All asthma Patients should have an action plan

Having a written asthma action plan can significantly reduce the risk of a serious asthma attack, says Cambridge expert Dr Robin Gore.

His comments come following a stark warning from Asthma UK which is urging people with asthma to be vigilant in winter as data shows the number of people who die because of an asthma attack peaks in January and remains high in February and March.

Research from the Office for National Statistics highlights that asthma is the cause of proportionately more excess winter deaths than other conditions and respiratory diseases were the underlying cause of death in more than a third of all excess winter deaths in 2014/15.

It is thought that cold weather and viruses like cold and flu may be partly to blame with 90 per cent of people with asthma reporting that cold and flu viruses make their asthma worse and 75 per cent find that cold weather triggers an asthma attack.

Dr Gore, one of the asthma specialists at Addenbrooke’s, said they have known for a long time that viruses such as colds and flu were common triggers.

“These have a much greater effect on the lungs with people who have asthma than people who don’t,” he said. “They are the most common triggers of asthma attacks.

“Asthma is a condition where we don’t understand all the factors that cause it but most patients will have inflammation in the lungs for much of the year. When a virus affects the lungs it makes that inflammation worse. The tubes get smaller and more narrow which obstructs the air flow and makes it more difficult to breath.”

Given the recent increase in reported cases of flu, Asthma UK wants to ensure that everyone with asthma takes their medicines as prescribed, uses a written asthma action plan and knows what to do if their symptoms start to deteriorate.

Dr Gore said an action plan was really important and every patient should have one.

“Asthma attacks can seem to occur quite unpredictably so you need to know what to do if your symptoms are getting worse,” he said. “Having a written action plan is a set of instructions telling the patient what to do if their asthma deteriorates, how to call for help and what emergency action to take.

“Research shows patients who have a plan given to them by their nurse or GP cuts down hospital admissions by four times.

“Many patients with asthma don’t have an annual review with their GP, where these plans are developed and revised. Many patients don’t go or are not called up.”

Dr Gore said patients who use their reliever inhaler a lot was a sign they might need to see their GP about their asthma control.

“If a patient uses six of these reliever therapies in one year, they should make an appointment with their GP,” he added. “Many patients don’t use enough of their preventer inhaler
News, Cambridge. “All Asthma Patients Should Have an Action Plan.” Cambridge News. Cambridge News, 26 Feb. 2016. Web. 19 Apr. 2016.

Youth football league adapting to concussion concerns

COLUMBUS — Concussion concerns have led to significant rule changes in professional and college football to improve player safety, from outlawing hits above the shoulders on quarterbacks to targeting penalties called on defenders for leading with their helmets or taking out defenseless receivers.

In Columbus, the same concerns about head trauma linked to health issues in former NFL players have reached the peewee level.

John Zwingman, who organizes Columbus Area Youth Football League, says the concussion scare fueled by media reports and the December release of a film that focuses on chronic traumatic encephalopathy (CTE) in professional football is impacting parents’ willingness to let their children play the sport.

During his annual report to the Columbus Board of Parks Commissioners this week, Zwingman said fewer kids are going out for youth football now, which prompted a decision to adjust the league to eliminate collisions, and tackling altogether, for the youngest participants.

This year, the local youth league will play flag football for the first time, putting third- and fourth-graders in helmets and pads but taking away the contact some parents fear.

“We’ll really limit collisions by not having full-contact in games,” Zwingman told the park board.

“I think that’s the way we have to go to keep our numbers going strong,” he said.

Zwingman said the league had player safety measures in place long before the “Concussion” movie starring Will Smith brought the CTE debate and connection between repetitive brain trauma and long-term health issues to the big screen.

They cut down on full-contact drills during practices, he said, have certified trainers on-site during all games and require players to sit out at least one contest if they suffer a head injury.

“We have some protocol that we have in place,” he said.

