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CONCUSSIONS AND THE MARKETING 

OF SPORTS EQUIPMENT 

HEARING 

BEFORE THE

COMMITTEE ON COMMERCE, 

SCIENCE, AND TRANSPORTATION 

UNITED STATES SENATE 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

OCTOBER 19, 2011 

Printed for the use of the Committee on Commerce, Science, and Transportation 

( 

(II) 

SENATE COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION 

ONE HUNDRED TWELFTH CONGRESS 

FIRST SESSION 

JOHN D. ROCKEFELLER IV, West Virginia, Chairman 

DANIEL K. INOUYE, Hawaii 

JOHN F. KERRY, Massachusetts 

BARBARA BOXER, California 

BILL NELSON, Florida 

MARIA CANTWELL, Washington 

FRANK R. LAUTENBERG, New Jersey 

MARK PRYOR, Arkansas 

CLAIRE MCCASKILL, Missouri 

AMY KLOBUCHAR, Minnesota 

TOM UDALL, New Mexico 

MARK WARNER, Virginia 

MARK BEGICH, Alaska 

KAY BAILEY HUTCHISON, Texas, Ranking 

OLYMPIA J. SNOWE, Maine 

JIM DEMINT, South Carolina 

JOHN THUNE, South Dakota 

ROGER F. WICKER, Mississippi 

JOHNNY ISAKSON, Georgia 

ROY BLUNT, Missouri 

JOHN BOOZMAN, Arkansas 

PATRICK J. TOOMEY, Pennsylvania 

MARCO RUBIO, Florida 

KELLY AYOTTE, New Hampshire 

DEAN HELLER, Nevada 

ELLEN L. DONESKI, Staff Director 

JAMES REID, Deputy Staff Director 

BRUCE H. ANDREWS, General Counsel 

TODD BERTOSON, Republican Staff Director 

JARROD THOMPSON, Republican Deputy Staff Director 

REBECCA SEIDEL, Republican General Counsel and Chief Investigator 

(III) 

C O N T E N T S 

Page 

Hearing held on October 19, 2011 .......................................................................... 1 

Statement of Senator Rockefeller ........................................................................... 1 

Statement of Senator Boozman .............................................................................. 3 

Statement of Senator Udall .................................................................................... 4 

Prepared statement .......................................................................................... 5 

Statement of Senator Klobuchar ............................................................................ 61 

Statement of Senator Pryor .................................................................................... 63 

Statement of Senator Thune ................................................................................... 68 

WITNESSES

Alexis Ball, Albuquerque, New Mexico .................................................................. 22 

Prepared statement .......................................................................................... 24 

Steven Threet, Tempe, Arizona .............................................................................. 26 

Prepared statement .......................................................................................... 28 

Jeffrey S. Kutcher, MD, Associate Professor, University of Michigan, Department of Neurology; Director, Michigan NeuroSport; Chair, Sports Neurology 

Section, American Academy of Neurology .......................................................... 29 

Prepared statement .......................................................................................... 31 

Ann C. McKee, MD, Professor of Neurology and Pathology, Boston University 

School of Medicine; Director, VISN–1 Neuropathology Laboratory for the 

New England Veterans Affairs Medical Centers; Director, Brain Banks 

for the Boston University Alzheimer’s Disease Center, Framingham Heart 

Study, and Centenarian Study; Co-Director, Center for the Study of Traumatic Encephalopathy ......................................................................................... 34 

Prepared statement .......................................................................................... 37 

Mike Oliver, Executive Director and Legal Counsel, The National Operating 

Committee on Standards for Athletic Equipment (NOCSAE) .......................... 46 

Prepared statement .......................................................................................... 48 

APPENDIX

Hon. Frank R. Lautenberg, U.S. Senator from New Jersey, prepared statement ...................................................................................................................... 79 

Hon. Mark Warner, U.S. Senator from Virginia, prepared statement ................ 79 

Sporting Goods Manufacturers Association (SGMA), prepared statement ......... 80 

Scott Hallenbeck, Executive Director, USA Football, prepared statement ......... 84 

Stanley Herring, MD, Clinical Professor Departments of Rehabilitation Medicine, Orthopedics and Sports Medicine, and Neurological Surgery University of Washington; Co-Medical Director Seattle Sports Concussion Program; Team Physician Seattle Seahawks and Seattle Mariners; and Member, National Football League’s Head, Neck and Spine Committee, prepared 

statement .............................................................................................................. 93 

Letter dated October 29, 2011 to Hon. Jay Rockefeller from Ralph & Joy 

Conradt ................................................................................................................. 95 

Response to written question submitted by Hon. Frank R. Lautenberg to 

Alexis Ball ............................................................................................................. 96 

Response to written question submitted to Steven Threet by: 

Hon. Frank R. Lautenberg ............................................................................... 96 

Hon. John Thune .............................................................................................. 96 

Response to written questions submitted to Jeffrey Kutcher, MD by: 

Hon. Frank R. Lautenberg ............................................................................... 97 

Hon. Tom Udall ................................................................................................ 98 

Hon. John Boozman ......................................................................................... 99 

Page

IV 

Response to written questions submitted to Ann C. McKee, MD by: 

Hon. Frank R. Lautenberg ............................................................................... 100 

Hon. John Boozman ......................................................................................... 100 

Response to written questions submitted to Mike Oliver by: 

Hon. Frank R. Lautenberg ............................................................................... 101 

Hon. Tom Udall ................................................................................................ 102 

Hon. John Thune .............................................................................................. 119 

(1) 

CONCUSSIONS AND THE MARKETING 

OF SPORTS EQUIPMENT 

WEDNESDAY, OCTOBER 19, 2011 

U.S. SENATE, COMMITTEE ON COMMERCE, SCIENCE, AND TRANSPORTATION, Washington, DC. 

The Committee met, pursuant to notice, at 2:34 p.m., in room 

SR–253, Russell Senate Office Building, Hon. John D. Rockefeller 

IV, Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JOHN D. ROCKEFELLER IV, 

U.S. SENATOR FROM WEST VIRGINIA 

The CHAIRMAN. This hearing will come to order, and it is going 

to be an absolutely wonderful hearing. 

There are actually 14 Senators in front of you. You just can’t see 

all of them. It is something that we are working on with NASA. 

We become invisible at proper moments. 

I am very proud that you are here, and I am very proud of our 

two Senators over here. This one, although you would never know 

looking at him, is a football player and—or was, I guess I should 

say. Yes. 

Senator BOOZMAN. Two stadiums ago. 

The CHAIRMAN. There you go. So I am going to make an opening 

statement, and then I wish each of them would. We try to keep it 

brief because we want to have plenty of time for you to talk and 

for us to question. 

I am so grateful for all of you being here, all of you. This is a 

massive subject. The story which I may tell about my son reveals 

that parents can’t always be as effective as they would like to be. 

I haven’t decided whether to do that or not, whether it is an invasion of his privacy. But you can advise me when you give your testimony. 

So, anyway, every afternoon at the end of the school day, millions of our children head to playing fields, gymnasiums, or hockey 

rinks to participate in team sports. I should have said soccer fields, 

too. Playing sports doesn’t just make our kids stronger and 

healthier. It also teaches them important values. They learn about 

hard work, about leadership, about living with pain and going 

through it, about working together for a common goal. 

The camaraderie that comes out of sports units is wonderful to 

see. It is real, and it lasts forever. Most of our young athletes will 

not end up playing sports at the collegiate or professional level, but 

we hope they will all carry the positive lessons they have learned 

on the playing fields with them throughout life, and they will. 

2 

So our hearing today is about the head injuries that tens of thousands of these athletes sustain every year while playing the sports 

they love. Many of us are reluctant to talk about the risks involved 

in playing sports because we know what a positive role that sports 

play in our communities. 

On the other hand, the last thing we can do here is not talk 

about this problem of concussions and gear and all the rest of it. 

I mean, America has to have this conversation, and there will be 

many, many hearings on it, I know. 

In fact, more of our children should be playing sports, not fewer. 

Too many kids are spending their afternoons in front of computer 

or televisions screens, instead of on the sports field. And that is 

said every day by everybody who is involved in healthcare. I am 

going to give you a couple of pathetic figures. 

According to the latest data compiled by the Centers for Disease 

Control, only 17 percent of American high school students get an 

hour of daily physical activity, which is our current health guidelines. They say that, that you need to have that to stay healthy— 

only 17 percent. One-third of our children are now overweight or 

obese, which makes it more likely that they will suffer from chronic 

health conditions, such as heart disease or diabetes, things which 

will plague them for the rest of their lives as, indeed, what we will 

be talking about today could do to some. 

But the risks involved in playing sports are also very, very real. 

And by now, we have all heard about the National Football League 

players who are struggling with serious mental and physical health 

problems because they sustained repeated mild traumatic brain injuries, which is what concussions are called, I guess, medically, 

during their playing years. And it is very, very sad. 

I mean, I have seen a number of these players, people that I had 

worshipped growing up, in wheelchairs. Who was the guy that 

played—he was a cornerback for the Raiders? The greatest interceptor of all time, Woody—come on, give me—— 

No. No. Doesn’t matter. Doesn’t matter. 

[Laughter.] 

The CHAIRMAN. But I mean, it was awful. I was at an event with 

him, and he was seated in a wheelchair, and he couldn’t even pull 

his head up. And I leaned down and whispered in his ear. I think 

I kissed him, too. I am not sure. But it was having seen from this 

to that and who knows, especially this was 8 years ago. Nobody 

was talking about it. 

We now understand, however, that this is not an injury only 

NFL players can suffer. According to research conducted at the Nationwide Children’s Hospital in Columbus, Ohio, more than 70,000 

high school football players sustain concussions every single year. 

And it is not just a football problem. One of our witnesses today, 

Alexis Ball, will talk about the concussions she suffered while playing soccer in high school and college. According to Nationwide Children’s Hospital, more than 10,000 high school girl soccer players 

sustain concussions each year. 

So what we are going to do is we are going to hear from Ms. Ball 

and our other witnesses today, who I should name. Dr. Jeffrey 

Kutcher. Jeffrey, you are not in my opening script. So I have to do 

this, and you forgive me. Associate Professor, Department of NeuVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
3 

rology, University of Michigan; Director, Michigan NeuroSport. 

And Dr. Ann McKee, Professor of Neurology and Pathology at Boston University and Director of Neuropathology Core, BU Alzheimer’s Disease Center. I guess that is Boston University’s. And 

Mr. Mike Oliver, who is Executive Director of the National Operating Committee on Standards for Athletic Equipment. 

We welcome all of you, and I will just close right there and ask 

if the Chairman of the Subcommittee would wish to say something 

because he has been just terrific on this subject and also the Ranking Member. 

Go ahead. 

STATEMENT OF HON. JOHN BOOZMAN, 

U.S. SENATOR FROM ARKANSAS 

Senator BOOZMAN. Well, thank you, Mr. Chairman, again for us 

holding this very important hearing this afternoon. 

As a former player, it is certainly something that I am interested 

in. But also there are so many moms and dads and coaches and 

players all across the country that also are very interested and 

probably should be more interested than what they realize. And I 

think that is the great thing about having this hearing is to try 

and get that information out and really discuss a potential very serious problem. Not a potential very serious problem, a very serious 

problem, period. 

Sports play a vital role in development of young men and women. 

They help build youth social relationships and learn to work as a 

team while keeping them physically active and healthy and having 

fun. According to the National High School Sports-Related Injury 

Surveillance Study, participation in high school sports has almost 

doubled in the last 30 years. 

This is fantastic news, and I think it is important for us to highlight the benefits of playing sports. However, participation in athletics does carry with it significant risk of injury. Just last week, 

there was news of a tragic death of a 16-year-old high school football player who died after sustaining a head injury during a game. 

It is important that everyone—coaches, parents, physicians, and 

the athletes themselves—understand those risks and be able to 

identify injuries when they occur. Concussions especially have the 

potential for severe injury, and multiple concussions can cause significant repercussions later in life, as we are going to hear about 

today. 

Especially with many recent media reports of high-profile incidents in the NFL, we often associate football with concussions. As 

I am well aware and as Mr. Threet will mention in his testimony, 

concussions are a risk with playing football, but players in many 

sports run the risk of sustaining concussion, as we will hear from 

Ms. Ball in her story about playing soccer. 

It is imperative for coaches and parents involved in all sports to 

be aware of the dangers associated with concussions, know how to 

recognize the signs and symptoms and what to do if a player suffers a concussion. I look forward to hearing from Dr. Kutcher and 

Dr. McKee about the research to further the knowledge that we 

have about concussions, but many questions remain as to the 

4 

causes and effects of concussions. I am very interested in hearing 

from the experts on what is known and where we can go from here. 

As we will also discuss, there is a wide variety of athletic equipment on the market that claim to use concussion-reducing or concussion-preventing technology. Parents want to keep their children 

protected, but navigating the many products and claims in the 

marketplace, especially online, can be overwhelming. It can be easy 

to read that something offers the best maximum security protection 

and assume that their child will be safe from injury. That is simply 

not true. 

