Brain Trauma

Unpacking cognitive behavioral neurology.

Sports Concussion Psychology: Should Helmets Be Taken Off?

Athletes may feel less vulnerable to concussions wearing safety equipment.

Helmets have come a long way, so have concussion rates.
President Obama recently announced during a White House “Safe Sports Concussion Summit” that concussions are now a national priority. He said more research is needed, more awareness, better protocols and better equipment. But what if safety equipment was contributing to the problem?

As absurd as this may sound, research suggests that this is a serious issue: The equipment designed to protect our athletes may, in fact, be weaponizing them and decreasing their sense of vulnerability.

It’s a concept called “risk compensation” which suggests that people adjust their behavior in response to the perceived level of risk, becoming more careful when they sense greater risk and less careful if they feel more protected. Translation: If you wear safety equipment, you’re inclined to take greater risk.

The theory emerged after several road safety interventions failed to meet expectations, and perhaps had the opposite effect. This “Peltzman Effect,” named after Sam Peltzman, a professor of economics at the University of Chicago Booth School of Business, was reported in 1975 with controversy. Peltzman’s study suggested increased highway safety regulation did not decrease highway deaths, saying “regulation was at best useless, at worst counterproductive.”

More studies ensued in other applications, including:

Football equipment has come a long way since it’s rugby-like days in late 1860s, when some players strapped crude leather “head harnesses” around their head. Around 1905, mounting concerns about serious injuries occurring led many colleges to ban the game altogether. Then, President Theodore Roosevelt stepped in to help save the newly-loved game, forming what would become the National Collegiate Athletic Association (NCAA).

In the 1939, the NCAA required helmets, which the National Football League (NFL) followed suit in 1943, to reduce the risk of injury.

Today’s American football players wear “Iron Man-like” armor, galvanized head to toe with thick synthetic materials. The shoulder pads stack 4-6 inches high, capable of absorbing -- and delivering -- enormous force. Helmets surround the skull snugly, protecting the skin and skull with virtually unbreakable polycarbonate alloy plastic, but surprisingly do little to protect the brain inside. Chest vests, appearing bullet-proof, cover the abdomen with extra protection.

Today’s athletes are bigger, stronger, faster and have become finely-tuned collision machines capable of producing greater force than ever.

But would they hurl themselves with such abandon if they did not wear all the safety equipment, like rugby players?

Maybe we could learn from rugby?
While rugby and American football have evolved from a common past, the games have many differences including rules and equipment designed to protect the athletes.

According to Jim McKenna, a professor at Leeds Metropolitan University, (and a rugby coach) American football players often tackle head first which is seldom seen in rugby. "Their head is the tip of the missile, with an enormous body of weight behind them," says McKenna. Meanwhile, the helmets and padding can actually make the situation worse, he thinks, encouraging them to use more force.

Maybe there’s a safety lesson we can derive from rugby? Dr. Warren King, a team doctor for the Oakland Raiders and who has also worked with the U.S. National rugby team thinks so.

"I think the biggest thing football can learn from rugby is that, no, you can’t use the head as a weapon,” Dr. King said.

Rugby's contact rules are centered around the wrap tackle. A tackler can't slam into the ballcarrier. He has to wrap his arms around and bring him to the ground. Tackling around the neck or head is illegal. Tackling low -- around the ankles or knees -- is fine, but because you have to wrap up, you're not barreling into a player which leads to various injuries.

Without helmets (although some rugby players wear padded hats that are a little like football helmets from the 1920s), rugby players are taught from an early age to get their head to the side, and make contact with the shoulder.

Dr. King added that helmets are a double-edged sword as they can give an athlete a false sense of security (risk compensation) and risk of repetitive concussions remains despite the latest technology.

"We've learning more and more that these small concussions over time in a variety of sports can have a serious, lasting effect later in life," Dr. King said.

Safety gear may dull the impact to the body, but no equipment can dull the impact to the brain. No matter how much protection you add, there’s no such thing as a “concussion-proof helmet.” The brain was not meant to sustain the force caused by athletes crashing head-first into each other while wearing helmets and padding designed to absorb impact. Ironically, this equipment may put athletes’ futures at greater risk.

It’s a radical thought, but what if the game of football were to ban helmets altogether? John Tamny, reporting for Forbes agrees, writing in 2012 that “if so, players will be far more careful about how they hit and tackle, and they’ll do both with much less force.”

Since the game itself has become more of a violent spectacle than athletic prowess, here are a few ideas to avoid risk compensation injury.

Tips to Avoid Risk Compensation Injury

1. Educate parents, coaches and athletes about the risk compensation phenomena.

2. Safety gear is for protection, and does not make athletes invincible or allow them to take more risks or be more aggressive.

3. Teach proper, alternative tackling techniques, in football.

4. Increase enforcement of rules, or alter them, to reflect desire to protect athletes from brain injury.

5. Promote significant penalties for any “bounty” that encourages gladiator attitude to hurt an opponent.

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Cognitive neurologist Harry Kerasidis, M.D. is the Founder of Chesapeake Neurology Associates in Maryland and XLNTbrain LLC. He also serves as the Medical Director for the Center for Neuroscience, Sleep Disorders Center and Stroke Center at Calvert Memorial Hospital. For more than 25 years, Dr. Kerasidis has studied changes of the electrophysiology of the brain as it relates to behavior, cognitive function and emotional function resulting from various brain trauma, including concussions. His work led to the establishing the first complete concussion management program, xlntbrain.com.

 

Harry Kerasidis, M.D., researches the impairment of cognitive and emotional performance resulting from brain trauma.

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