Zwingman told the park board he looked at the Heads Up Football program created by USA Football and backed by the NFL, but the player safety initiative doesn’t mesh with the league schedule. The program calls for a specific number of practices without pads or contact before tackling begins, he said, and the local youth football league doesn’t have enough days available to meet those guidelines.

Instead, he opted to eliminate contact entirely for third- and fourth-graders.

This year is also the first time third-graders will play in the league.

The league previously included youths in fourth through seventh grades, but Zwingman decided to drop seventh grade and add third since many area schools, including all three local schools, have seventh-grade football programs.

In 2015, a total of 382 youths participated in the football league, but only 11 seventh-graders.

Zwingman said he’s fighting an “uphill battle” when it comes to participation numbers since some kids are giving up football to focus on a single sport and others are opting to play club soccer or fall baseball.

He told the park board the flag football portion of the league will still focus on the fundamentals of blocking and tackling, but without the contact. Fifth- and sixth-graders will continue to play tackle football.

Columbus High head football coach Craig Williams hasn’t noticed the same drop-off in player numbers reported by Zwingman.

“I don’t think we’ve seen anything that has taken kids out of the sport,” Williams said in a phone interview.

Williams said conversations about concussions and how to properly protect student-athletes have been occurring for some time at the high school level.

“We are absolutely more aware of everything,” he said. “As coaches, we’re better trained to recognize signs and get them to a trainer.”

Athletic trainers from Columbus Community Hospital work with Columbus High, Lakeview and Scotus Central Catholic and Williams said the schools have good relationships with local physicians.

“That’s a blessing for us,” he said.

CHS started using computer-based ImPACT testing to determine when an athlete can return to practice and competitions following a concussion several years ago, before a state law required all Nebraska schools to pay closer attention to head injuries, and the athletic trainer, school nurse and counselors work together to adjust coursework and get students the rest and recovery time they need after suffering a concussion.

Rob Marshall, who serves as the full-time athletic trainer at CHS and director of the hospital’s athletic training program, was part of the team that drafted the state’s Concussion Awareness Act, which mandates concussion education for coaches, parents and players, sets rules of play for youths suspected of having a concussion and requires written approval from a licensed health care professional and the student’s parent or guardian before an athlete can return to action.

Under Marshall’s guidance, CHS received the National Athletic Trainers’ Association Safe Sports School award in 2014, making it the first high school in Nebraska to gain the distinction.

Williams said schools and youth football programs must be proactive when it comes to addressing head injuries, although he admitted he’s an “old-school guy” who doesn’t like to see tackling removed from the sport.

“But we’ve got to look out for the best interests of the kids,” he said.

Ellyson, Tyler. “Youth Football League Adapting to Concussion Concerns.” Columbustelegram. Columbustelegram, 20 Feb. 2016. Web. 19 Apr. 2016.

Concussion: Symptoms & return to play protocol

SAN DIEGO (CBS 8) – If your child plays sports it’s important to know how to recognize a concussion and the steps you need to take before your child returns to play.

San Diego 8th-grader Gianna Callipari has been playing soccer since she was 3 years old, but a series of concussions put her on the sidelines.

“I was going up for a header right when a girl was coming down for a header and my head hit the bottom of her head,” Gianna said.

“My head just was dizzy and my eyes were hurting and in pain. The referee was like you need to go to the hospital right now, you don’t look right.” she said.

Gianna wanted to keep playing but thankfully she followed the advice of her coach and parents.

“You just have to be aware of how you’re feeling and know the symptoms,” said Gianna.

Symptoms like slurred speech, burry vision, nausea, headache and disorientation are all warning signs of a concussion.

Doctors at Rady Children’s Hospital say under no circumstances should a student return the game after a head injury and suspected concussion.

“Have the game stopped; that kid needs to come out of the game, be evaluated by a professional and medical trainer, or somebody on the field that understands what a concussion is,” said Dr. Pritha Dalal, a concussion expert at Rady Children’s.

Concussions can happen any time, during practice or play, and students need to know it’s okay to report the injury to a coach or trainer.

