Rachael Hearn
@rachhearn11

Another year and, what d’ya know, we have another silver bullet to solve the NFL’s concussion crisis. Remember the mouthguards that were going to stop concussions in their tracks? What about Russell Wilson’s concussion water? Or Tom Brady’s CTE vitamins?

This year, it’s all about the Guardian cap.

WHAT IS THE GUARDIAN CAP

You’ll have seen the Guardian caps sported in training camps and practices throughout the league. They are big, padded, martian-looking helmets designed, it is suggested, to reduce the impact of collisions and, therefore, help limit concussions.

And so, it stands to reason, players, fans and commentators are asking: If the caps are effective in practice, if they live up to the advertising promise, why don’t players wear them in games?

WHY DOES IT WORK (OR NOT)

First question: are the Guardian caps as effective as the NFL claims? Despite the nice headlines and positive press, the answer is a resounding no.

The NFL has been back out on the media rounds, touting a 52% decrease in concussions sustained by position groups who wore the Guardian during the offseason and preseason camps. By this logic, we can expect to prevent a total of, drum roll please, approximately six-and-a-quarter concussions during the regular season this year. That’s six-and-a-quarter down from the total of 161 concussions reported during the regular season last year.

Let’s be clear: the flaw is not with the Guardian caps themselves — at least not entirely. The flaw primarily lies with the application of the device. It’s been reported that the NFL now mandates that linemen, linebackers, running backs, and fullbacks are all expected to wear Guardian caps during contact practices throughout the regular 2023 season.

The caps are a no-go during games, though [This has obviously changed for 2024 – Ed.]. The look, feel and general aesthetic of The Shield and its games must be protected at all costs. And here’s the problem with that: according to the league’s own data, that approach makes little sense. The league’s concussion data from 2015-22 states that the majority of concussions incurred at the professional level came during games not during practice.

We could, of course, dig into the reasons for that: it’s more difficult to conceal a concussion during games; the league has independent spotters to track potential concussions during games and not during practice; players are running at full tilt, playing against competitive opposition on Sundays rather than preparing for an upcoming game with their own teammates as they do throughout the week.

But let’s stick with the NFL’s own theory of the case. The eight-year average of concussions reported during regular season practices is 10, while the eight-year average of concussions reported during regular season games is 149. By simple math, concussions are reported nearly 15 times more often during live action than when compared with practices.

It seems odd, then, that where the Guardian caps would prove most effective, they are absent. How far should the TV-to-injury-protection trade-off go? The league has already legislated away things like big hits in favour of preserving the health of its players — and, in doing so, fueling an offensive explosion that has only heightened its broadcast product.

Changing the rules and dynamics of the game is fair game, it seems. Those are aesthetics the league can stomach. But changing the physical design of its players, sticking an oversized cap on Travis Kelce or Fred Warner would be a step too far.

The Guardian caps are not the only product or service looking to help reduce football’s issue with collisions. There is a seemingly never-ending stream of hi-tech products designed to help protect players (at all levels) or better collate data that can be used to help identify a concussion (or subconcussive hit) during practices or game days.

There are four ways to sustain a concussion, three of which are relevant to football: the head being struck with an object; the head striking a hard object or surface; the brain undergoing an acceleration/deceleration movement without direct contact between the head and an object or surface (i.e. a hard tackle).

Efforts in the past (and present) have, so far unsuccessfully, sought to determine what level of impact might be used as an upper limit to help inform the diagnosis of a concussion. With the implementation of new ‘smart mouth guards’, World Rugby has established an upper limit of head impact forces which will now indicate the necessity for a head injury assessment. These mouthguards aren’t exactly new, but they have never been used clinically in such a way — only to collect data, never to inform decision making. Now, if the mouthguard measures an acceleration above 70g and 4,000 rad/s2 for men or 55gs and 4,000 rad/s2 for women, the athlete will be pulled from play and assessed for injury. According to World Rugby, the mouthguards will also be worn for practices. Coaches can now track these acceleration forces to help manage and tailor training loads.

There are, however, criticisms of this newly established threshold. The numbers are arbitrary; concussions do not have to reach those levels to occur, and impacts that have hit those levels have not always resulted in concussions. As the mouthguards produce more data, we may be able to draw more accurate conclusions. Perhaps we’ll learn each individual’s threshold is different. Maybe, one day, the NFL’s independent spotter will have access to a real-time feed of data with an upper league-wide limit on the force a player can experience; or perhaps there will be individual thresholds for each player.

