Relationship between Football Helmet Fitting Techniques and Concussions In High School Football Athletes

Abstract

Much of the focus on concussions has been on early detection and appropriate management; there has not been much attention on prevention. A previously published study concluded that high school athletic trainers more properly fit football helmets compared to high school coaches. PURPOSE: To investigate who fits the football helmet and with what techniques in high school football players, and the relationship to concussion injury rate. METHODS: High School Athletic Directors in Pennsylvania (N= 850) and New Jersey (N= 350) were mailed a 12-item questionnaire at the end of the 2001–2002 academic year. The questionnaire included close-ended questions inquiring about (1) demographics; (2) who fits the football helmet; (3) reconditioning of football helmet; (4) number of concussions; and (5) helmet fitting techniques. Injury rates were calculated by dividing the number of concussions by the number of players for each individual high school. A one-way analysis of variance was computed for the four subgroups (ATC, coach, ATC and coach, other) comparing mean injury rates. Helmet fitting techniques were analyzed using a 2 X 4 chi-square test for independence. RESULTS: 1200 surveys that were mailed, 289(24.1 %) were returned. Varsity, junior, and freshman football teams comprised 22,888 players and 286 concussions reported during the 2001 football season. 96.5% (N=279) of high schools recondition their helmets once a year. 43.4% of high school coaches fit the athletes helmet, followed by ATC (23.6%), coach and ATC (21.2%), and other (11.8%)- these were the four subgroups of “fitters”. The overall concussion injury rate was 3.53/1 00players (comparable to previous studies). There was no significant difference between the 4 subgroups for helmet fitting and concussion injury rates (F3,284= 1.43, P = .234). The four subgroups were significantly different on 7/10 helmet fitting techniques (χ2 = 9.05, P = 0.029). Chi-square test of independence indicated that the four subgroups were significantly different on 8/10 helmet fitting techniques (χ2 = 8.71, P = 0.033). The most commonly missed helmet fitting techniques by coaches were facemask 2″ from nose (25.5%), helmet 1″ above eyebrows (17.5%), and chin straps equal distance apart (17.5%). CONCLUSION: Concussion injury rates were not statistically significantly different among the four groups of “fitters”. Fitting techniques used, however, were significantly different. Concussion prevention starts with properly fit football helmets. This study did corroborate that ATCs may be better at fitting helmets. Further studies are indicated to determine whether better fit helmets will contribute to a decrease in concussions.