreased risk of ED was found: The men who exercised more than 200 kcal/day had the lowest risk.

"Exercise, which is beneficial for many other cardiovascular conditions, benefits sexual function as well," says Irwin Goldstein, MD, lead author of the study and professor of urology at Brown University School of Medicine in Boston. "The implications of this are enormous."

Use the Post-Olympics Glow to Motivate Kids
The American Council on Exercise (ACE), based in San Diego, has several suggestions for harnessing the energy of Olympic coverage to get young people and their families moving. An ACE press release encouraged families to watch the Olympics together, then discuss what events the children most enjoyed watching and which ones they might like to try themselves. In this instance, what families do on the couch may encourage children to spend more hours away from the couch. They offer several other suggestions for getting young people to exercise:

  • Show kids that exercise can be fun—for example, go biking, hiking, or in-line skating together, or join younger children on the jungle gym to build strength and coordination.
  • Demonstrate how vigorous tasks, such as gardening or washing the car, can be fun.
  • Plan walking-oriented outings such as trips to a zoo, theme park, or even the mall.
  • Check if local fitness centers offer exercise programs and facilities for children.
  • Create activity-related rewards, such as sports equipment, to keep children moving.
  • Emphasize the positive aspects of organized sports, such as improved health, teamwork, and self-esteem.
  • Appeal to teenagers' need for entertainment and social interaction when planning fitness activities. For example, include their friends whenever possible.
  • Be a good role model with eating habits. If changes in eating habits are planned, make them gradually. Offer reasonable alternatives as you replace high-fat, high-sugar foods with healthier items.


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