At times, it seems companies and sporting leagues are chasing a unicorn. Helpful as this information would be, there is scepticism that this can ever be established with any sense of confidence (or reliable evidence). Every concussion looks different, every individual is different, and identifying a concussion objectively is quite a task when you can’t truly see the injury.

Helmet and mouthguard designs continue to be at the forefront of innovation across impact sports, two areas that have not been proven to help prevent concussion, much less the impact of repetitive head trauma which could lead to CTE.

As detailed in Issue 71 of Gridiron, resources are being poured into short-term, visual treatments rather than long-term studies that could, one day, lead to meaningful results. Fans and media members can see martian-looking helmets. The players can strap them on. The implicit understanding is that something is happening; that someone is working to try to protect players and that fans should feel comfortable tuning in on Sundays (and Mondays… and Thursdays). Isn’t something better than nothing?

Less discussed is whether any of these new innovations actually, you know, work. The Guardian caps are the flavour of the moment, but just as headline-grabbing have been the new, position-specific, helmets introduced by VICIS. Do either really reduce the rate of concussion?

The answer: TBD. VICIS hangs its hat on the fact that its helmets have outperformed all other helmets in the NFL and NFLPA’s Annual Testing. According to the NFL and NFLPA, ‘The rankings are based exclusively on the ability of the helmet to reduce head impact severity measures in laboratory testing.’ That’s a positive. The new helmets likely do contribute to an increase in individual player safety, but the total effect is also likely overblown.

“The concussion numbers will be what they will be, and we will report those out over the course of the season,” Jeff Miller, the NFL Executive Vice President of Communications, Public Affairs & Policy, said during a preseason player health and safety media briefing. “But more importantly, in many ways, is around the individual impacts that players experience. Decreasing each of those 15-20% over the course of a preseason or a season is a substantial cumulative decrease in force.”

It should be noted that, to reach that 15-20% impact force reduction that Miller cites, both players involved in the contact would need to be wearing a VICIS helmet. When worn by a singular player, the NFL reports an impact force reduction of 11-12%.

Add to that: The VICIS helmets address only two of the three injury mechanisms. Only in certain circumstances can the helmets reduce the impact by 15-20%. More often than not, the reduction will likely fall in the 11-12% reduction band instead. In the circumstances of an indirect mechanism, the helmets reduce the impact forces by 0%. What’s worse, these acceleration/deceleration-type concussions are arguably the most damaging acutely and in the long-term.

Issue two: there is no evidence (yet – possibly ever) to back up the claim that reducing impact forces by 10-20% will prevent concussions. Give some credit to Guardian Sports, they’re transparent about that. “No helmet, practice apparatus, or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports,” a statement reads on the company website. “Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions. No conclusions about a reduction of risk or severity of concussive injury should be drawn from impact absorption tests.”

VICIS concurs. “No helmet can prevent head, brain, or neck injuries, including paralysis or death, a player might receive while participating in football,” a statement on the company’s product warning page says. Contact in football may result in concussion and other serious brain injuries, which no helmet can prevent.”

Unlike Guardian Sport, there’s no indication or explanation on VICIS’ website about whether (or how) reduced impact forces can reduce the risk of concussion.

So, the league is aiming for an illusory target that’s not yet supported by scientific data.

But helmets are not the only source of ‘medical’ innovations designed to reduce the force of collisions, and thereby, hopefully, reduce the rate of concussive blows.

A personal favorite: the Q-collar. For a mere $200, you can purchase an FDA-approved, one research study backed (using unvalidated measures and drawing questionable conclusions) necklace…sorry, device…that claims to ‘aid in the protection of the brain from effects associated with repetitive sub-concussive head impacts.’ It does so by applying pressure to the jugular veins to increase blood volume in the skull. This, in turn, attempts (a keyword) to reduce the movement of the brain. Yes, you read that correctly.

The Q-collar likes to tout its FDA-approved status. America’s Food and Drug Administration. A point of note: the FDA approved the device due to minimal risk of wearing the device. In its decision summary, however, the FDA flagged a couple of things that the inventors of the Q-collar are not so keen to highlight:

The Q-Collar has not been demonstrated to prevent long-term cognitive function deficits, and the ultimate impact on clinical outcomes has not been evaluated. Data does not demonstrate that the device can prevent concussion or serious brain injury. Wearers of the device should not depend on the device to protect them from all harmful effects of head impacts.