“If there’s any of the slightest bit of a problem, whether it’s headache or any of the associated head trauma, we want them to come see us,” said Ryan Nokes, an athletic trainer at Point Loma High School.

“We want them to tell us because we’re going to make sure they stay safe,” said Nokes.

The lead physician at the San Diego Unified School District advises complete rest for the first 24 hours following a concussion.

“If they get a second concussion before the first one is healed, that second one is really so apt to cause some long term damage,” said Dr. Howard Taras.

The district’s “return to learn” protocol means no homework, no television, and no cell phone use during the first phase of recovery, said Taras.

Phase two includes a gradual “return to play” protocol, which usually takes at least seven days.

For Gianna’s parents, allowing their daughter back on the field was the hard part. “Every time she sets foot on that field it’s very scary, especially if she goes down,” said Gianna’s mother, Gina Callipari.

“If I were to not play soccer anymore it would be really sad and depressing,” said Gianna.

To help reduce head injuries, San Diego City School athletes can expect to see less full-contact drills during practices; and more volunteer coaches are being trained in how to recognize concussions.



CBS 8. “Concussion: Symptoms & Return to Play Protocol.” – CBS News 8. CBS 8, 18 Feb. 2016. Web. 19 Apr. 2016.

Improve your life with an asthma action plan

Approximately 9,000 people (12 per cent) living in Bermuda have asthma.

It is the number one reason children take medication whilst at school, and the number one reason they miss school. It’s also the leading reason adults miss days from work.

Respiratory disease is repeatedly one of the top causes of admission to King Edward VII Memorial Hospital. People suffering from asthma were the most frequent visitors to the Emergency Department and Urgent Care Centre last year.

Chronic Obstructive Pulmonary Disease is strongly associated with smoking, factory work and mining. It is a smaller problem in Bermuda than elsewhere, as these factors are less common. Approximately one in seven adults (14 per cent) of people in Bermuda are smokers, according to the STEPS survey 2014.

In 2012 we started to collect COPD inpatient and outpatient statistics at KEMH. I am finding it is underreported and underdiagnosed — as it is around the world — but even after taking this into account we still have a lower percentage of people with COPD in comparison to most other countries.

Why are action plans important?

Education is very important for patients, carers and family members. Asthma and COPD affect the dynamics of a family as a whole, however the greater the education of the family, the more they can help and offer support. It is important that education strategies are also geared to enable patients to self-manage. In the past year alone, there were 1,888 asthma visits to the Emergency Department yet only a small percentage of these patients have come to get asthma education.

Every asthma visit to the Emergency Department and Urgent Care Centre is a failure of treatment. Healthcare professionals can empower their clients and help give them the tools they need to control their asthma by providing their patients with an asthma action plan!

American, British, Australian, Canadian and Global Initiative for Asthma guidelines suggest that all clients are offered self-management education, including a written, individualised asthma action plan.

The National Review of Asthma Deaths in May 2014 by the Royal College of Physicians in England showed that of the 195 asthma deaths from February 2012 until January 2013, less than a quarter (23 per cent), of those had ever been given an asthma action plan.

As a certified asthma/COPD educator I set up the Asthma Centre in KEMH in April 2000. The goal was to create a centre that works to improve the lives of people in Bermuda living with long-term lung conditions.

Today this education continues as part of Bermuda Hospitals Board’s Diabetes Respiratory Endocrine and Metabolism Centre. Located at Fairview Court on the grounds of the Mid-Atlantic Wellness Institute, I provide clients one-on-one asthma and COPD education. The service is covered by insurance. I work in close partnership with the Government Health Department, the Ministry of Education’s school asthma nurse and Bermuda’s asthma charity Open Airways.

Everybody who has asthma should have an action plan from their doctor. The physician gives advice specific to the patient providing the patient with a written agreement that helps them stay in control of their asthma. It includes specific daily asthma medications and what to do when the asthma gets worse, or if they have asthma attack.