Some products may offer better protection than others, but we 

need to explore what resources exist to help parents and coaches 

know what level of safety a product will actually provide. I also do 

not know how the average parent or coach can be confident that 

the equipment they purchase genuinely offers a greater safety benefit or if its advertisement contains misleading or deceptive claims. 

I hope our witnesses today will be able to help me answer this 

question. 

Along with knowing the safety benefits and limitations of sports 

equipment, parents and coaches need to educate themselves on 

what to look for in the event that an athlete has a potential concussion. There are a number of different materials available for this 

purpose. Perhaps the most well-known education effort is the 

‘‘Heads Up’’ initiative, led by the CDC in partnership with dozens 

of professional organizations and individuals. 

Individual associations, like USA Football, also have their own 

education campaigns for coaches, how to teach proper execution of 

plays and tackles so athletes are in as little danger as possible. 

However, education campaigns must be effective in order to effect 

change. I am interested to learn if there is data that shows whether these efforts are reaching a wide enough audience and promoting awareness sufficiently. 

Mr. Chairman, I know today’s hearing will draw attention to this 

important safety issue. Parents, coaches, and athletes must have 

the resources available to them to understand the severity of concussions and how to react when one occurs. As I said earlier, the 

benefits from participating in sports are many, and I hope that the 

potential for injury does not prevent anyone from playing. 

Mr. Chairman, again, I thank you for calling this very important 

hearing and look forward to hearing from our witnesses. I ask 

unanimous consent that a statement from the Sporting Goods Manufacturers Association and USA Football be in the record. 

The CHAIRMAN. It is so done. 

[The statement can be found in the Appendix.] 

Senator BOOZMAN. And with that, I yield back. 

The CHAIRMAN. I thank the Senator and call upon Senator Udall, 

who has been huge in putting together all of this. 

STATEMENT OF HON. TOM UDALL, 

U.S. SENATOR FROM NEW MEXICO 

Senator UDALL. Thank you, Chairman Rockefeller, and thank 

you for that nice comment. 

And I very much appreciate you holding this hearing today. I 

would like to say a few words and ask that my full statement be 

5 

put in the record. And Mr. Chairman, I greatly appreciate your efforts to promote brain research and, as Chairman of this Subcommittee, your close attention to consumer protection issues. 

Concussions used to be dismissed as simply ‘‘dings’’ or ‘‘bell-ringers.’’ We know now that a concussion is a form of traumatic brain 

injury that should be taken seriously. According to a recent Centers for Disease Control report, emergency room visits for sports 

and recreation-related traumatic brain injuries increased by 60 percent among children and adolescents over the last decade. 

The CDC attributes this rise to greater concussion awareness, 

which is a good thing. Now that athletes, coaches, and parents 

have a better understanding of concussions, some sports equipment 

makers appear to be taking advantage. There are a number of socalled ‘‘anti-concussion’’ and ‘‘concussion-reducing’’ devices on the 

market. 

While we should encourage any innovation to protect young athletes, we need to make sure that advertisers play by the rules. Expert witnesses today can shed some light on ‘‘anti-concussion’’ 

claims used by some sports equipment manufacturers. 

Although we now know more about the dangers of concussions, 

we shouldn’t forget how important sports and physical activity is 

for children. The CDC estimates that only 18 percent of American 

high school students participate in at least 1 hour of physical activity a day. That is the amount recommended by the Department of 

Health and Human Services. 

Among high school students in New Mexico, only 23 percent are 

getting it. This could lead to negative health consequences that last 

a lifetime. So we need to encourage kids to play sports, to exercise, 

and to be more physically active. Injury is always a risk, but the 

benefits far outweigh the dangers. And as we learn more about the 

dangers of concussions for young athletes, we can take steps to 

make sure that they are played more safely. 

I want to thank all the witnesses for being here and testifying 

today. I especially want to recognize Ms. Alexis Ball, who traveled 

from Albuquerque to share her experience with sports concussions. 

In reviewing Dr. McKee’s testimony, I find it especially poignant 

that she discusses Dave Duerson, a former NFL player who tragically took his own life earlier this year. In 2007, he testified before 

this committee. According to news reports, Duerson informed his 

family that he wanted his brain to be studied. He hoped people 

could learn more about the effect of brain trauma so kids could 

play football more safely in the future. 

In keeping with this sentiment, I hope that this hearing today 

will advance the goal of making sports safer for our children. 

With that, Chairman Rockefeller, thank you very much, and 

thanks for being here and the Ranking Member for being here. Appreciate it. 

The CHAIRMAN. That is a pretty powerful statement. 

Senator UDALL. Thank you. 

[The prepared statement of Senator Udall follows:] 

PREPARED STATEMENT OF THE HON. TOM UDALL, U.S. SENATOR FROM NEW MEXICO

Concussions used to be dismissed as simply ‘‘dings’’ or ‘‘bell ringers.’’ Today we 

know that a concussion is a form of traumatic brain injury that should be taken 

6 

seriously. For young people between 15 and 24 years old, playing sports is the second-leading cause of traumatic brain injury—second only to motor vehicle crashes. 

According to a recent Centers for Disease Control and Prevention (CDC) report, 

Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities 

Among Persons Aged ≤19 Years—United States, 2001–2009, emergency room visits 

for sports and recreation-related traumatic brain injuries increased by 60 percent 

among children and adolescents over the last decade. The CDC attributes this rise 

to greater concussion awareness, which is actually a good thing. 

Now that athletes, coaches, and parents have a better understanding of concussions, some sports equipment makers appear to be taking advantage of their new 

concerns about safety. There are a number of so-called ‘‘anti-concussion’’ and ‘‘concussion reducing’’ devices on the market—from helmets and headbands to mouth 

guards, and even dietary supplements. While we should encourage any innovation 

to protect young athletes, we need to make sure that advertisers play by the rules. 

Claims they make about the safety of their equipment should be truthful and not 

misleading. Expert witnesses today can shed light on some of these concussions-related claims, and I look forward to hearing their testimony. 

Earlier this year, I asked the Federal Trade Commission (FTC) to investigate 

some of the safety claims used to sell football helmets. Given the seriousness of concussion risk and the potential for real injury to children, the FTC should have the 

ability to impose civil penalties, at the agency’s discretion, for any violation of the 

FTC Act that involves the use of false injury prevention claims to sell children’s 

sports gear. 

I also introduced legislation. This bill, the Children’s Sports Athletic Equipment 

Safety Act, would allow the FTC to impose civil penalties for using false injury prevention claims to sell any kind of children’s sports equipment. Again, under my bill 

the use of this enforcement power would be at the agency’s discretion. It would also 

require improvements to the current voluntary safety standard for football helmets. 

I am pleased to be working on this important legislation in a bipartisan manner 

with Representatives Bill Pascrell and Todd Russell Platts, the Co-Chairs of the 

Congressional Brain Injury Task Force. I also want to thank fellow Commerce Committee member Sen. Lautenberg for his support and co-sponsorship of the legislation. 

I believe it is important to share with my Commerce committee colleagues some 

of the potentially misleading advertising that is used to market so-called ‘‘anti-concussion’’ and ‘‘concussion reducing’’ sports gear for children’s use. 

My January 4, 2011 letter to FTC Chairman Jon Leibowitz cited several troubling 

advertisements for youth football helmets in particular. For example, one troubling 

claim comes from Riddell, the leading helmet-maker in the country. Riddell continues to use a concussion reduction claim that appears to be deceptive, misleading, 

and unsubstantiated. 

The CEO of Riddell, Dan Arment, told the House Committee on the Judiciary at 

a January 4, 2010 hearing on ‘‘Legal Issues Relating to Football Head Injuries’’ that: 

‘‘We have independent, peer-reviewed, published research in the medical journal 

Neurosurgery, February of 2006, showing that the Revolution [helmet] reduces 

the risks of concussions by 31 percent when compared to traditional helmets. 

. . . Today, over one million high school, college, and professional players have 

made the switch from traditional helmets to the Revolution family of helmets.’’ 

(See also ‘‘House Judiciary Committee hearing—Dan Arment opening statement.’’ Video recording. Available at http://www.youtube.com/watch?feature 

=player_embedded&v=v1gmwk2nqi4 accessed Oct. 19, 2011) 

Riddell bases this claim on a single study of high school football players using 

brand new Riddell Revolution helmets compared with players wearing used and reconditioned helmets of unknown condition. Scientists who commented on the article 

cautioned against drawing broad conclusions from a single study that compared the 

performance of new helmets with used headgear of unknown condition and that examined just 136 high school players who experienced concussions. 

Nevertheless, Riddell launched a media campaign featuring the claim from the 

2006 study that, according to its ‘‘Riddell Revolution UPMC Media Campaign Highlights’’ video news release, created ‘‘over 60 million media impressions, nearly 150 

television placements, over 100 newspaper clips, over 250 on-line placements, [and] 

6 live sports radio interviews.’’ (See http://www.riddell.com/pressreleases_upmc 

study/, accessed Jan. 6, 2011.) 

Several helmet and sports safety experts have criticized Riddell’s use of this concussion prevention claim to sell Revolution type helmets. In his 2007 book, Head 

Games: Football’s Concussion Crisis from the NFL to Youth Leagues, Chris Nowinski 

notes that: 

7 

‘‘As it is well established that rotational forces have a major role in football concussions, and that football helmets do little to reduce those forces, we could skip 

the discussion of the benefits of the newest football helmets, the Riddell ‘Revolution’ and the Schutt ‘DNA.’ If they make any difference it all, it would be minor. 

But. . .. both these companies are spending a lot of money to get you to buy 

these newer and more expensive helmets. You deserve to know what’s really 

going on.’’ 

In his book, Nowinski also quotes Dr. Robert Cantu, a board member of the National Operating Committee on Standards for Athletic Equipment (NOCSAE), who 

told him that: 

‘‘The theory behind the [Riddell] ‘Revolution’ is that if you build a helmet that’s 

a little bit bigger, especially in the temple area, and padded more thickly, then 

you’ll reduce force more than you would if you had thinner padding and not so 

big an outer shell. That theory is good for blows that go right to the temple, 

but that’s it.’’ 

NOCSAE’s technical director, Dave Halstead, told the New York Times in an October 27, 2007 story titled ‘‘Studies for Competing Design Called Into Question’’ that 

‘‘. . . the [Riddell] Revolution is a good helmet. . . . But I have problems with that 

particular [2006 Neurosurgery] study. The helmet is not shown to do what they say 

it does.’’ In another October 21, 2010 New York Times article titled ‘‘As Injuries 

Rise, Scant Oversight of Helmet Safety,’’ Halstead bluntly told reporter Alan 

Schwarz that ‘‘. . . I don’t believe that 31 percent [reduction in concussion risk 

claim] for a Yankee minute.’’ These public statements from one author of the 2006 

study and other helmet safety experts call into question whether there is competent 

and reliable scientific evidence to substantiate Riddell’s marketing claim. 

Moreover, Riddell advertisements cited in my letter to the FTC do not disclose 

that the company provided a grant to underwrite the 2006 Neurosurgery study. Nor 

do they disclose that Riddell’s vice president of research and development, Thad Ide, 

was one of the study authors. An official Neurosurgery commenter highlighted the 

authors’ conflicts of interest and stated that the study’s conclusions ‘‘should be interpreted accordingly.’’ Nevertheless, this claim has been extensively used in Riddell 

marketing of high school and youth helmets. 

Here is just one example taken from the website of Riddell’s parent company, Easton Bell, that does not disclose Riddell’s role in funding and writing the 2006 study: 

‘‘An extensive long-term study by the University of Pittsburgh Medical Center 

was published in the February 2006 issue of Neurosurgery. The results were 

impressive: Players wearing the Riddell Revolution football helmet were 31 

percent less likely to suffer a concussion than athletes who wore traditional or 

standard football helmets. For athletes who had never suffered a previous concussion, wearing the Riddell Revolution decreased their relative risk of concussion by 41 percent. . . .* * NEUROSURGERY, FEBRUARY 2006, VOL. 58, NO. 

2’’ (See http://www.eastonbellsports.com/brands/riddell, accessed Oct. 19, 

2011). 

The same Easton Bell webpage includes an image of a Riddell Revolution Speed 

helmet with the claim that ‘‘[r]esearch shows a 31 percent reduction in the risk of 

concussion in players wearing Riddell Revolution helmets when compared to traditionally designed helmets.* *NEUROSURGERY, FEBRUARY 2006, VOL. 58, NO. 

2.’’ (See image at end of statement.) 

Riddell also uses its reduced risk of concussion claim to sell youth helmets that 

were not actually tested in the 2006 study of high school football players. For example, Riddell’s online store advertises the Riddell Revolution Youth football helmet 

with the claim that research shows a 31 percent reduction in the risk of concussion 

when wearing the Riddell Revolution helmet compared to traditional helmets. This 

webpage does not disclose that the youth helmet was not actually included in the 

published study: 

Based on the same technology that made the varsity Riddell Revolution helmet 

possible—we offer in a Youth version—the Riddell Revolution Youth. . . . 