While the league and outside companies continue to look to technology to try to find long-term solutions, players have started to embrace alternative paths to help in the short-term.

Tua Tagovailoa took to training in jiu-jitsu this offseason after the horrors of last year, where the quarterback sustained multiple concussions in short order, one of which led to him lying in the ‘fencing’ position on national TV.

The idea of Tagovailoa ‘learning to fall’ was an oft-mocked notion heading into the season. It’s an outside-the-box approach, but it’s one that has merit. The ability to reduce whiplash injuries is a valuable one. Two of Tagovailoa’s diagnosed concussions last season came on tackles where he was spun around and his head snapped against the ground.

F1 drivers have adopted a similar strategy to try to reduce the force on their necks and heads. Drivers undertake neck strengthening protocols to reduce whiplash, neck strains and concussions. Put simply: whiplash injuries are a major contributing factor to lingering concussion symptoms. An ability to reduce these kinds of injuries can certainly reduce the complications of the concussion itself. This might mean less time missed, less severe symptoms, or a reduced risk of developing post-concussion syndrome; however, the inherent ability to significantly reduce concussion risk outright — whether it be through bracing or neck strengthening — have yet to be firmly established.

Tagovailoa’s jiu-jitsu training might not help him to prevent a concussion, but it could potentially help him recover quicker if he does sustain another brain injury.

THE SILVER BULLET APPROACH

Let’s be pragmatic, though. The new mouthguards can still be helpful. Clinicians on the ground have been begging and pleading for an objective measure for years. It is frustrating to try to convince an athlete to tell the truth about potential concussion symptoms. It is even more difficult to tell a coach that their player is being pulled for a suspected (not necessarily diagnosed) concussion. Even if a concussion can’t be objectively diagnosed the way many other injuries can, to take some of the guess work away is helpful.

The position specific helmets might also help. Experts are still trying to understand the cumulative load of head impacts and how that relates to short and long-term consequences of concussion (thinking about post-concussion, CTE, and dementia). All this to say, they are imperfect solutions, but potential solutions, nonetheless. Chasing perfection can be the enemy of progress.

Consequences of concussion, however, short and long-term, will never be resolved with one quick fix. It will take the continued implementation of new technology, introduction of policy changes, and the continued progress in medical management strategies. To think any different fails to truly understand the complexity and severity of the issue at hand.

HANS TO THE FACE

Prompted heavily by the death of NASCAR ace Dale Earnhardt in 2001, motorsport moved quickly to adopt the HANS (head and neck support) device across all categories in a bid to avoid — or at least limit — repeat incidents. Although not specifically designed to prevent concussions, the lightweight carbonfibre U-shaped device connects to the driver’s helmet via a pair of anchors behind the neck, and is supported by the shoulders with the two arms of the ‘U’ sitting over the pectoral muscles. Its principal aim is to prevent basilar skull fractures caused by the sudden deceleration in accidents.

Although it’s somewhat bulky nature would prevent something similar appearing in football (the HANS device is secured against the body by the driver’s seatbelts), neck braces are not uncommon. Cowboys linebacker Leighton Vander Esch — who was was diagnosed with spinal stenosis in 2019 —has worn one from his playing days at Boise State, in order to prevent his neck from snapping too far back in contact situations.

Attempts to limit both concussions and neck injuries are being made at all levels — and by all kinds of people. York County, Pennsylvania, chiropractor Kevin Jackson made news with his development of the XOSKELETON device, which connects helmet to shoulder pads using rubber tubing in a bid to slow the acceleration of the head and brain, and restrict excessive neck movement, caused by impact during a game. Jackson explains that the rubber tubing mitigates angular acceleration, and cites an 11% decrease in such acceleration under live testing in youth football, where an impact of as little as 5G is enough to create a brain-stem concussion.

“There is currently no protective equipment on the market for acceleration/deceleration injuries (or whiplash effect),” Jackson told the York Dispatch. “With the rubber bands on the XOSKELETON, it slows down the acceleration of the head and brain and the excessive movement of your neck after an impact takes place. These hits can add up, causing (mild traumatic brain injury), and, neurologically, can have a lifelong effect — but this discussion is being swept under the table.”

 

This article originally appeared in Issue LXXX of Gridiron magazine in Autumn 2023 – for individual editions or subscriptions, click HERE