An action plan can help reduce the number of visits to the Emergency Department and the doctor’s office, which in turn can improve quality of life and reduce the number of days that people have off work and school due to asthma. An action plan should be updated yearly by your doctor or asthma nurse for most adults, and more frequently if more severe.

Contact or 239-1652 for more information or an appointment.



Barbosa, Debbie. “Improve Your Life with an Asthma Action Plan | The Royal Gazette:Bermuda Wellness.” The Royal Gazette. The Royal Gazette, 17 Feb. 2016. Web. 19 Apr. 2016.

US Lacrosse Experts to Serve as Presenters at Concussion Summit

While there have been great advances in recent years in the understanding of concussions and head injuries, more discussion and data is always welcome in furthering the knowledge base.

It’s that continued quest for greater insight that will draw medical experts, media members, program leaders and others together on Saturday, February 27 at Georgetown University in Washington, D.C. for the International Summit on Female Concussion and Traumatic Brain Injury.

The event, sponsored by Pink Concussions with support from US Lacrosse and the NCAA, will feature presentations, roundtables and panel discussions exploring the current research, treatment and protocols for concussions and TBI. Sports related concussions and head injuries will be one of the specific topics discussed.

Serving as panelists to discuss concussion differences by gender in sports will be US Lacrosse Sports Science and Safety (SS&S) Committee chair, Dr. Margot Putukian, as well as committee members Dr. Shane Caswell and Dr. Andy Lincoln. Another SS&S Committee member, Dr. Ruben Echemendia, will discuss treatment and protocols, while Melissa Coyne, director of games administration at US Lacrosse, will serve as a panelist discussing how to improve care for female athletes.

“As the national governing body of lacrosse, we’re fortunate to have the outstanding leadership of national and international experts to help guide our policies and best practices for game safety and injury prevention,” said Dr. Bruce Griffin, director of health and sport safety at US Lacrosse. “They serve as a great resource for the lacrosse community, and it comes as no surprise that so many of them are giving their time to share their expertise at this event.”

Led by the expertise of the SS&S Committee, US Lacrosse strives to serve as a source of lacrosse safety education for all members of the leader community. As part of that effort, last year US Lacrosse released guidelines for teams, clubs and organizations to use in developing local concussion management plans. Additional information about concussion awareness in lacrosse is available online.


Ohanian, Paul. “US Lacrosse Experts to Serve as Presenters at Concussion Summit.” US Lacrosse Experts to Serve as Presenters at Concussion Summit. USlacrosse, 16 Feb. 2016. Web. 19 Apr. 2016.

Should You Be Worried About a Concussion?

Taking a hit to the head is almost expected for kids horsing around or athletes involved in contact sports, so most of us act as though a concussion is the same as a bruised knee. It’s no big deal. You get up, shake it of, take a breather, then you’re good to go. But what if it is a big deal? What if that bump in the noggin leads to serious medical conditions down the road?

More and more research is finding suffering a concussion drastically increases your odds of suffering from various neurodegenerative diseases. The NFL has found itself facing scores of lawsuits filed by former players and their families seeking damages for life-altering brain injuries incurred from career-related concussions. Though the league denied the accusations for years, there was no ignoring the problem when an in-depth analysis revealed almost one-third of retired players will suffer from cognitive issues. The findings also clearly stated the former football stars will face these brain problems significantly sooner in their lives than the general population.

Neurodegenerative disorder is a catch-all term that covers everything from Alzheimer’s disease to Parkinson’s disease. The conditions vary, but ending up with any of them is life changing in the worst way. Many studies surrounding the links between these diseases and head injuries have focused on retired NFL players specifically, including one that found they’re four times more likely to die from Alzheimer’s disease or amyotrophic lateral sclerosis (ALS) than the general U.S. population. Trying to wave off the risk as something only those who wear shoulder pads and helmets as part of their job is foolish, though, because anyone who’s suffered a concussive event is in danger.