After an extensive long-term study by the University of Pittsburgh Medical 

Center was published in the February 2006 issue of Neurosurgery. The results 

were impressive: research shows a 31 percent reduction in the risk of concussion in players wearing a Riddell Revolution football helmet when compared to 

traditional helmets.* * NEUROSURGERY, FEBRUARY 2006, VOL. 58, NO. 2’’ 

(See https://shop.riddell.com/riddell/app/displayApp/%28cpgsize=20&layout= 

7.0-7_2_3_75_12_13_67_77_6_4_5&carea=0000000002&cpgnum=1%29/.do?rf=y, 

viewed Oct. 17, 2011) 

8 

Since concussion risk may differ depending on the age group and skill level of 

players, the results of a single study of high school football players may not be valid 

for younger children, especially if they wear a different helmet not used in the 

study. That the youth helmet was not actually tested in the 2006 Neurosurgery 

study may be a significant omission in such marketing claims used by Riddell and 

other retailers to sell Revolution youth helmets. 

As the official helmet of the National Football League (NFL), Riddell also highlights the use of its products ‘‘by the pros’’ when marketing helmets for high school 

and younger players. I am concerned by some of the product testimonial claims from 

one NFL head athletic trainer, Tim Bream of the Chicago Bears, who states in a 

Riddell Revolution Video News release titled ‘‘Riddell Revolution UPMC Media 

Campaign Highlights:’’ 

‘‘We’ve had some players who have had ongoing problems with head injury, and 

we made the switch to the new protective headwear when it came out, at its 

inception. And these players have had no problems since then, or no repeated 

concussions.’’ 

Bream does not name the players who ‘‘had ongoing problems with head injury’’ 

before switching to Riddell Revolution helmets. However, the NFL Injury Report 

website and news articles discussing head injuries suffered by Chicago Bears players during the 2010 football season seem to contradict the claim that wearing the 

Riddell Revolution helmet prevents all repeated concussions. Three Chicago Bears 

players who are listed as having head injuries during the 2010 season seem to be 

wearing Riddell Revolution helmets in press photos. Even if this Riddell Revolution 

testimonial claim of ‘‘no repeated concussions’’ were true at the time the video was 

made, one can question whether those who buy the Riddell Revolution helmet for 

youth or high school players would see similar results of ‘‘no repeated concussions.’’ 

Riddell uses additional endorsements from this athletic trainer in a January 9, 

2006 press release titled Research Shows Riddell Revolution Football Helmet Provides Better Protection Against Concussions (available at: http://www.riddell.com/ 

wp-content/uploads/2006_UPMC_Press_Release_web3.pdf, accessed Oct. 19, 2011) 

and a 2006 Riddell brochure titled Revolution Helmet Research Findings (available 

at: http://www.lohud.com/assets/pdf/BH1661391028.PDF, accessed Oct. 19, 2011). 

In the brochure, Bream states that the ‘‘new data [from the 2006 Neurosurgery 

study] helps our players make an informed choice when deciding which helmet is 

best for them.’’ 

Coaches and athletic equipment managers for youth and high school teams with 

players who have suffered concussions might also be particularly susceptible to such 

injury prevention claims. The Orlando Sentinel newspaper’s Varsity Sports blog reported on October 17 that one high school football coach and athletic trainer issued 

a fundraising appeal to buy 60 new Riddell helmets that are ‘‘the most-up-to-date 

. . . concerning concussion reduction technology’’ since he is concerned about team 

athletes with multiple concussions. He told the Varsity Sports blog that: 

‘‘In the last three years, we have had eight concussions on the football team. 

. . . What brought us to this point is we have a player who has had a second 

concussion and of course there is [former South Sumter linebacker] Your highness Morgan [a junior] at Florida Atlantic University but he can’t play because 

he has had three concussions in the last two years. We’re afraid we are putting 

our kids at risk. There are recent studies that have shown multiple concussions 

can lead to a lifetime of medical problems. It’s twice the price of the helmets 

we are wearing now and it’s a lot of money to ask a small community to raise 

but truly, I’m not sure how you cannot afford to get these helmets.’’ (Available 

at http://blogs.orlandosentinel.com/sports_highschool_varsity/2011/10/17/ 

south-sumter-raising-money-for-new-helmets/, accessed Oct. 19, 2011.) 

New Riddell helmets may be very good products. It may also be advisable for this 

team to replace its old helmets with new headgear. Yet there are still real dangers 

to overstating the ability of children’s sports equipment to prevent brain injury, particularly to coaches and parents of young athletes who have already suffered multiple concussions. 

Unfortunately, misleading ‘‘anti-concussion’’ claims appear in advertisements for 

more than just football helmets. There are other troubling examples of children’s 

sports equipment sold with concussion prevention claims. Although there is evidence 

that wearing properly fitted mouth guards reduces the risk of dental injuries, Dr. 

William Meehan, director of the Sports Concussion Clinic at Children’s Hospital 

Boston, writes in his 2011 book Kids, Sports, and Concussion: A Guide for Coaches 

and Parents that any ‘‘effects of [custom mandibular orthotics] and other mouth 

guards on concussions remains unknown.’’ 

9 

Such uncertainty about the ability of mouth guards to prevent concussions does 

not keep some companies from using concussion reduction claims to market mouth 

guards for youth and high school athletes. The product packaging for the Brain Pad 

Lo Pro+ junior mouth guard, which is sold for athletes aged eleven years and under, 

prominently states that it ‘‘Reduces the Risk of CONCUSSIONS!’’ and ‘‘Creates this: 

BRAIN SAFETY SPACE!’’ On its Brain Pad Blog, the company highlights in a banner image the claim ‘‘BioMechanically Tested and Proven to Reduce Concussions 

Risk by 40 percent!’’ (see: http://blog.brainpads.com/, accessed Oct. 19, 2011). 

In Brain Pad’s online video advertisement titled Head Trainer announces ‘‘Zero 

concussions with Brain Pad mouth guards!’’, a head athletic trainer ‘‘at one of the 

top 5 private [high] schools in the country’’ who is ‘‘responsible for the well-being 

of 800 student athletes at the school’’ states that: 

‘‘We’ve been using the Brain Pad since 1995. In all those years, whenever I go 

out on the field, especially if somebody has a potential of a concussion, I always 

check to see what type of mouth guard they’re wearing. And I have never, ever 

seen anybody wearing the Brain Pad and having a concussion. . . . Since 1995, 

my experience with this mouth guard preventing concussions has been absolutely awesome.’’ (see http://www.youtube.com/user/brainpads#p/u/3/mtg1EF 

6LdVQ, accessed Oct. 17, 2011.) 

Similar to the Riddell Revolution helmet video described above, this testimonial 

claim of no concussions among student athletes wearing the Brain Pad mouth guard 

seems to imply that those who purchase the product will have similar results. This 

could lead to young athletes putting themselves at greater risk of head injury if they 

believe that they will never suffer a concussion while wearing the Brain Pad mouth 

guard. 

Another company makes the ‘‘Tap Out Youth Mouthguard’’ for ages 5 to 11 years. 

The back of the product packaging states that the mouth guard has a ‘‘Concussion 

Defense System backed by a $30,000 Dental Warranty.’’ Although this Tap Out 

mouth guard claim is not as prominent as the previously cited claims for the Brain 

Pad mouth guard, it is not clear how the product’s ‘‘Concussion Defense System’’ actually protects children from sports-related head injury. 

There are also sporting goods companies that sell protective headbands for soccer 

players with potentially misleading concussion prevention claims. Dr. Meehan notes 

in Kids, Sports, and Concussion: A Guide for Coaches and Parents that although 

many headbands advertise the ability to reduce the risk of concussion, there is little 

medical evidence to support this assertion. 

The website for ForceField FF headband describes concussions as a problem in 

soccer and notes that their headband ‘‘can come between you and a head injury’’ 

(see image at end of statement). The company website states that: 

‘‘Research on concussions in soccer has shown that soccer players have concussion rates similar to football and ice hockey. . . . The ForceField FF Headband 

will reduce the risk of head injury when exposed to any type of external force.’’ 

(See http://www.forcefieldheadbands.com/sportrelated.html accessed Oct. 17, 

2011) 

Another webpage indicates that the result of wearing the ForceField headband is 

a ‘‘[s]ignificant reduction of the risk of head injuries when exposed to all types of 

impacts’’ (available at: http://www.forcefieldheadbands.com/rationale.html, accessed Oct. 17, 2011). The company also markets this headband specifically for use 

by young children (see: http://www.forcefieldheadbands.com/children.html, accessed Oct. 17, 2011). 

Full90 Sports sells other ‘‘performance headguards’’ to protect against concussion 

in soccer. The company’s online store claims the F90 Performance Headguard’s 

‘‘ForceBloc foam reduces impact force by up to 50 percent, meaning fewer concussions overall and a reduction of severity of injury.’’ The company further states that 

an unnamed ‘‘recent study’’ found that ‘‘college players not wearing a Full90 Performance Headguard were 2.65 times more likely to receive a concussion than players that did.’’ (See http://www.full90.com/products/protect/club/ accessed Oct. 19, 

2011). 

Full 90 Sports’ website also includes a product testimonial from a pro soccer player supported by a photo apparently taken moments after he collided with another 

player. Wearing Full90 headgear, the player looks at his opponent who, not wearing 

any headgear, appears injured on the ground. The quote accompanying the image 

is as follows: 

‘‘We don’t know exactly how much [the headgear] reduced the force of [the impact] but I just thank God . . . I was wearing that thing because I might not 

10 

be here talking to you had I not worn it. (available at http://www.full90.com/ 

players/pro/ accessed Oct. 19, 2011. See also image enclosed at end of statement.) 

Although this photo and testimonial statement may accurately convey the player’s 

honest belief in the protective properties of Full90 headgear, it is questionable 

whether there is a reasonable basis to claim that such soccer headgear actually reduces the likelihood and severity of brain injury to any degree. 

Such concussion prevention claims used in advertising for a variety of children’s 

sports equipment are very concerning. Paying for a product that does not work as 

effectively as advertised is bad enough. It is far worse when a product sold for children’s use might actually increase the risk of brain injury due to a false sense of 

security. Enacting the Children’s Sports Athletic Equipment Safety Act would discourage companies from misleading coaches, parents, and young athletes. 

Unfortunately, one even finds similar, potentially misleading concussion claims in 

marketing for dietary supplements for children’s use. Newport Nutritionals sells 

Sports Brain Guard, a ‘‘[d]aily tri-delivery bioactive protection program’’ that 

‘‘help[s] protect your brain from concussion injury’’ (see http://www.sports 

brainguard.com/ accessed Oct. 19, 2011; See also image at end of statement). Elsewhere on the website, Sports Brain Guard claims to ‘‘maximize the brain’s ability 

to heal and reduce inflammation.’’ While this claim may be true, it is not clear that 

there is enough scientific evidence to date to substantiate that this dietary supplement actually protects the brain from concussion. 

Moreover, the net impression of the product’s advertising may improperly convey 

the message that athletes who are concussed or recovering from the lingering effects 

of concussion can safely ‘‘stay in the game’’ by taking Sports Brain Guard supplements. This ‘‘stay in the game’’ advertising slogan, which is used throughout the 

product’s website, contrasts with the concussion safety and awareness efforts promoted by the CDC and various sports leagues. In fact, the CDC recommends that 

concussed athletes never return to sports activities ‘‘the day of the injury and until 

a health care professional, experienced in evaluating for concussion, says they are 

symptom-free and it’s OK to return to play’’ (see http://www.cdc.gov/concussion/ 

what_to_do.html, accessed Oct. 19, 2011). 

Yet, despite all this, elsewhere on the site, Newport Nutritionals also prominently 

announced on the product’s homepage that Sports Brain Guard is ‘‘Recommended 

by Dr. Joseph Maroon—Expert in head Injury treatment, Heindl Scholar in Neuroscience, [and] Team Neurosurgeon for the Pittsburg Steelers’’ (See Sports Brain 

Guard website from Feb 10, 2011. Internet Archive Wayback Machine. Available at 

http://web.archive.org/web/20110210114509/http://sportsbrainguard.com/, 

accessed Oct. 19, 2011). In a separate webpage highlighting his expert endorsement, 

Maroon states: 

‘‘Over the past 30 years, as a practicing neurosurgeon, I have treated thousands 

of athletes with sports related concussions—players from the NFL, NHL, NBA, 

NCAA and all the way down to kids playing youth sports. . . . I have personally recommended [this] product, Sports Brain Guard, to athletes at all levels 

following concussions.’’ (See http://www.sportsbrainguard.com/maroonmsg. 

aspx, accessed Oct. 19, 2011 and see also image at end of statement) 

This kind of testimonial in support of the product from a doctor who has worked 

in the field of sports concussion is very concerning. It is seems to be intended to 

provided a level of consumer confidence in the efficacy of Sports Brain Guard supplements that does not appear to be justified by scientific data. 

