When it comes to playing sports like football and soccer, using your head may actually be the best way to lose it - or at least to lose a little bit of your cognitive power.
But there are ways to reduce the potential damage, such as playing with proper technique and ensuring helmets fit properly.
More and more research is coming out that reveals that hits to the head - whether they result in a concussion or not - add up over time and can lead to loss in cognitive function, memory, concentration, and similar problems.
What the Research Says
Though most people worry about a concussion, recent research out of Purdue University revealed that the smaller hits that football players sustain over time may be a greater danger.
Just one season of football at an Indiana high school gave players between 200 and 1,900 hits to head with impact ranging from 20 Gs to over 100 Gs (1 G is the force of gravity on Earth). Subsequent brain scans and cognitive tests showed changes in how the players mentally solved problems after each season.
Studies of soccer players have shown similar findings. One study presented at the Radiological Society of North America in December studied adult soccer players who headed the ball over 1,100 times in one year and found they showed losses in the white matter of their brains in the parts associated with memory, attention and visual processing.
Another study last year from Humboldt State University tracked 51 male and female soccer players in the school's Division II program and found that those who headed the ball most often did more poorly on memory tests at the end of the season than they did at the beginning.
These kinds of hits have not yet been linked to the more serious problems of chronic traumatic encephalopathy (CTE), the degenerative disease that afflicts some "punch-drunk" boxers and professional football players. CTE can only be accurately diagnosed after death with an autopsy and is marked by a large amount of a protein called tau in the brain, the same protein linked to Alzheimer's disease.
But even successive hits or a single concussion can have long-term effects, including depression and anxiety, blurred or double vision, cognitive impairment or a high risk of CTE, according to Dr. Howard Derman, the director of the Methodist Concussion Center in Houston, Texas.
"Head trauma, especially concussion, continues to be the most under diagnosed problem in sports," Derman wrote in a recent column about the myths and realities of head injuries. "The medical treatment for concussions focuses on allowing the brain to heal itself and to utilize rest."
Properly Fitting Helmets Help
The only certain way to avoid head injury in sports like soccer or football is not to play them. But in lieu of that option, there are ways to reduce players' risk of suffering from too many hits. One of the best options is to ensure their helmets fit properly.
"Helmet fit is definitely a critical extrinsic factor that can be modified to reduce the risk of head injury in football," said Dr. Daniel Clearfield, D.O., a sports medicine and concussion specialist and an assistant professor of orthopedic surgery at the University of North Texas Health Science Center. Clearfield compares a properly fitted helmet to wearing a seatbelt.
"If the helmet doesn't fit well and you get hit, then it is similar to the motions that would occur to you in a car if you were t-boned and unrestrained," he said. "You would get jostled around, and there is a greater chance of severe injury to an unrestrained driver. Several people take the risk of driving around without a seatbelt on, but not if they enter a demolition derby where impact is imminent. In football, taking impact to the head is imminent, so you had better be 'buckled-in' with a proper fitting helmet."
Recent research backs up Clearfield's assessment of the importance of helmet fit. In a study by Dr. Joseph Torg, M.D., at Temple University in Philadelphia, those athletes who wore properly fitting helmets, according to their team's certified athletic trainers, were 82 percent less likely to lose consciousness with a concussion.
Torg's research, presented February 11 at the American Orthopaedic Society for Sports Medicine's Specialty Day in San Francisco, involved investigating 1,398 reports involving concussions among high school football players from 2005 to 2009.
They gathered the data from the National High School Sports-Related Injury Surveillance System and looked at cases that involved a player's loss of consciousness or amnesia. Among the players' studied, 44 lost consciousness and 267 had some form of amnesia.
The researchers then ran calculations based on how well the helmet fit, the player's age, whether the helmet was new or reconditioned, and the padding system on the inner part of the helmet.
The helmet's age and condition did not play a significant part in determining an athlete's risk of having amnesia or losing consciousness, but wearing a properly fitting helmet did help.
The authors included in their report a review of the research on helmets and concussions. They note that no data currently exists to support the possibility that more advanced design and technology in helmets necessarily protects better against the possibility of concussion or similar head injury, such as brain hemorrhaging.
The studies they found that claimed this were industry-funded and contained methodological flaws and potential bias.
Torg's team did, however, find in their review an association between use of air bladder helmet liners and concussions leading to a loss of consciousness. Among injuries reported from 1989 to 2001, 84 percent of the cases with a loss of consciousness involved air helmets.
"As we look at preventing concussions and minimizing risk, it is important to realize that it is the responsibility of the athletic director and head football coach to have policies that: Insure that each player has a properly fitted helmet and that a responsible adult supervises and oversees proper helmet air bladder inflation on a weekly basis," Torg said.
The authors note there is no such thing as a "concussion proof" helmet but that the severity of a concussion can be minimized if the helmet fits properly and the player plays with appropriate technique. This last point is also emphasized by Clearfield, who said that most kids play football with whatever helmet they're handed and likely have "a false sense of security regarding their head's safety."
"If you are given a helmet and told that it will protect your head, then you will feel like you have an extra weapon available for tackling and hitting," Clearfield said. "The best solution to the 'concussion epidemic' that is going on is to modify the way players learn to tackle, and perhaps to not introduce tackle football until a child's motor skills are better developed and they can control their bodies better."
How to Ensure a Proper Fit
The authors suggest that teams carry at least two styles of helmets to ensure they can meet the needs of all the players' head shape and sizes. include the following suggestions for ensuring a good helmet fit.
They then offer seven steps to ensure a good fit.
- Inspect each helmet for defects and cleanliness.
- Find out each athlete's injury history and how well past helmets have fit. Inspect each athlete's head for any physical abnormalities.
- Measure each athlete's head with a cloth tape measure, starting at the side and wrapping around the head about an inch above the eyebrow. Helmet sizes include medium (20-22.5 inches), large (21.5-23.25 inches) and XL (23-25.5).
- Using information about the athlete's history and head size, each athlete should try on several helmets and use the most comfortable one, fitting it according to the manufacturer's instructions. Torg's paper states, "Inflation should raise the frontal rim of helmet about one inch above eyebrow and snug around circumference of the head. Jaw pads should be touching the jaw and not the ears. The rear padding should be infirm but with comfortable contact with the head."
- Ensure the chinstrap is adjusted with equal tension on the front and rear straps.
- Check the fit in three places: crown pressure, lateral grip and vertical grip. When the helmet is pulled straight down over the player's head, the pressure should be evenly distributed on the top of their head and the helmet shouldn't reach their nose. When the helmet is pulled side to side, the player's skin should bunch up as the padding grips the head instead of sliding across the face. The skin should also bunch up when the helmet is pulled forward and backward, taking the head with it and not allowing the helmet to touch the nose.
- Maintain the helmets by examining them weekly and regularly checking the air-bladder suspension. Replace face masks that get bent, and inspect the helmet for cracks and rust, replacing screws that may be difficult to remove quickly in an emergency. Constantly check in with the athlete to be sure the fit is comfortable and that each step in the process is explained to educate them and build their trust.