At the end of 2013, Neurology published a study that took a closer look at the link between impaired cognitive function and concussions in a general population sampling from Olmsted County in Minnesota. Researchers discovered individuals suffering from mild cognitive impairment who reported some sort of head trauma had more amyloid deposits, which are associated with Alzheimer’s disease, in their brains than those who hadn’t suffered from the injury.

Soccer and football are usually blamed for concussions among children, which makes sense for activites that can be so rough. Still, just about any sport you can think of carries some risk of concussion. Those who suffer a head injury while participating in gymnastics or swimming may even be more at risk because they could be less likely to believe it’s serious enough to be a concussion. Research suggests brain injuries are underreported, even among those who play contact sports.

image of crinkled paper forming a brain to indicate injury or brain damage

Source: iStock

For certain individuals, negative consequences from head trauma are even more immediate. Some doctors have found patients, including teenagers, are more likely to develop anxiety disorders and depression when a concussion isn’t allowed to heal properly. This can happen even when patients have no history of mental illness.

It’s also worth mentioning some folks suffer multiple concussions, which is typical in the NFL cases. Simply put, the more head injuries a person suffers, the worse the outcome. This is why getting proper treatment and allowing a concussion to heal is so important.

It all starts with taking into account any symptoms you experience after a hit to the head. They’re not usually outlandish, so it’s easy brush off a headache or feeling of fogginess as normal. If you notice any difference in the way you feel after the event, take it seriously and head to the doctor. You’re more likely to get hurt again if you try to get back to your regular activities when suffering from a concussion, so follow your physician’s orders.

It should go without saying that any athlete should use the proper protective gear, but that goes for regular Joes as well. If you participate in an activity that offers some sort of headgear, protect your noggin no matter how goofy you think the helmet looks. The same goes for biking. Looking slightly nerdy is a small price to pay.



Person, and Christine-skopec. “Should You Be Worried About a Concussion?” The Cheat Sheet. The Cheat Sheet, 15 Feb. 2016. Web. 19 Apr. 2016.

New rules ban, decrease soccer headers

Starting this season, soccer players under 10 years old will be penalized for using their heads to strike the ball during a game.

Because of a new recommendation by the U.S. Soccer’s Player Safety Campaign, the Illinois Youth Soccer Association has placed a ban on the use of headers during soccer games, practices and tournaments.

Now, if a player intentionally heads a ball during a game, the opposing team will be awarded an indirect kick — the same penalty for handballs and fouls. Also, the the safety campaign recommends a limitation on the number of head balls players from 11 to 13 can perform a week.

Jacksonville Soccer Association President Daniel Hackett said the association — which works with players from preschool to eighth grade — will enforce the new rule for the fall session, but said it is already too late for the spring session, which has already started.

“It won’t be difficult for the younger kids, just a quick change,” Hackett said.”Starting at U-8, those kids are use to (headers). They are told to do that. It’s ingrained, you go up for headers.”

Hackett said the change is one that is needed, especially because of the youth players lack of knowledge on soccer-related concussions.

“A lot of those kids don’t know what its supposed to feel like, what it’s not supposed to feel like,” Hackett said. “They don’t always know something is wrong and with these younger sports there’s not a medical staff right there on call, watching every youth game.”

Hackett said the association coaches and referees will have to be vigilant in reminding the players of the ban until they get use to the new rule.

A study on concussion rates among younger players found there were 4.5 concussions for girls and 2.8 among boys for every 10,000 athletic exposures — a student participating in a game or practice.

“The rates are pretty high,” Hackett said. “For the younger children, that really has an effect.”

Hackett said this ban will also decrease the number of other head injuries, such as knocked out teeth from a headbutt gone wrong.

The change came after a group of parents and players brought a civil case against U.S. Soccer, U.S. Youth Soccer, the American Youth Soccer Organization, U.S. Club Soccer and the California Youth Soccer Association regarding problems with concussions in youth sports.