Also of great concern, the product website homepage includes a ‘‘Notice to Parents’’ about children and concussion risk that seems to indicate that this product 

is sold for use by young athletes (See http://www.sportsbrainguard.com/, accessed 

Oct. 19, 2011; see also image at end of statement). Given the intent seems to be 

to sell for use by young athletes, it is even more important that the product advertising claims are accurate and supported by scientific evidence. 

There are undoubtedly more examples of ‘‘anti-concussion’’ and ‘‘concussion reducing’’ products marketed for children’s use. The examples cited above, however, demonstrate that this is already a problem that could become even worse as awareness 

of sports concussion increases. As we continue to look for the best ways to tackle 

the problem of sports concussion, we should work to take false advertising out of 

the game. I hope that responsible sporting goods manufacturers and sports 

leagues—which are already working to improve concussion awareness among athletes, coaches and parents—will also join in this important effort. 

In conclusion, I want to emphasize the very positive role of sports for individuals 

and our society. Although we now know more about the dangers of concussion, we 

11 

must not forget how important physical activity and sports are for children. The 

CDC estimates that only 18 percent of American high school students participate 

in at least one hour of physical activity a day. That is the amount recommended 

by the Department of Health and Human Services. Among high school students in 

New Mexico, only 23 percent are getting the recommended amount of physical activity. This could lead to negative health consequences that last a lifetime. 

We know that physically-active youth have lower rates of body fat, better cardiorespiratory fitness, stronger muscles and bones. They also have less anxiety, stress, 

and depression. As highlighted in HSS’s Physical Activities Guidelines for Americans, the bottom line is that the health benefits of physical activity far outweigh 

the risks of adverse events for almost everyone. 

So we need to encourage kids to play sports, to exercise, and to be more physically 

active. As we learn more about the dangers of concussions for young athletes, we 

can take steps to make sure sports are played more safely. 

Enclosures: 

1. Image from Easton Bell website, available at http://www.eastonbellsports.com/ 

brands/riddell, accessed Oct. 19, 2011. 

2. Image and testimonial statement from ‘‘Riddell Revolution UPMC Media Campaign Highlights’’ video news release available at: http://www.riddell.com/press 

releases_upmcstudy/, accessed Jan. 6, 2011. 

3. Image of product packaging (top front) for Brain Pad Lo Pro+ junior mouth 

guard. 

4. Image of product packaging (back) for Brain Pad Lo Pro+ junior mouth guard. 

5. Image from ForceField FF Headbands website, available at http://www.force 

fieldheadbands.com, accessed Oct. 19, 2011. 

6. Image from ForceField FF Headbands website, available at http://www.force 

fieldheadbands.com/children.html, accessed Oct. 19, 2011. 

7. Image and testimonial statement from Full90 Sports website, available at 

http://www.full90.com/players/pro/, accessed 10–19–11. 

8. Image from Sports Brain Guard website, available at http://www.sports 

brainguard.com/purchase.aspx, accessed Oct. 19, 2011. 

9. Image of Sports Brain Guard website, ‘‘Stay in the Game with Sports Brain 

Guard.’’ available at http://www.sportsbrainguard.com/maroonmsg.aspx, accessed 

Oct. 19, 2011. 

10. Image of Sports Brain Guard website and text excerpt, ‘‘Stay in the Game 

with Sports Brain Guard.’’ available at http://www.sportsbrainguard.com/maroon 

msg.aspx, accessed Oct. 19, 2011. 

12 

Enclosures 


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The CHAIRMAN. Ms. Alexis Ball, I would like to call on you first. 

STATEMENT OF ALEXIS BALL, ALBUQUERQUE, NEW MEXICO 

Ms. BALL. Chairman Rockefeller and members of the Committee, 

I want to thank you for inviting me here today. 

My name is Alexis Ball, and I am a senior at the University of 

New Mexico. Concussions have greatly altered my life, and I appreciate the opportunity to take an advocacy role on concussion awareness. 

I have played soccer since I was 4, and I have always been the 

high-achieving student athlete. In high school, I was New Mexico’s 

Gatorade Player of the Year and our valedictorian. By my junior 

year in college, I was an academic all-American, captain of my 

team, and had received first team all-conference honors. 

However, for as many awards as I have accumulated, I have accrued about as many concussions. I was medically disqualified from 

playing collegiate athletics in December 2009. This decision came 

after a season of struggle, following two concussions I sustained in 

the beginning of the season. 


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23 

The CHAIRMAN. Ms. Ball, what you are saying is so important 

and so moving and powerful that I want you to slow down just a 

tiny bit so we don’t miss a syllable. 

Ms. BALL. I am sorry. 

The CHAIRMAN. OK? 

Ms. BALL. During preseason, I was offered the opportunity to 

shadow a doctor in the ER. A man came in with a knee laceration, 

which I was not prepared to see. I fainted and hit my head. It was 

clear I had a concussion, due to the dizziness, vomiting, and seizures that followed. 

My coaches were not pleased when I called them the following 

morning, informing them of the concussion. In accordance with the 

team doctor’s requirements, I sat out for a week. After that week, 

I met with him again. He asked me the normal concussion questions. Do you have a headache? Are you dizzy? Can you remember 

these three words? 

I was still experiencing headaches and bouts of dizziness at the 

time, but it was the week of our first game and I wanted to play. 

Thus, I supplied the necessary answers to get cleared. I played for 

about 2 weeks with minimal issues. However, in our third game, 

I took a header on the top of my head. 

I was not able to stand up and needed assistance to leave the 

field. I had sustained another concussion. I sat out for about a 

week and returned to play. However, the weeks following this concussion were horrible. I was playing terribly and simply was not 

myself. 

I was no longer able to sleep at night. I would fall asleep around 

3 o’clock in the morning after lying restlessly in my bed since 10 

p.m. the night before. I could not pay attention in any of my classes. 

However, the most disturbing change was the twist in my personality. I no longer enjoyed partaking in anything. I would go to 

practice and feel void of emotions, or I would begin crying randomly in the middle of practice. I would also sit in my room and 

stare into space, not comfortable in my own body. I did not know 

who I was anymore. 

I thought that Alexis, the high-achieving student athlete, was 

permanently gone. My mom was seriously concerned about my 

well-being and forced me to go see my doctor. I told him about all 

my struggles, and he, too, was rather concerned. 

In an effort to see what was happening, I took a neuropsych test. 

The test revealed that my visual memory was impacted. I now fall 

in the 20th percentile of all people for visual recall, and my doctor 

also explained that I was experiencing prolonged symptoms from 

the combination of the two concussions I had sustained months 

prior. 

I was shocked. My doctor and I also talked about the status of 

my future in soccer. We talked about implications for my future if 

I were to sustain another concussion. I had already accumulated 10 

concussions in about 8 years, most of which while wearing protective headgear. 

The doctor concluded that for the safety of my future, I should 

hang up my cleats. This was a crushing blow, yet one that needed 

to be done. Ultimately, I had to separate my head from my heart. 

24 

Concussions are a very serious insult to your brain. People frequently claim an athlete ‘‘just sustained a concussion,’’ like it is no 

big deal. Too often, coaches, athletes, and parents dismiss the severity of concussions because it is not a visible injury. If an athlete 

tears their ACL or sprains their ankle, it is apparent externally 

that they are injured. This is not the case with concussions. 

A doctor or coach often cannot see the physical manifestations of 

the concussion. Moreover, many of the symptoms of post-concussion 

syndrome are not usually associated with the initial blow. I had no 

idea that my insomnia or the sadness I had felt could be correlated 

to an injury that I had sustained in the months prior, which is 

something I really want to emphasize today. 

Athletes must be aware that if they sustain a concussion, symptoms can last longer than a few days, or weeks, for that matter. 

They can last a lifetime. 

Another issue athletes need to be aware of is the limited efficacy 

of headgear or helmets. I wore protective headgear since my second 

concussion in high school, per the recommendation of my trainers. 

It was supposed to be a preventive measure against concussions, 

and clearly, this did not hold true. I sustained about eight concussions since wearing that. It is essential for athletes and coaches to 

know that athletes are not free from concussions because they have 

protective headgear. 

Furthermore, I believe it is important to note that the mentality 

to return to play as quickly as possible is very prevalent in the 

world of athletics. There is a lot of pressure on athletes to just deal 

with their injuries, or they will be in jeopardy of losing their starting position or playing time. 

This cultures an environment in which it is really easy to lie 

about your symptoms, especially when it comes to concussions. I 

knew the answers needed to return to play. No one could prove 

whether I had a headache or not, so I was apt to lie. In retrospect, 

this was a very poor decision, but I did not understand the severity 

of concussions at the time. 

I continued to play much longer than I probably should have, due 

to the high number of concussions I had throughout my career. 

And I most certainly returned to play too quickly. People have only 

one brain for life. I will never regain the visual memory I once had. 

I will also not be able to regain the respect I lost while I struggled 

through my final season of soccer. 

I hope from my story you have learned that concussions and 

brain injury are not a minor injury. In order to prevent more stories like mine, concussion awareness needs to be more prevalent 

among coaches and athletes in our society. I believe that most 

coaches and athletes do not truly understand the long-term ramifications of concussions. And people also need to understand that 

wearing protective gear does not stop concussions from occurring. 

Therefore, I want to thank you again for inviting me here today 

in a step to further public education about this invisible injury. 

[The prepared statement of Ms. Ball follows:] 

PREPARED STATEMENT OF ALEXIS BALL, ALBUQUERQUE, NEW MEXICO

Chairman Rockefeller, Ranking Member Hutchison, and members of the Committee, I want to thank you for inviting me here today. My name is Alexis Ball, and 

25 

I am a senior at the University of New Mexico. Concussions have greatly altered 

my life. I appreciate the opportunity to take an advocacy role in concussion awareness. I have played soccer since I was four and have always been a high achieving student athlete. Throughout my career, I earned numerous academic and athletic 

awards. In high school, I was New Mexico Gatorade Player of the Year and our valedictorian. By my junior year in college, I was an Academic All American, captain 

of my team, and had received First Team All Conference honors. My coaches often 

spoke of my potential to lead our team to a place that it has never been. However, 

for as many awards as I have accumulated, I have accrued about as many concussions. I sustained approximately five concussions prior to college and five concussions throughout college while wearing ‘‘protective’’ headgear. In fact, it was a concussion that terminated my collegiate career a year early. 

I was medically disqualified from playing collegiate athletics in December 2009. 

This decision came after a season of struggle following two concussions I sustained 

in the beginning of the season. During pre-season, I was offered the opportunity to 

shadow an ER doctor. I excitedly took the opportunity because I want to be a doctor. 

A man came in with a knee laceration that I was not prepared to see, and I fainted 

and hit my head. It was clear I had a concussion due to the dizziness, vomiting, 

and seizures that followed. 

My coaches were not so pleased when I called them the following morning informing them of the concussion. I had already sustained three concussions at UNM, and 

no one wanted me to add any more to the list. In accordance with the team doctor’s 

requirements, I sat out for a week. However, my rest time still forced me to be 

watching practices in the blistering hot temperatures of August in New Mexico. I 

met with the sports medicine doctor a week after the concussion in order to be 

cleared to play. The doctor asked me the normal concussion questions, such as ‘‘do 

you have a headache right now?’’ Or ‘‘can you remember these three words?’’ I had 

heard these questions all too many times before. I was still experiencing headaches 

and bouts of dizziness at this time, but it was the week of our first game and my 

coaches wanted me to play. Thus, I supplied the necessary answers to get cleared. 

I played for about two weeks without many issues. I did not play well, but I was 

there. In about our third game, I took a header off the top of my head (an area of 

my head which was not covered by my head gear). I was not able to stand up and 

needed assistance to leave the field. I had sustained another concussion. I sat out 

for a week again and then returned to play. 

However, the weeks following this concussion were horrible. Not only had I lost 

my starting position, but I seemed incapable of getting it back. I was playing terribly and simply was not myself. Many other things had changed as well. I no 

longer was able to sleep at night. I would fall asleep around 3 o’clock in the morning 

after lying restlessly in my bed since 10 o’clock at night. I could not pay attention 

in any of my classes. However, the most disturbing change was the twist in my personality. I no longer enjoyed partaking in anything. I would go home and sit in my 

room and stare into space, not comfortable in my own body. I did not know who 

I was anymore. I would either go to practice and feel void of all emotion or begin 

crying uncontrollably randomly in the middle of it. I was lost. My teammates initially asked if I was ok, and I would shrug my shoulders, replying weakly, ‘‘yes I’m 

fine.’’ 

As the weeks progressed and my playing continued to deteriorate, I felt my teammates distancing themselves from me. About two months into the season, I had a 

meeting with my fellow captains. They informed me that they had lost respect for 

me and felt that I was selfish by acting so introverted at practices. I was in disarray, and these comments only worsened my fragile emotional state. Only my best 

friend and my parents remained by my side. I didn’t know who to be anymore. I 

thought that Alexis, the high achieving student athlete, was permanently gone. 

