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Football helmets are not built to prevent concussions — but they could be

Dr. Dean Sicking is tackling the problem of concussions in football the same way he approached fatal NASCAR crashes.

Football has a concussion problem — and helmets are to blame, says safety expert Dr. Dean Sicking. “They are so poorly designed.”

In 2017, the National Football League documented 291 diagnosed concussions, throughout the preseason and regular season games and practices. For the five years prior, between 212 and 279 concussions were diagnosed each season.

Concussions are increasingly linked to diseases, including dementia, Alzheimer's, depression and chronic traumatic encephalopathy (CTE) — all of which have been found in the brains of retired football players and have cast a shadow over America’s most popular sport.

But, according to Sicking, we don’t understand enough about how football blows translate into concussions. There is limited data on the player-to-player impact in football, leaving researchers without enough information to solve the problem. 

Sicking is best known for developing roadside and racetrack safety barriers that dissipate the energy of high-speed crashes, preventing injuries and saving lives. This work earned Sicking the 2005 National Medal of Technology and Innovation.

“The measure they are using for risk of concussion is not very accurate,” Sicking said of the NFL and helmet manufacturers. “They are using the wrong test and the wrong measurement and the wrong indicator. Three strikes and you’re out.”

The measurements and tests currently used in helmet development tackle a different problem.

Before concussions, football players faced another danger on the field: skull fractures. Between 1961 and 1970, from the sandlot to the professional level, there were 244 football related deaths. Among those fatalities, 73.4 percent resulted from a cerebral hemorrhage, and 16.4 percent resulted from cervical spinal cord injuries, according to findings from Dr. Robert Cantu, a Boston University School of Medicine clinical professor of neurology and neurosurgery.

“That was a horrible thing because skull fractures are very serious,” Sicking said. “So they set about figuring out how to solve that problem.”

Studies at that time involved testing of cadavers in automobile crashes and testing of cadaver wearing helmets.

“They concluded if they could keep the peak load on the helmet below a certain level, a severity index of 1,100 [pounds of force], they just about could eliminate skull fracture,” Sicking said.

After a few years, with improved helmets protecting players from the force that causes a skull fracture, “they wiped out” the problem, Sicking said.

“But ever since then the problem has not been skull fractures. It’s been concussions,” Sicking said. “But no one has reorganized that study of helmet performance for concussions.” And improvements in the equipment “stalled out.”

“They have this measure of risk for skull fractures, [but] they are using that as an indirect indicator of concussions,” Sicking said. “The indicator for risk of skull fracture has got little to do with the indicator for risk of concussion,” because a concussion can occur from impacts that are not forceful enough to cause skull fractures.

“They are using the wrong test and the wrong measurement and the wrong indicator. Three strikes and you’re out.”

“Although helmets perform much better on the criteria used to evaluate helmets, they don’t change the outcome on the field at all," Sicking added.

Sicking was working at Midwest Roadside Safety Facility at the University of Nebraska-Lincoln when a student’s dynamic impact analysis project showed him just how poorly football helmets were protecting football players.

“One of my students decided he wanted to study football helmets,” Sicking said. “He did some basic testing of the materials and came back and showed it to me. I said, ‘No, you did something wrong. This can't be right. Not possible.’”

The former student, Scott Peterson, also assumed human error was at fault when he saw the results of the force of helmet-to-helmet collisions.

“The impacts were a much greater force than we expected it to be,” Peterson said. 

So he repeated the test for Sicking. 

“We went back, got a few more helmets and I watched him do the test. He did it right. The data was correct. The helmet was just very poorly designed,” Sicking said. 

The issue stuck with Sicking and eventually led him to the University of Alabama at Birmingham, where his lab studies safety technologies, including how to improve helmets.

A better helmet design could be the key to drastically reducing the risk of brain injury on the field, according to Sicking. 

“I concluded that there was a serious need for impact analysis. I started looking into it. I found that there was a tremendous need for new work in that field,” he said.

Sicking is tackling the problem of concussions from football impacts in the same way he approached fatal crashes. When tasked with how to prevent deadly NASCAR crashes, Sicking’s team recreated every known crash that caused severe injury or death.

“We found that basal skull fracture — where you get enough force, tension on the neck to pull the head off the neck — research has shown it takes about 4,000 newtons or 900 pounds [of force] to do that,” Sicking said. “We had our problem defined: If we could keep the neck tension in the drivers below 4,000 newtons or 900 pounds — we could keep them alive.”

Less than two years later new barriers were on racetracks that eliminated the problem. 

“First, we had to define the problem before we eliminated it,” Sicking said. But in football, “no one wants to take the time to define the problem, so we can’t eliminate it. We can’t even make any progress. We’re just guessing. Spitting in the wind.”

What researchers do know is the forces players endure on the field are startling. According to research from University of Nebraska physics professor Timothy Gay, the average NFL defensive back can deliver 1,600 pounds of tackling force.

But the exact force that causes a concussion remains unknown.

“Until we get the definition of the problem, we can’t solve it,” Sicking said. 

“Once we know the threshold values we can identify what kind of equipment to put on these people to keep them from getting injured, from getting concussions,” he added.

The problem is that identifying the thresholds for concussions through multiple studies could come at a price tag of $18 million to $20 million, according to Sicking. 

He envisions a study monitoring several football teams, including detailed MRI brain analyses of players before the season. Any player that goes through the concussion protocol would do another MRI scan, to identify physical differences in the brain tissue. This information would be paired with video monitoring of practices and games to analyze the hit that prompted the concussion protocol.

Researchers can then determine the impact speed at which distortions in the neural tissue appear.

“We need to monitor at least 1,000 hits like that where you can identify throughout the brain how much distortion was felt by every portion of the brain, [then] identify what portion of the brain took structural damage as indicated by the MRI and what the symptoms were,” Sicking said.

Sicking says half a million to a $1 million could fund a small study “to really start doing this detailed analysis of what is going on inside the brain during an impact.”

“We can identify what is causing concussions, and cut them way back,” he added. “If we can reduce concussion by 75 to 90 percent — you’ve solved the problem.”

Sicking says so far he hasn’t been successful in getting the necessary funding to solve the concussion problem.

“This would be so valuable to every walk of life — not just football players, cyclists, workers on the job in the construction industry, anywhere that you have a risk of getting hit in the head, it would be a tremendous benefit.”