Along with the settlement that reformed the rules, U.S. Soccer also has to improve concussion awareness among coaches, referees and parents, as well as other regulations that help prevent more damage.

“It needs to change, it needs to happen,” Hackett said. “Just to doing away with it will fix a lot of things.”

Samantha McDaniel-Ogletree can be reached at 217-245-6121, ext. 1233, or @JCNews_samantha.


Ogeltree, Samantha. “New Rules Ban, Decrease Soccer Headers – Journal-Courier –” Journal-Courier. Journal-Courier, 13 Feb. 2016. Web. 19 Apr. 2016.

Using an Asthma Action Plan

An asthma action plan is a written series of steps and management techniques that should be used when a patient with asthma experiences worsening in symptoms of the condition.

The aim of an asthma action plan is to enable patients and caregivers to recognize early warning signs of an asthma attack and take the appropriate steps to improve control of the condition and minimize complications.

Child playing sport having an asthma attack

Image Copyright: Lopolo, Image ID: 249852262 via Shutterstock

What is an Action Plan?

An asthma action plan is a written, step-by-step guide to enable patients to maintain control of their asthma symptoms. It is usually made by the patient and health professional together and outlines what to do when:

  • Asthma is well controlled
  • There is a flare up of asthma symptoms
  • An asthma attack occurs

The plan will usually list any triggers, remind patient when to take which medication and stipulate how bystanders can help if an attack occurs.

Asthma Action Plan

Click here or the image to view an Asthma Action Plan from Asthma Action Plan from the US National Institutes of Health (PDF)


Research has supported the benefits that a written asthma plan can offer when individuals are managing asthma in the home environment. It helps to:

  • Establish clear guidelines on when and how to act in response to certain changes and symptoms related to the condition.
  • Monitor changes and understand when the condition is well-controlled o pharmacological treatment alterations are needed.
  • Provide patients with the knowledge of when to act and seek emergency medical aid.

An asthma action plan assists in the communication between the healthcare practitioner and the patient, allowing relevant information to be clearly presented in a written and easy-to-follow format. It doesn’t take long to discuss and write up the action plan but the benefits of the plan are clear. In fact, individuals that have an action plan are four times less likely to require hospitalization to manage severe symptoms.

Daily Maintenance

The everyday section of the action plan should detail the regular medications and management techniques that should be employed to prevent symptoms as asthma.

This often includes the avoidance of asthma triggers, in addition to preventative medication to reduce inflammation of the airways. Reliever medication is also indicated when symptoms worsen for a short period of time.


Flare-ups of asthma symptoms are most likely to occur when individuals have been exposed to triggers of asthma or have recently been ill with a cold or influenza. These periods are marked by increased use of reliever medication or a reduction in peak expiratory flow (PEF) values at home, and should be considered as a warning sign to initiate treatment to prevent an attack.

The plan will differ according to the needs of each individual, but often involves a “step up” approach in medications or a short course of corticosteroids to manage inflammation

Emergency Action

An asthma plan plays an essential role to guide decision-making when in an emergency situation such as an asthma attack. It is marked by the significant worsening of symptoms such as difficulty breathing, chest tightness and wheezing.

The plan should be easily accessible for other members of the family to refer to and help in the management of the attack. In most cases, reliever medication should be administered, and an ambulance should be called if no improvement occurs.

Other Advice

It is important that the asthma action plan is reviewed and updated regularly, at least annually, to ensure the plan is suitable for the individual case.

Additionally, the action plan can only be utilized if the patient has it on hand when it is needed. If should be located in a place at home that allows people to see it and refer to it quickly when needed. It can also be useful to make several copies to be kept in other areas, such as in the car, at school and the sporting club.


Further Reading


Smith, Yolanda. “Using an Asthma Action Plan.” News-medical, 09 Feb. 2016. Web. 19 Apr. 2016.

Improve football safety for young players: Your Say

Sports columnist Nancy Armour totally misses the mark (“Armour: How many CTE cases does it take before attitudes change?”).