My mom was seriously concerned about my well-being. She e-mailed a doctor that 

she knew with her concerns and urged me to consult with him. I was very resistant 

to this idea because I felt that not sleeping and having some gloomy days were such 

silly reasons to see the doctor. I finally went and talked to him. I told him all about 

my struggles, and he was rather concerned. In an effort to see what was happening, 

I took a neuropsychology test. The test revealed that my visual memory was impacted. I now fell in the 20th percentile of all people for visual recall. My doctor 

informed me that I was experiencing prolonged symptoms from the combination of 

the two concussions I sustained months prior. I was shocked. 

My doctor and I talked about the status of my future in soccer. We discussed the 

numerous concussions I have had throughout my soccer career. I had accumulated 

10 concussions in about 8 years. We also talked about the implications for my future 

if I were to sustain another one. The doctor concluded that for the safety of my fuVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00029 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
26 

ture, I should hang up my cleats. It was a crushing blow, yet one that needed to 

be done. Ultimately I had to separate my head from my heart. 

Concussions are a very serious insult to your brain. People frequently claim an 

athlete just sustained a concussion, like it is no big deal. Too often coaches, athletes, 

and parents dismiss the severity of concussions because it is not a visible injury. 

If an athlete tears their ACL or sprains their ankle, it is apparent externally that 

they are injured. This is not the case with concussions. A doctor or coach often cannot see the physical manifestations of a concussion. Moreover, many of the symptoms of post-concussion syndrome are not easily associated with the initial blow. I 

had no idea that my insomnia or the sadness I had felt could be correlated to an 

injury that I had sustained months prior. That is one message that I want to emphasize today. Athletes who have had concussions must be aware that symptoms 

can last longer than a few days or weeks. They can last for months and in some 

cases for life. 

Another issue athletes need to be aware of is the limited efficacy of head gear or 

helmets. I wore protective head gear since my second concussion in high school per 

the recommendation of my trainer. It was supposed to be a preventative measure 

against concussions. Clearly this gear did not prevent me from sustaining further 

concussions. It is essential for coaches and athletes to know that athletes are not 

free from concussions because they have protective head gear. 

Furthermore, I believe it is also important to note that the mentality to return 

to play as quickly as possible is very prevalent in the world of high school and collegiate athletics. There is a lot of pressure on athletes to just deal with their injuries 

or they will be in jeopardy of losing their starting position or playing time. This cultures an environment in which it is really easy to lie about your symptoms, especially when it comes to concussions. I knew the test questions and the answers 

needed to return to play. No one could prove whether I had a headache or not, so 

I was apt to lie. In retrospect, this was a very poor decision, but I did not understand the severity of concussions at the time. I also believe that most coaches and 

athletes do not truly understand the long term ramifications of concussions. I continued to play much longer than I probably should have due to the high number 

of concussions I had throughout my entire career. I most certainly returned to play 

too quickly. People only have one brain for life. It is not something that can be repaired via surgery like most other injuries. I will never regain the visual memory 

I once had. I also will not be able regain the respect I lost while I struggled through 

my final season of soccer. 

Concussions adversely impacted my life. I hope from my story you have learned 

that concussions and brain injury are not a minor injury. In order to prevent more 

stories like mine, concussion awareness needs to be more prevalent among coaches 

and athletes in our society. People need to understand that wearing protective gear 

does not stop concussions from occurring. Therefore, I want to thank you again for 

inviting me here today in a step to further public education about this invisible injury. 

The CHAIRMAN. Thank you. You did extremely well. 

Mr. Steven Threet, who is a student at Arizona State University, 

was a quarterback and is still there. A starting quarterback, but 

you are still associated—— 

Mr. THREET. Yes, sir. 

The CHAIRMAN. Working with the team? 

Mr. THREET. Yes, I am coaching with the team. Yes. Yes, sir. 

The CHAIRMAN. OK. We welcome you. 

STATEMENT OF STEVEN THREET, TEMPE, ARIZONA 

Mr. THREET. Thank you, Chairman Rockefeller and the other 

Committee members, for inviting me. 

It is a great honor to be speaking here on a topic that has 

changed my life, and I am happy to help raise awareness about 

such a critical issue in both male and female sports. Dealing with 

concussions can be a very difficult process for the injured player 

and their family. So it is exciting for me to see such a prestigious 

and capable group of individuals who are willing to learn more in 

an effort to help better educate and protect all athletes. 

27 

Throughout my playing career, I faced a multitude of injuries. 

However, none caused more confusion, both literally and figuratively, at the time they occurred than concussions. Each of the 

four documented concussions that I experienced were unique in the 

way in which they occurred. 

I sustained concussions from hits directly to my head by another 

player, from my head hitting the ground, and also as a result of 

consecutive impacts on separate plays. While my symptoms were 

often similar—they ranged from slight dizziness and blurred vision 

to extreme light sensitivity and constant headache—the severity of 

my symptoms had no recognizable pattern. 

In two of the cases, I returned to play 1 week after the injury 

I sustained. In one instance, it only took me 2 weeks to recover. 

However, my final concussion I suffered on November 26, 2010, 

and the resulting symptoms were the reason that I decided to end 

my football playing career. 

During my playing days, brain injury was never a major concern 

to me. After my first concussion, which happened on the last play 

of a high school game senior season, I was able to start the next 

game. It was not until my symptoms became serious that my attitude about the injury changed. 

At the time when I decided to retire, I saw my decision simply 

as the right one to make. However, in the aftermath, it has become 

apparent to me that my decision can also be seen as an example 

of how dangerous brain injury is. 

I want to make it clear that my goal in speaking is not to deter 

athletes from competing. I only wish that they acknowledge the seriousness of brain injury and respect the process that comes with 

the recovery. 

In all sports, a certain aggressive mentality is required to be successful. The passion and intensity a football player relies on is an 

example of this, and it is what I think makes the game beautiful. 

As a former quarterback at premier college football programs, I 

know the importance of and took pride in being physically and 

mentally tough, outworking my opponent and leaving it all on the 

field, and playing through injury. 

However, athletes must understand that a mild brain injury is 

not a mild shoulder separation. It is not an injury to be played 

through. They must understand that playing through a brain injury is not a sign of toughness, but it is a sign that says athletes 

are still uninformed on the topic. 

Statistics have recently revealed that about 40 percent of athletes who have sustained a concussion returned to play too early 

and that up to 50 percent of concussions go unnoticed. This makes 

me believe that the only focus should be to create an open dialogue 

between athletes, coaches, doctors, and families that address the 

seriousness of brain injuries in athletics and the need for a full recovery before we return to play. 

I know it is possible to decrease those statistics, and I also know 

progress on this issue is already being made, and many states have 

passed legislation dealing with concussion protocols. Unfortunately, 

there is no brain brace. There is no concussion-proof helmet or 

magic pill for immediate recovery. However, I believe there is a 

28 

misunderstanding about concussion prevention and treatment 

within the athlete cohort, as well as the general public. 

For example, a football helmet is often thought of as a brain protector when, in reality, it is designed to protect the bone structure 

of the individual and not the brain. If the helmet could guarantee 

concussion prevention, I would still be playing football. 

Once again, I would like to thank you for the opportunity, but 

more importantly, thank you for taking the time to learn and show 

your support for this issue today. And I look forward to the future 

progress that I know can and will be made on the topic. 

Thank you. 

[The prepared statement of Mr. Threet follows:] 

PREPARED STATEMENT OF STEVEN THREET

First I would like to thank Chairman Rockefeller and the other committee members for inviting me. It is a great honor to be here speaking on a topic that has 

changed my life and I am happy to help raise awareness about such a critical issue 

in both male and female sports. Dealing with concussions can be a very difficult 

process for the injured person and their family; so it is exciting for me to see such 

a prestigious and capable group of individuals who are willing to learn more in an 

effort to better educate and protect all athletes. 

Throughout my playing career I faced a multitude of injuries. However, none 

caused more confusion both literally and figuratively at the time that they occurred 

than concussions. Each of the four documented concussions that I experienced were 

unique in the way in which they occurred. I have sustained concussions from hits 

directly to my head by another player, from my head hitting the ground, and also 

as a result of consecutive impacts on separate plays. While my symptoms were often 

similar, they ranged from slight dizziness and blurred vision to extreme light sensitivity and a constant headache. The severity of my symptoms had no recognizable 

pattern. In two of the cases I was cleared and played without problem one week 

after I sustained a concussion. In one instance I returned to play two weeks after 

the injury. However the most severe symptoms were a result from my last concussion, which I suffered on November 26, 2010. Those symptoms ultimately led to my 

decision to end my football playing career. 

During my playing days, brain injury was never a major a concern to me. After 

my first concussion, which happened on the last play of a high school game my senior year, I was able to start the next game. It was not until my symptoms became 

serious that my attitude about the injury changed. At the time when I decided to 

retire, I saw my decision simply as the right one to make. However, in the aftermath it has become apparent to me that my decision can also be seen as an example 

of how dangerous brain injuries can be. I want to make it clear that my goal in 

speaking is not to deter athletes from competing. I only wish that they acknowledge 

the seriousness of a brain injury and respect the process that comes with recovery. 

In all sports a certain aggressive mentality is required to be successful. The passion and intensity football players rely on is an example of this; and what makes 

the game beautiful. As a former quarterback at premier college football programs 

I know the importance of and took pride in being physically and mentally tough, 

out working my opponent, leaving it all on the field, and playing through injury. 

However, athletes must understand that a mild brain injury is not a shoulder separation. It is not an injury to be played through. They must understand that playing 

through a brain injury is NOT a sign of toughness, but it is a sign that says athletes 

are still uninformed. 

Statistics recently revealed that about 40 percent of athletes who have sustained 

a concussion return to play too early and that 50 percent of concussions go unnoticed. This makes me believe that the only focus should be to create an open dialogue between athletes, coaches, doctors, and families that addresses the seriousness 

of brain injuries in athletics and the need for a full recovery before returning to 

play. I know it is possible to decrease those statistics. I also know progress on this 

issue is already being made and many states have already passed legislation dealing 

with concussion protocols. 

Unfortunately, there is no brain brace, concussion proof helmet, or magic pill for 

immediate recovery. However I believe THERE IS a misunderstanding about concussion prevention and treatment within the athlete cohort as well as the general 

public. For example, a football helmet is often thought of as a brain protector. HowVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00032 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
29 

ever, it is designed to protect the bone structure of the head, not the brain itself. 

If a helmet could guarantee protection from concussions, I would still be playing 

football. 

Once again thank you for this opportunity but more importantly thank you for 

taking the time to learn and show your support for this issue here today. I look forward to the future progress that I know can and will be made. 

The CHAIRMAN. Thank you very, very much. 

And you talk about an elite program. You are exactly right. You 

are exactly right. 

Dr. Kutcher, bring us some Michigan and NeuroSport wisdom. 

STATEMENT OF JEFFREY S. KUTCHER, MD, 

ASSOCIATE PROFESSOR, UNIVERSITY OF MICHIGAN, 

DEPARTMENT OF NEUROLOGY; DIRECTOR, MICHIGAN 

NEUROSPORT; CHAIR, SPORTS NEUROLOGY SECTION, 

AMERICAN ACADEMY OF NEUROLOGY 

Dr. KUTCHER. I will do my best, sir. 

Chairman Rockefeller, members of the Committee, and distinguished guests, it is my distinct honor to join you today. I am extremely grateful to be given the opportunity to provide my testimony. 

My name is Jeffrey Kutcher. I am a sports neurologist and team 

physician at the University of Michigan. Since 2005, I have been 

the director of Michigan NeuroSport, University of Michigan’s comprehensive academic sports neurology program. 

Our program provides clinical care for athletes of all ages and 

abilities, conducts clinical and basic science research on sports concussion, provides education to athletes, parents, coaches, administrators, and healthcare providers. In my clinical practice, I care for 

athletes at the time of injury, through the return-to-play process, 

over the course of their seasons, their careers, and after they retire. 

Since 2009, I have also been the Chair of the Sports Neurology 

Section of the American Academy of Neurology. The American 

Academy of Neurology is dedicated to the neurological care of athletes at all levels and is a leading voice in the arena of sports concussion. 

I am currently co-leading the academy’s effort to produce an evidence-based clinical practice guideline on sports concussion, an effort that includes the critical review and grading of every academic 

paper ever published on sports concussion. 

Also pertinent to this topic, I have recently been named the director of the National Basketball Association’s concussion program, 

and I also consult for the National Hockey League Players Association. 

Clearly, the issue of sports concussion has been gaining significant public and Government interest over the past several years. 

A majority of this interest has been focused on those athletes already in the spotlight, the ones who play our professional contact 

sports. 

While these athletes are experiencing the greatest doses of head 

impact over their lifetimes, they represent only a small fraction of 

the population at risk of being injured, which is why I am encouraged that today’s hearing is focusing on the protective equipment 

being used by all athletes, regardless of level of play, age, or gender. 

30 

It is a common misconception that concussion is a problem seen 

only in males. As Ms. Ball has demonstrated, concussions occur in 

females as well, with some data suggesting that concussion incidence is actually higher in females when compared to males playing similar sports. 

