The use of headgear and helmets in sport, especially rugby and rugby league, has been the focus of much debate in the media. It has been suggested that this type of equipment should be made compulsory in an effort to reduce the risk of concussion. Headgear manufacturers are also increasingly marketing their products to consumers with claims that their products will help reduce the risk of injury. While this seems like a good common sense move, the available evidence does not suggest that this is likely to be an effective strategy.
Concussions are caused by a force that is transmitted to the brain. In many cases of concussion, the mechanism of injury does not involve a blow to the head. For example, a heavy blow to the chest may create a ‘whiplash’ type mechanism where the brain is subjected to a shearing force. Helmets and headgear are unlikely to be effective in these cases. This is reflected in the available clinical evidence. This data has failed to show any meaningful benefit from helmet, headgear or headband use in terms of reducing concussion. The lack of effectiveness of helmets in collision sport is highlighted well by the high rates of concussion in American football, where everyone is required to wear a helmet. Despite this the rates of concussion remain very high.
Helmets do have a role in sport - just not in preventing concussion. In rugby (and other collision sports) headgear has been clearly shown to reduce the risk of lacerations, cauliflower ears and other soft tissue injuries. In cycling, and in other sports where a helmet is worn, it’s use has also been shown to be beneficial in reducing the risk of skull and facial fractures.
Finally, some authors have suggested that headgear and helmets may be counterproductive. They have suggested that using this type of equipment may actually increase the risk of injury by making it more likely that the player may take unnecessary risks by becoming “overconfident”. This has largely been disproven.
In summary, while headgear and helmets may not reduce the risk of concussion, there are still good reasons to use them. In collision sports, they reduce the risk of soft tissue injuries and do not appear to create any adverse effects. In sports where a hard-shelled helmet is used, for example, cycling, snow-sports and in equestrian, they reduce the risk of other types of head and face trauma.
Have you, or do you know someone who has, suffered a concussion recently? It’s better to play it safe and have your injury assessed by an experienced professional before you return to play, than risk further injury. We run Auckland’s most comprehensive sports concussion service.
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