The issue is not that the NFL must act, but that mothers and fathers whose boys play football must act, either by stopping their children from playing football or by changing the game so that their children’s brains are not knocked around in their skulls while playing a game.

The “dumb jock” football player in school is likely a function of playing a game that can affect his brain every time he tackles or is tackled.

Many of the boys who never make it to the NFL may suffer from chronic traumatic encephalopathy. By the time one makes it to the NFL, it might be too late to prevent the damage.

Anita Heygster; Pasadena, Md.

POLICING THE USA: A look at race, justice, media

Comments from Facebook are edited for clarity and grammar:

My son plays middle linebacker in high school, so the issue is very important to us. What I have not read is what are the lives of players who have CTE like in their later years? Do they suffer from dementia so bad that they are debilitated? How do the brains of players with CTE compare with athletes in other contact sports, such as mixed martial arts or hockey? We saw “Concussion,” and if the portrayal of player Mike Webster was even halfway accurate, it is a scary thought.

— Lambros Balatsias

The deceased players chose the risk of injury to play the game they loved. Granted, this condition isn’t pretty. It strikes at the core of what makes a man a man: his mind. However, players today now know this risk and still choose to play. Hand-wringing is not going to change anyone’s mind about what’s at stake. Yes, some people don’t choose to live wrapped in a no-risk bubble. Accept it.

— James King



USA Today. “Improve Football Safety for Young Players: Your Say.” USA Today. USA Today, 7 Feb. 2016. Web. 19 Apr. 2016.

The Limits of Football Helmets

In its earliest days, the purpose of the football helmet was to prevent the sport’s scariest, most visible injuries: grisly skull fractures and broken necks. Today’s safety standards for helmets were developed in response to the high number of fatalities in 1968, when 36 players were killed across all levels of the sport. But in recent years, a growing body of evidence has shown that these helmets still aren’t nearly enough to prevent dangerous head injuries. The concussion-proof helmet has become the holy grail of helmet design. But can such a thing really exist?

“A concussion can actually happen without actually hitting your head,” said Kyle Lamson, the head of research and development at Xenith, a helmet company based in Detroit, Michigan. And “if you can get a concussion without actually hitting your head, then a helmet can’t possibly prevent every concussion that can actually happen.”

Glenn Beckmann, the director of marketing communications for Schutt Sports, echoed those sentiments. “There is no such thing as a concussion-proof helmet. And there won’t be for the foreseeable future,” he wrote in an email. “We still aren’t anywhere close to knowing enough to say we can prevent concussions. There are just too many unknowns when it comes to defining a concussion and what causes it.”

Still, many athletes, parents, and coaches view the helmet—perhaps the most recognizable safety measure in modern sports—as something of a savior, the thing that will keep most concussions at bay.  According to a University of Pittsburgh Medical Center poll, only one in four Americans “understand[s] that safety equipment—such as helmets or mouth guards—cannot prevent the majority of all concussions.” The company that makes the safest helmet can sell its product at a premium. (For example, Riddell’s SpeedFlex, which topped Virginia Tech’s STAR safety-ratings study in 2014, sold for $400, or $100 more than most competing helmets.) Consequently, most helmet companies pour a large percentage of their resources into research and development.

But what exactly are they moving towards? Consumers demand safety, but safety can be hard to define. Several athletic-equipment companies’ promises of concussion reduction haven’t held up to scrutiny. In 2013, for example, the Federal Trade Commission ruled that Riddell could not claim that its Revolution model reduced concussion risk by 31 percent; the following year, the agency sent a letter asking several sporting-goods retailers to substantiate the descriptions of mouth guards on their websites as protecting against concussions. Public studies like Virginia Tech’s, then, are a way for companies to imbue their safety claims with some authority.