Concussion is an injury that occurs at every age, at every level 

of play. Up to 3.8 million concussions are estimated to occur in the 

United States each year from sports and recreational activities, and 

the majority of those occur in our youth. 

There is great uncertainty and great concern regarding the notion of possible long-term effects from concussion, especially on the 

pediatric population, which may be at even greater risk given the 

ongoing development of the pediatric brain. 

So what is a concussion? I will spend a moment just describing 

that in my own words. It is an injury to the brain that occurs when 

the brain moves fast enough or suddenly enough to disrupt the normal electrical function of its component cells. 

Given that the brain is floating in fluid inside of the skull and 

that the head can act as a pendulum when the body is struck, 

movements of the brain significant enough to cause concussion can 

occur with or without a direct blow to the head. As long as the 

skull and thus the brain inside of it is accelerated or decelerated 

with enough force, the normal processes of the brain may be compromised. 

The resulting concussion can take on many different forms, but 

typically includes transient disorientation, slowed thinking, memory difficulties, or other signs of brain dysfunction. Symptoms such 

as headache, nausea, and sensitivity to light are also quite common. 

Concussions cannot be diagnosed by any test. That is extremely 

important to remember. It is a diagnosis that can only be made 

after a careful clinical evaluation performed by a healthcare professional, and preferably one with training and experience caring for 

brain injuries. 

It is important to realize that concussion is not the only brain 

injury that can occur from head trauma. Emergent injuries, such 

as bleeding in or around the brain or skull fracture, can occur anytime an athlete or an object is moving quickly in the field of play. 

On the other side of the spectrum, there is emerging evidence— 

brought forth by Dr. McKee, for example with some of her excellent 

work—that forces from multiple impacts that may not even 

produce concussion may be having potentially negative long-term 

health effects on athlete’s brains. 

Helmets have an extremely important role to play in head injury 

prevention. Without them, the potential for serious injury would 

make many of our sports and recreational activities unacceptably 

risky. In this way, helmets are extremely effective pieces of equipment. 

With the introduction of hard-shell helmets, for example, skull 

fractures from playing football have essentially been eliminated. 

What helmets do not do well is significantly slow down the contents of the skull when the head is struck or moved suddenly. 

Since concussions occur not as a result of the forces experienced 

by the skull, but by those experienced by the brain, it is extremely 

31 

unlikely that any helmet can be designed that will prevent concussions to the same significant degree that they have been shown to 

prevent skull fractures. 

Currently, there are no convincing data in the published medical 

literature that show any particular helmet being better than any 

other at preventing sports concussion. Such data is hard to collect, 

grant you, for two main reasons. 

First, given the many variables that exist in the athletic population and the varied exposure to impacts, it is extremely difficult 

to perform a randomized, controlled clinical trial on similar populations of athletes. Second, given that concussion is a clinical diagnosis with no available reference standard or diagnostic test, any 

study of concussion is significantly limited by the ambiguity of the 

very clinical outcome that is being studied. 

For these same reasons, there are no published data supporting 

the idea that other types of protective equipment, such as mouth 

guards or soccer headbands, prevent concussion. Moreover, in 

sports such as soccer, where protective headgear is the exception 

rather than the rule, I have seen the use of headgear result in athletes altering their playing style in the wrong direction as their 

newfound sense of protection encourages more physically aggressive play. 

Every week, I am asked in my clinic by patients, parents, and 

coaches about the claims they hear and what equipment they 

should buy to prevent concussions. The simple truth is that no current helmet, mouth guard, headband, or other piece of equipment 

can significantly prevent concussions from occurring. They occur as 

the result of the nature of our sports. 

Concussion prevention is much more about teaching proper technique, playing by the rules, and limiting the overall dose of impacts. The potential harm that I see caused by products that claim 

to prevent concussion when they do not is far more than simply the 

financial harm of paying more for something that isn’t likely to 

work as claimed. It is the harm that comes from having a false 

sense of security, from not understanding how the injury occurs, 

and what can actually be done to prevent it. 

The public deserves to know that equipment has a significant, 

but inherently limited ability to prevent concussion. There is still 

a tremendous amount yet to be learned about the nature of concussions and their possible effects on brain health. In the interim, I 

am deeply encouraged by today’s hearing and honored to be included in the efforts of the Committee as we work together for the 

safety of our athletes. 

Thank you. 

[The prepared statement of Dr. Kutcher follows:] 

PREPARED STATEMENT OF JEFFREY S. KUTCHER, MD, ASSOCIATE PROFESSOR, 

UNIVERSITY OF MICHIGAN, DEPARTMENT OF NEUROLOGY; DIRECTOR, MICHIGAN

NEUROSPORT; CHAIR, SPORTS NEUROLOGY SECTION, AMERICAN ACADEMY OF NEUROLOGY

Chairman Rockefeller, members of the Committee, and distinguished guests, it is 

my distinct honor to join you today and I am extremely grateful to be given this 

opportunity to provide my testimony. 

My name is Jeffrey Kutcher. I am a sports neurologist and team physician at the 

University of Michigan. Since 2005, I have been the Director of Michigan 

32 

NeuroSport, the University of Michigan’s comprehensive academic program in 

sports neurology. The NeuroSport program provides clinical care for athletes of all 

ages and abilities, conducts clinical and basic science research on sports concussion 

and other issues in sports neurology, and provides education to athletes, parents, 

coaches, administrators, and health care providers. My experience allows me to 

speak directly to the complete spectrum of athletes that experience sports-related 

brain injuries. I care for athletes at the time of their injury, over the course of their 

season, their career, into their retirement, and beyond. 

Since 2009, I have also been the Chair of the Sports Neurology Section of the 

American Academy of Neurology. The American Academy of Neurology, the world’s 

largest professional association of neurologists, is dedicated to the neurological care 

of athletes at all levels by optimizing clinical practice, research, and education, and 

is a leading voice in the arena of sports concussion. I am currently co-leading the 

American Academy of Neurology’s effort to produce a meaningful, evidence-based, 

clinical practice guideline on sports concussion, an effort that includes the critical 

review and grading of every academic paper published on sports concussion. Also 

pertinent to this topic, I am the Director of the National Basketball Association’s 

Concussion Program and a consultant to the National Hockey League Players’ Association. 

The Scope of the Problem 

Clearly, the issue of sports concussion has been gaining significant public and government interest over the past few years. Fueled by increasing awareness of possible long-term effects from head injuries, the majority of the media coverage has 

focused on those athletes already in the spotlight, the ones who play our professional contact sports. While these athletes are experiencing the greatest doses of 

head impact over their lifetimes, they represent only a very small fraction of the 

population at risk of being injured. That is why I am encouraged that today’s hearing is focusing on the protective equipment being used by all athletes, regardless 

of level of play, age, or gender. 

It is a common misconception that concussion is a problem seen only in males. 

Concussions occur in females as well, with some data suggesting that concussion incidence is higher in females when compared to males playing similar sports. Concussion is an injury that occurs at every age and at every level of play. Up to 3.8 million concussions are estimated to occur in the United States each year from sports 

and recreational activities, and the majority of these occur in our youth. There is 

great uncertainty, and with it significant concern, regarding the notion of possible 

long-term effects from concussion, especially on the pediatric population, which may 

be at even greater risk given the ongoing development of the pediatric brain. 

What is Concussion? 

Simply put, concussion is an injury to the brain. It occurs when the brain moves 

fast enough, and suddenly enough, to disrupt the normal electrical function of its’ 

component cells. Given that the brain is floating in fluid inside of the skull, and 

that the head can act as a pendulum when the body is struck, movements of the 

brain significant enough to cause concussion can occur with or without a direct blow 

to the head. As long as the skull, and thus the brain inside of it, is accelerated or 

decelerated with enough force, the normal processes of the brain may be compromised. The resulting concussion can take on many different forms, but typically 

includes transient disorientation, slowed thinking, memory difficulties, or other 

signs of brain dysfunction. Symptoms, such as headache, nausea, and sensitivity to 

light are also quite common. I should also note that a loss of consciousness is relatively rare in concussion, occurring in less than 10 percent of cases. Concussion 

cannot be diagnosed by any one test. It is a diagnosis that can only be made by 

a careful clinical evaluation performed by a health care professional, and preferably 

one with training and experience caring for brain injuries. 

It is important to realize that concussion, as defined above, is not the only brain 

injury that can occur from head trauma. More acutely serious or emergent injuries, 

such as bleeding in or around the brain or a skull fracture, can occur anytime an 

athlete or an object is moving quickly in the field of play. On the other side of the 

spectrum, there is emerging evidence that forces from multiple impacts that are not 

significant enough to result in a concussion may have potentially negative effects 

on long-term brain health. 

Equipment Limitations 

Helmets have an extremely important role to play in head injury prevention. 

Without them, the potential for bone fracture or intracranial injury would make 

many of our sports and recreational activities unacceptably risky. In this way, helmets are extremely effective pieces of equipment. With the introduction of hard-shell 

33 

helmets, for example, skull fractures and resulting deaths from playing football 

have essentially been eliminated. What helmets do not do well is significantly slow 

down the contents of the skull when the head is struck or moves suddenly. Since 

concussions occur not as a result of the forces experienced by the skull, but by those 

experienced by the brain, it is extremely unlikely that any helmet can be designed 

that will prevent concussions to the same significant degree that they have been 

shown to prevent skull fractures. 

Currently, there is no data in the published medical literature that shows any 

particular helmet being better than any other at preventing sports concussions. 

Such data is hard to collect for two main reasons: First, given the many variables 

that exist in the athletic population and the varied exposure to impacts, it is extremely difficult to perform a randomized, controlled, clinical trial on similar populations of athletes. Second, given that concussion is a clinical diagnosis, with no 

available reference standard or diagnostic test, any study of concussion is significantly limited by the ambiguity of the very clinical outcome that is being studied. 

For these same reasons, there are no published data supporting the idea that 

other types of protective equipment, such as mouthguards or soccer headbands, prevent concussion. Moreover, in sports such as soccer, where protective headgear is 

the exception rather than the rule, I have seen the use of headgear result in athletes altering their playing style in the wrong direction, as their newfound sense of 

protection encourages more physically aggressive play. 

While clinical data that speaks to concussion prevention is hard to generate, there 

are many extremely well performed laboratory studies that provide excellent data 

on the amount of force a helmet allows to get through to a model brain in a mechanical head. This does not mean that these data can be used to construct an estimate 

of concussion risk. Concussions do not occur at a particular force threshold. They 

occur across a wide range of forces and are dependent on the complex and variable 

physiological nature of each individual’s brain. 

The Potential Harm of Misinformation 

With the increased public awareness of an injury that occurs frequently in children and may produce significant negative long-term health outcomes, it is not surprising that the marketplace for products designed to prevent concussions is a busy 

one. Every week I am asked by patients, parents, and coaches about the claims they 

hear and what equipment they should buy to prevent concussions. I wish there was 

such a product on the market. The simple truth is that no current helmet, 

mouthguard, headband, or other piece of equipment can significantly prevent concussions from occurring. They occur as the result of the nature of sports. Concussion 

prevention is much more about teaching proper technique, playing by the rules, and 

limiting the overall dose of impacts. Preventing bad outcomes and long-term damage, meanwhile, is clearly about recognizing the injury when it occurs, removing 

that athlete from participation, and allowing for appropriate recovery before they return. 

The potential harm that I see being caused by products that claim to prevent concussion when they do not is far more than simply the financial harm of paying more 

for something that isn’t likely to work as claimed. It is the harm that comes from 

having a false sense of security, from not understanding how the injury occurs and 

what can actually be done to prevent it. This issue is a growing public concern, and 

rightly so. The public deserves to know that equipment has a significant, but inherently limited, ability to prevent concussions. For the health of all athletes, we must 

see that each player, parent, and coach becomes educated on concussion, including 

the use of proper technique, the need for reporting the injury, and the importance 

of allowing for a full recovery before returning. 

There is still a tremendous amount yet to be learned about the nature of concussions and their possible effects on brain health. In the interim, I am deeply encouraged by today’s hearing and honored to be included in the efforts of the Committee 

as we work together for the safety of our athletes. 

The CHAIRMAN. Thank you very much, Doctor. 

And can we go on now to Dr. McKee? 

34 

STATEMENT OF ANN C. MCKEE, MD, PROFESSOR OF 

NEUROLOGY AND PATHOLOGY, BOSTON UNIVERSITY SCHOOL 

OF MEDICINE; DIRECTOR, VISN–1 NEUROPATHOLOGY 

LABORATORY FOR THE NEW ENGLAND VETERANS AFFAIRS 

MEDICAL CENTERS; DIRECTOR, BRAIN BANKS FOR 

THE BOSTON UNIVERSITY ALZHEIMER’S DISEASE CENTER, 

FRAMINGHAM HEART STUDY, AND CENTENARIAN STUDY; 

CO-DIRECTOR, CENTER FOR THE STUDY OF TRAUMATIC 

ENCEPHALOPATHY 

Dr. MCKEE. Chairman Rockefeller and members of the Committee, thank you for the invitation to testify today on sports concussions and their consequences. 

My name is Dr. Ann McKee. I am a Professor of Neurology and 

Pathology at Boston University’s School of Medicine, and I direct 

the neuropathology laboratory for the New England Veterans Affairs Medical Center at the Boston VA. 

I am also Co-Director for the Center for the Study of Traumatic 

Encephalopathy. My testimony today reflects my professional opinion. I am not speaking officially on behalf of the Department of 

Veterans Affairs. 

Mild traumatic brain injury, or concussion, is a temporary state 

of neurologic dysfunction resulting from forces on the brain—acceleration, deceleration, lateral and rotational forces. Subconcussion is 

caused by these same type of forces, but the forces are milder, and 

no symptoms are produced. 

In all of these conditions, concussion or subconcussion, the brain 

looks normal after the injury, and there is no detectable damage 

on routine neuroimaging, such as CT scan or MRI, which is why 

these injuries are sometimes considered invisible. However, the acceleration, deceleration, rotational forces cause the brain to move 

rapidly within the skull, and the brain, which is firm, but gelatinous, is stretched and deformed by these forces. And as the brain 

as a whole is deformed, there is also stretch and strain of the individual nerve cells and support cells within the brain. 

The brain abnormalities associated with concussion and subconcussion occur at the microscopic, cellular, molecular, and metabolic levels. If an athlete returns to play before the symptoms resolve, the athlete risks developing post-concussive syndrome and 

second impact syndrome, or SIS, a rare, but often fatal condition. 

In addition, repetitive mild concussive injury can trigger a progressive deterioration of the brain called ‘‘chronic traumatic 

encephalopathy.’’ Chronic traumatic encephalopathy is a progressive neurodegeneration that evolves slowly over decades and usually does not become apparent until many years after the player 

has retired from the sport. 

CTE is triggered by repetitive concussive injuries superimposed 

on a brain that has not healed from a previous injury. This is why 

concussion awareness is so critical and why proper diagnosis and 

management of concussion, allowing the brain to completely rest 

and recover after an injury, is so important in youth sports. 

The CHAIRMAN. Perhaps even more so on the part of very relatively young children whose brains are still growing? 

Dr. MCKEE. Absolutely. 

The CHAIRMAN. They are still playing football, other things. 

35 

Dr. MCKEE. Right. The youth or immature brain is more susceptible to concussive injuries than the mature adult brain. Children 

and young adults recover more slowly from a concussion. Youth 

athletes are also more at risk for concussion due to their 

disproportionally large head size compared to body size and the 

weakness of their neck musculature. 

Furthermore, young athletes are uniquely susceptible to second 

impact syndrome, which has only been reported in athletes under 

the age of 24 and most often under the age of 18. Second impact 

syndrome occurs when a young athlete sustains an initial head injury, then suffers a second head injury before the symptoms associated with the first impact have cleared. 

Typically, the athlete returns to play too early and receives a second blow to the head, which may be remarkably minor. The affected athlete may appear stunned at first, but in the next few seconds to minutes, the athlete collapses to the ground, semi-comatose, and the outcome is often fatal or associated with severe and 

permanent disability. 

Since 2008, as Director of the Center for the Study of Traumatic 

Encephalopathy Brain Bank, I have diagnosed chronic traumatic 

encephalopathy in the brains of 58 athletes and other individuals, 

which is more than double the history of the world’s experience 

with this condition. I have diagnosed CTE in 40 football players, 

and that includes professional football players, college football players, as well as high school football players, 5 hockey players, and 

15 military veterans. 

Chronic traumatic encephalopathy causes changes in behavior 

and personality. In particular, individuals with CTE become more 

irritable, angry, or aggressive. They develop mood changes, such as 

depression, and sometimes become suicidal, and develop drug and 

alcohol abuse. As the disease progresses, they develop short-term 

memory loss, which leads to increasing cognitive impairment and 

ultimately dementia and, in some cases, parkinsonism. 

Pathologically, CTE is caused by a buildup of a protein called 

tau. It forms neurofibrillary tangles within the brain. Under normal circumstances, this abnormal tau protein is found in only limited quantities, but in CTE, there is a striking buildup of this protein, even at young ages. 

For example, advanced chronic traumatic encephalopathy was 

found in the brain of Dave Duerson, a former defensive back for 

the Chicago Bears. Dave Duerson began playing football at age 8 

and experienced more than 10 concussions in his 11-year NFL career. After retiring from the NFL, he was very successful and had 

a loving family and four children. 

At the age of 46, he experienced financial difficulties and the dissolution of his marriage. He became hot-tempered, physically and 

verbally abusive. He developed memory lapses, mood swings, and 

piercing headaches. And on February 17, 2011, he killed himself inside his Florida apartment. He left instructions to donate his brain 

to my laboratory, and my examination showed that he was suffering from moderately severe CTE, even though he was only 50 

years old. 

Another example is Owen Thomas, a defensive end for the University of Pennsylvania who played football since age 9. One day 

36 

in the spring of 2010, he called his parents and told them he was 

stressed by school and having trouble with several of his courses. 

And 2 days later, he hanged himself in his off-campus apartment. 

When I looked at Owen’s brain, I saw unmistakable changes of 

early CTE. In fact, if you compare the brain of Owen Thomas to 

the brain of Dave Duerson, there was remarkably similar, although 

milder pathology, suggesting that if Owen Thomas had lived another 30 years, his CTE would have progressed to the advanced 

stage demonstrated by Dave Duerson. 

I have recently had the opportunity to study the brain of a 17- 

year-old high school football player. He suffered a concussion 3 

weeks before the day of his death and had recently been cleared 

to return to play. During the game, he intercepted a pass, was 

tackled, and hit the ground. As he walked to the bench, he complained of a severe headache, then collapsed to the ground, unconscious. He died the following day. 

Neuropathologic examination showed a thin subdural hemorrhage consistent with SIS and very early changes of CTE. He is the 

youngest player ever diagnosed with changes of CTE. 

I have now examined the brains of 58 individuals with CTE, and 

I have found early CTE in college and high school players, including players as young as 17 and 18. We know that CTE is a 

neurodegeneration associated with repeated concussive injury that 

usually occurs in an individual’s teens and 20s. 

We know that once CTE is triggered, the neurodegeneration progresses slowly over decades to involve widespread degeneration of 

many brain structures. We know that the symptoms of CTE are 

subtle and begin in mid life with personality and behavioral 

changes, including irritability, short fuse, depression, suicidal ideations, impulsivity, and memory loss. We know there is a slow deterioration that progresses to dementia and parkinsonism. 

However, there are many things that we do not understand 

about CTE. We do not understand or we do not know the exact incidence and prevalence of this disorder, even though we now clearly 

understand that this disease exists, and it is surprisingly common. 

What factors determine who will develop CTE? How many concussions, how many subconcussive injuries, how close together the 

injuries, how severe, and at what age? All of these are aspects of 

the disease that are unknown at this time. 

Importantly, we do not know how to diagnose this disease in living individuals, how to stop its progression, or how to reverse its 

course. But we can make important changes to prevent this disease 

from developing in young athletes, and those changes include understanding what a concussion is, recognition of concussion when 

it occurs, and proper medical management of concussion after it 

happens. 

We can also teach our young athletes to play smart and keep 

their head out of the game as much as possible. Rule changes to 

protect athletes from dangerous styles of play, rule enforcement, 

and player and coach education will go a long way toward reducing 

the frequency of concussion and subconcussion. 

With these changes in the way that sports are played, continued 

education, increased scientific interest and research into the mechanisms of CTE pathogenesis, and the development of diagnostic 

37 

tools and therapeutic strategies to interrupt this disease progression, we can make enormous improvements to protect the mental 

health of millions of young athletes and military service members 

for many years to come. 

Thank you. 

[The prepared statement of Dr. McKee follows. In addition to her 

written testimony, Dr. McKee submitted three articles:] 

Brandon E. Gavett, PhD, Robert A. Stern, PhD, and Ann C. McKee, MD, ‘‘Chronic 

Traumatic Encephalopathy: A Potential Late Effect of Sport-Related Concussive and 

Subconcussive Head Trauma,’’ Clinical Sports Medicine 30 (2011) 179–188 

Daniel H. Daneshvar, MA, Christine M. Baugh, AB, Christopher J. Nowinski, BA, 

Ann C. McKee, MD, Robert A. Stern, PhD, Robert C. Cantu, MD ‘‘Helmets and 

Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions,’’ Clinical Sports Medicine 30 (2011) 145–163 

Ann C. McKee, MD, Robert C. Cantu, MD, Christopher J. Nowinski, AB, E. Tessa 

Hedley-Whyte, MD, Brandon E. Gavett, PhD, Andrew E. Budson, MD, Veronica E. 

Santini, MD, Hyo-Soon Lee, MD, Caroline A. Kubilus, and Robert A. Stern, PhD, 

‘‘Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury,’’ Journal of Neuropathology and Experimental Neurology Vol. 

68, No. 7, July 2009, pp. 709–735 

PREPARED STATEMENT OF ANN C. MCKEE, MD, PROFESSOR OF NEUROLOGY AND

PATHOLOGY, BOSTON UNIVERSITY SCHOOL OF MEDICINE; DIRECTOR, VISN–1 

NEUROPATHOLOGY LABORATORY FOR THE NEW ENGLAND VETERANS AFFAIRS

MEDICAL CENTERS; DIRECTOR, BRAIN BANKS FOR THE BOSTON UNIVERSITY

ALZHEIMER’S DISEASE CENTER, FRAMINGHAM HEART STUDY, AND CENTENARIAN

STUDY; CO-DIRECTOR, CENTER FOR THE STUDY OF TRAUMATIC ENCEPHALOPATHY

Mr. Chairman and Members of the Committee: 

Thank you for the invitation to testify today on sports concussions and their consequences. My name is Dr. Ann McKee. I am a Professor of Neurology and Pathology at Boston University School of Medicine and I am the Director of the 

Neuropathology Laboratory for the New England Veterans Affairs Medical Centers 

at the Boston VA Medical Center. I also direct the Brain Banks for the Boston University Alzheimer’s Disease Center, the Framingham Heart Study, and the Centenarian Study, and I am a co-director for the Center for the Study of Traumatic 

Encephalopathy at Boston University. My testimony today reflects my professional 

opinion; I am not speaking officially on behalf of the Department of Veterans Affairs. 

I received my medical degree in 1979, and I am board certified in both Neurology 

and Neuropathology. I have broad experience in neuropathology of neurological disease and have written extensively on the neuropathology of many neurodegenerative 

diseases, including Alzheimer’s disease, Parkinson’s disease, Frontotemporal Dementia and Traumatic Brain Injury. For the past 25 years, I have been studying 

the brains of individuals after death and correlating the pathological findings to the 

patient’s clinical symptoms during life. For the past 9 years I have been specifically 

analyzing the effects of repetitive mild traumatic brain injury or repetitive concussion on the brain. 

A traumatic brain injury (TBI) is caused by a blow, a jolt to the head or a penetrating head injury that disrupts the function of the brain. A TBI may range from 

mild—with a brief change in mental status—to severe, with an extended period of 

unconsciousness or amnesia after injury. Eighty percent of all TBI is mild, approximately 10% is moderate, and approximately 10% is severe. What we are primarily 

concerned with today is repetitive mild TBI (mTBI) or concussion; the terms concussion and mild TBI are interchangeable. Mild TBI and concussion are temporary 

states of neurological dysfunction resulting from acceleration, deceleration, lateral 

and rotational forces on the brain. Subconcussion is caused by the same acceleration-deceleration-rotational forces but the forces are milder and no symptoms are 

produced. In all these conditions, the brain appears macroscopically normal after 

the injury and there is no detectable damage on routine neuroimaging, including CT 

scan or MRI, which is why concussion and subconcussive injury are sometimes considered ‘‘invisible’’ brain injuries. However, these acceleration deceleration-rotational 

forces cause the brain to move rapidly within the skull and the brain, which is firm, 

but gelatinous, is stretched and deformed by these forces. As the brain as a whole 

38 

is deformed, there is also stretch and strain of the individual nerve cells and supporting cells within the brain. The brain abnormalities associated with concussion 

and subconcussion occur at the microscopic, cellular, molecular and metabolic levels. 

There is mild, but widespread injury to axons, the long, slender projections of a 

nerve cell that conduct electrical impulses away from the nerve cell and contact 

other nerve cells. The nerve cell and axonal injury most often completely resolve 

with rest. Indeed, most individuals recover completely from a single mTBI or concussion within weeks to months, but in some individuals (fewer than 10%), post-concussive symptoms can last for months to years, especially in situations where an 

athlete is not properly treated after a concussion. If an athlete returns to play before 

symptoms resolve, the athlete also risks a rare but sometimes fatal event known 

as second impact syndrome (SIS). In addition, repetitive concussion or repetitive 

subconcussion can trigger a progressive deterioration of the brain called Chronic 

Traumatic Encephalopathy (CTE) (McKee 2009, McKee 2010, Gavett 2010, 

Daneshvar 2011, Gavett 2011). 