Since it was developed by the Virginia Tech engineering professor Stefan Duma in 2011, the STAR (Summation of Tests for the Analysis of Risk) system has been influential in determining which helmets see higher sales than others. Some high-school coaches and even school boards have made five-star helmets mandatory for their players. In response, many companies have altered their models to better conform to the system’s criteria—“The STAR system has significantly affected how we design helmets,” Beckmann wrote—but not all companies are happy about STAR’s power in the field.

“These ratings are misleading people,” Robert Erb, the CEO of the helmet company Schutt, told Bloomberg in January. “People are now using them to determine which helmets to put their youth leagues into, which is truly insane.” (The safest helmet for a kid isn’t necessarily the safest for an adult, and vice versa.) When Schutt released its “VTD” helmet line (short for “variable thickness and durometer”) in 2014—which included two helmets that received a five-star safety rating—the company’s press release noted Schutt’s disagreement with the Virginia Tech methodology. “To date, there is scant evidence to support the conclusion that the VA Tech study is predictive,” the release reads, “that is, that a higher STAR rated helmet will reduce the likelihood of concussive episodes in football players.”

Some helmet-safety researchers feel the same way. The STAR system has been come under fire in recent years for failing to incorporate rotational acceleration into its criteria. The Virginia Tech methodology only looks at linear acceleration, or straight-line blows. But evidence shows that rotational acceleration—the kind of force that comes from a head-spinning blow—is the more important factor in determining concussion risk. Worse, a helmet built primarily to withstand linear forces may actually leave the athlete more exposed to rotational forces. “If you make a big, fat, soft helmet,” Blaine Hoshizaki, a researcher at the University of Ottawa’s Neuro-trauma Impact Science Laboratory, told Washingtonian in 2014, “you’re making a huge helmet that will increase the risk of getting hit and may create higher rotations.”

A recent study from the NFL and the NFL players association addressed this gap, issuing a new safety ranking of 17 helmets that incorporated rotational acceleration.

Thomas Mayer, a physician with the NFL Players Association, emphasized that there was no statistically significant difference between the 10 top-performing helmets—but that hasn’t stopped Xenith, the manufacturer of the highest-rated helmet, from loudly touting its score as a victory. “That’s obviously one of our bigger marketing tools we’ve ever had,” said Joe Esposito, Xenith’s CEO. On Xenith’s website, the first thing consumers see is a large image celebrating the Epic Varsity helmet’s top ranking in the study. “We’ve seen a big jump in the percentage of our sales tied to Epics.”

The company has also seen a boost in sales of its youth helmets, even though the NFL-NFLPA safety ratings don’t transfer from one product to another—the study specifically examined conditions typical to National Football League games. A memo from the NFL and NFLPA study authors to the league’s players, trainers, and equipment managers noted: ” It is important to emphasize that these results were based on testing intended to represent NFL impacts and thus, the conclusions on helmet performance cannot be extrapolated to collegiate, high school, or youth football.”

The caveat highlights a broader problem with the helmet industry as a whole, one that’s become clearer as concussion awareness has caused the industry to swell over the past decade. Football helmets cannot possibly be a foolproof measure against concussion, which is an extremely complicated injury to measure and diagnose. This leaves helmet companies scrambling for ways to separate their products from the rest of the pack—and with so little concrete evidence around, the companies chase down any accolades they can, no matter how incomplete or irrelevant the methodology.

“Helmets do two things very well: protect the skull, and absorb direct linear force impact. But protecting the brain from injury? There’s no real way to do that,” Beckmann writes. “Think of a carton of eggs. We’ve figured out how to protect the shells and keep them from cracking, but if you shake an egg, the yolk can still get scrambled. So, it’s unwise to expect a helmet to do something it’s not designed to do.”

“We’re seeing a false sense of security in the marketplace, driven by the desire to find simple answers to a very complex biological injury,” he added. “But, ultimately, there is no simple answer to the question of how to prevent concussions.”


Moore, Jack. “The Limits of Football Helmets.” The Atlantic. Atlantic Media Company, 5 Feb. 2016. Web. 19 Apr. 2016.