CTE is a progressive neurodegeneration triggered by repetitive concussion and 

subconcussion that evolves slowly over decades and usually does not become apparent until many years later. Although the exact relationship between concussion, 

subconcussion and CTE is not entirely clear, most likely repetitive concussive and 

subconcussive injury superimposed on unresolved nerve cell and axonal injury initiates a series of metabolic, ionic, membrane, and cytoskeletal disturbances that triggers the pathological cascade that leads to CTE. This is the reason why concussion 

awareness is so critical and why proper diagnosis and management of concussion, 

allowing the brain to completely rest and recover after an injury, is so important 

in youth sports and all other activities that result in mTBI. 

There is also evidence that the youth or immature brain may be more susceptible 

to concussive injuries than the mature adult brain. The brain continues to develop 

and mature, laying down myelinated fiber tracts, until the mid-twenties. Children 

and young adults recover more slowly from a concussion than adults. Youth athletes 

are also more at risk for concussion due to their disproportionately large head size 

compared to body size and the weakness of their neck musculature. Further evidence of the enhanced susceptibility of young athletes to mTBI is second-impact syndrome (SIS), an entity that has only been reported in athletes 24 years and younger, 

and the vast majority of the SIS cases in the literature have involved athletes under 

the age of 18. 

SIS occurs when a young athlete sustains an initial head injury and then suffers 

a second head injury before the symptoms associated with the first impact have 

cleared (Cantu and Gean 2010). Typically, the athlete suffers post-concussion symptoms after the first head injury, which may include headache; dizziness; visual, 

motor, or sensory changes; confusion and memory problems. Before these symptoms 

resolve, which may take days or weeks, the athlete returns to competition and receives a second blow to the head. The second blow may be remarkably minor. The 

affected athlete may appear stunned, usually does not experience loss of consciousness but in the next few seconds to several minutes, the athlete, who is conscious 

yet stunned, precipitously collapses to the ground, semicomatose. The outcome is 

often fatal or associated with severe permanent disability. The pathophysiology of 

the SIS is generally believed to be caused by a loss of autoregulation of the 

cerebrovasculature. This dysautoregulation leads to precipitous brain swelling, high 

intracranial pressure, brain herniation and often, death. The adolescent or youth 

brain does not autoregulate well and is more susceptible to poor outcomes following 

mTBI (Chaiwat 2009). 

In 2008, we created the Center for the Study of Traumatic Encephalopathy 

(CSTE) with the goal of studying the long-term effects of sports-related mTBI and 

CTE. We initiated a brain donation registry, a clinical registry of amateur and professional athletes, and the CSTE Brain Bank at the Bedford VA. The purpose of the 

VA CSTE Brain Bank is to study the effects of repetitive mTBI (repetitive concussion and subconcussion) by neuropathologically examining brains donated by deceased athletes and other individuals with a history of repetitive mTBI. 

CTE was first reported in 1928 by Harrison Martland, a New Jersey pathologist 

and medical examiner, who described the clinical spectrum of abnormalities found 

in ‘‘nearly one half of the fighters who have stayed in the game long enough’’ 

(McKee 2009, Gavett 2011). Boxers exhibiting cognitive, behavioral, or motor abnormalities were well known within the community and were referred to by various 

terms, such as ‘‘punch drunk,’’ ‘‘goofy,’’ and ‘‘slug-nutty’’, and later by the more formal term ‘‘dementia pugilistica.’’ By the 1970s, a sufficient number of boxers with 

dementia pugilistica had been studied pathologically to support the conclusion that 

this distinct neurodegeneration was a consequence of repeated mTBI and was not 

restricted to boxers, and the term ‘‘chronic traumatic encephalopathy’’ or CTE, beVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00042 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
39 

came most widely used. Over the last few decades, clinical and neuropathologic evidence of CTE has emerged in association with various sports, including American 

football, professional wrestling, professional hockey, and soccer, as well as other activities associated with repetitive mild head trauma, such as physical abuse, epileptic seizures, head banging and military service. Although the incidence and prevalence of CTE is currently unclear, it most likely varies by sport, position, duration 

of exposure, and age at the time of initial or subsequent head trauma, and additional variables, such as genetic predisposition. 

In 2009, I reviewed the world’s literature on neuropathologically-verified CTE and 

found 51 cases of CTE including 3 cases of our own from BU and the Bedford VA 

(McKee 2009). Over the past 31⁄2 years, the brains and spinal cords of 97 athletes 

and military veterans who experienced mTBI or concussion have been donated to 

the VA CSTE Brain Bank. We have found CTE in 58 individuals, more than doubling the history of the world’s experience combined. We have neuropathologically 

diagnosed CTE in 40 football players, at all levels of play, professional, college and 

high school, 5 hockey players, and 15 military veterans and are currently preparing 

a manuscript for submission describing our experience. 

The onset of CTE is often in midlife, usually after athletes have retired from their 

sport. The early manifestations of CTE affect behavior and personality; in particular, individuals with neuropathologically documented CTE have been described 

as being more irritable, angry, or aggressive or as having a shorter fuse. There are 

mood changes, usually of depression, and increased suicidality, drug and alcohol 

abuse, and paranoia may be present. These changes are usually followed by shortterm memory loss and executive dysfunction. Later in the disease, increasing cognitive impairment, movement disorders (e.g., parkinsonism), and speech disorders 

may emerge. 

Macroscopic pathological changes found in CTE include an anterior cavum septum 

pellucidum and posterior septal fenestrations. These changes are likely caused by 

the force of the head impact being transmitted through the fluid ventricular system, 

thereby affecting the integrity of the intervening tissue. Enlargement of the lateral 

and third ventricles is also commonly seen in CTE with the third ventricle disproportionately widened. In advanced cases, there is also atrophy of the frontal and 

temporal cortices and medial temporal lobe, thinning of the hypothalamic floor, 

shrinkage of the mammillary bodies, pallor of the substantia nigra, and 

hippocampal sclerosis. 

Microscopically, CTE is characterized by an abundance of neurofibrillary tangles 

(NFTs), neuropil threads, and glial tangles within the brain, composed of hyperphosphorylated tau protein. CTE is distinguished from other neurodegenerations associated with build up of tau protein, such as Alzheimer’s disease, by several unique 

features. First, the distribution of tau pathology in CTE is strikingly perivascular 

and most dense at the depths of cortical sulci, especially in early stages of the disease. The tau pathology in CTE is also extremely irregular and superficial, largely 

confined to foci in the frontal, temporal, and insular cortices. With increasing severity the tau pathology spreads to involve the limbic cortices, subcortical nuclei and 

brainstem. 

Recently, in addition to severe tau neurofibrillary pathology, we have found that 

there is a widespread TDP-43 proteinopathy in more than 80% of their cases of 

CTE. Ten percent of athletes with CTE and a florid TDP-43 proteinopathy also develop a motor neuron disease similar to Amyotrophic Lateral Sclerosis (McKee 

2010). The deposition of both tau and TDP-43 as aggregated phosphorylated proteins associated with neurodegeneration in CTE suggests that repetitive mTBI or 

repetitive axonal injury provokes the pathologic accumulation of both proteins. 

Case studies 

Cognitively normal individuals 

Under normal circumstances, phosphorylated 1au protein, is found only in very 

limited quantities in the brains of cognitively normal people. I have examined over 

70 brains of cognitively intact individuals ranging in age from 18–103 years using 

the identical techniques that I use in studying the athlete brains. Basically, unless 

the individual is in the preclinical stages of a neurodegenerative disease, there is 

very little ‘‘normal’’ build up of phosphorylated tau protein in the brain and then 

only in restricted regions of individuals aged 70 years or older (Figure 1). 

40 

Figure 1. Coronal sections of brain from a 65-year-old cognitively normal individual without 

a history of mild TBI compared to the changes found in a 66-year-old former NFL player with 

CTE. The brain sections have been immunostained for phosphorylated tau protein, which appears as a dark brown color when the slides are viewed with the naked eye. The normal brain 

does not contain any appreciable amounts of phosphorylated tau protein, however there are substantial deposits of tau protein in many regions of the brain in the individual with CTE. 

Case 1. Former professional boxer 

In January of 2003, as part of my work with the Boston University Alzheimer’s 

Disease Center and the Bedford VA, I examined the brain of a man who died at 

the age of 72 after 15 years of severe dementia requiring institutionalization. The 

man had been a world champion boxer and had been clinically diagnosed with Alzheimer’s disease beginning at the age of 58. However, when I looked at his brain 

on postmortem examination, I found that there was absolutely no evidence of Alzheimer’s disease; there was no evidence of beta amyloid, a protein that accumulates 

in the brain in people with Alzheimer’s disease and is thought by many to be the 

cause of Alzheimer’s disease. Instead, the brain of this world champion boxer 

showed a massive build-up of phosphorylated tau protein as NFTs and glial tangles 

throughout his brain. The neurofibrillary and glial tangles were distributed in a 

unique pattern that is diagnostic of CTE; this pattern not found in any other 

neurodegenerative condition. When viewed microscopically it was clear that many 

individual nerve cells of the boxer contained NFTs, in fact they were found in nearly 

every nerve cell and there were almost no normal appearing cells. In CTE, tau protein builds up in individual nerve cells and prevents them from making normal connections with other nerve cells, eventually killing the cells. In this man’s brain, 

there were massive numbers of NFTs and glial tangles, so many in fact that you 

could see the abnormalities on the glass slides without the use of a microscope (Figure 2). This individual, a former professional boxer, had been clinically diagnosed 

with Alzheimer’s disease during life, but the disease that actually caused his tragic 

15 year decline in intellect and eventual hospitalization for severe dementia was 

CTE, a disorder that would have been entirely prevented if he hadn’t suffered repeated head injury in his younger years as a boxer. 


1019MCKE1.eps
41 

Figure 2. Left panel, top and bottom: coronal section of brain from a normal control showing 

the absence phosphorylated tau protein (dark brown). The bottom section is a microscopic view 

of a normal brain showing intact nerve cells and support cells. Middle panel, John Grimsley, 

showing marked deposition of tau protein in the amygdala and temporal cortex (top) and nerve 

cells filled with abnormal tau protein (bottom). The sections on the right are from a 72 year 

old professional boxer who died with advanced CTE. The top section shows dense deposition of 

abnormal tau protein in the amygdala and the bottom section shows a microscopic view of the 

dense accumulation of tau in nerve cells and support cells. 

Case 2. John Grimsley, former linebacker Houston Oilers 

John Grimsley, a former linebacker for the Houston Oilers died of an accidental 

gunshot wound while cleaning his gun at the age of 45. According to his wife, he 

was concussed 3 times during his college football years, and at least 8 times during 

his NFL career, however, only one ‘‘cerebral concussion’’ was medically confirmed. 

He was never formally diagnosed with post concussion syndrome and never sought 

medical attention for residual cognitive and behavioral difficulties. There was no 

history of ever losing consciousness for more than a few seconds and he never required being carried off the field or hospitalization. He never took any performance 

enhancing drugs or used illicit drugs. He was a nonsmoker and there was no known 

family history of dementia. According to his wife and close friends, he began showing changes in his behavior and cognitive decline at age 40. He developed difficulties 

in short-term memory, attention, concentration, organization, planning, problem 

solving, judgment, and the ability to juggle more than one task at a time. For example, he would ask the same questions repeatedly over the course of the day and he 

would ask to rent a movie that he had already seen. He had difficulty assembling 

his tax records, shopping alone, and understanding television. His symptoms gradually progressed and became quite severe by the end of his life. He also developed 

a ‘‘shorter and shorter fuse’’ and would become angry and verbally aggressive over 

seemingly trivial issues. When I first looked at his brain, it showed the exact same 

pattern of changes that I had found in the brains of boxers with CTE. There were 

large numbers of tau containing neurofibrillary tangles throughout all parts of the 

brain and there was absolutely no evidence of beta amyloid protein or Alzheimer’s 

disease. The brain of this 45 year old husband and father, at the prime of his life, 

showed profound neurofibrillary degeneration, changes of CTE that were identical 

in nature to the changes I found in the brains of the boxers, but were now found 

in a football linebacker some 30 years younger. In John Grimsley’s brain, there were 

striking changes in regions of the brain controlling personality and behavior, such 

as the frontal lobes, profound changes in the areas controlling impulsivity and rage 

behavior such as the amygdala, and severe changes in anatomic structures that are 

responsible for memory, such as the hippocampus, mammillary bodies and thalamus. In Figure 2, the brain of John Grimsley is seen in the middle; in the top middle panel, you can see severe tau deposition in the frontal lobe and microscopically; 

in the bottom middle panel, you can see numerous nerve cells containing tau and 

NFTs. In a normal 45 year old, absolutely none of these changes would be found. 


1019MCKE2.eps
42 

Indeed these changes would not be found in a normal 65 year old, 85 year old or 

100 year old. 

Case 3. Louis Creekmur, former offensive lineman Detroit Lions 

Louis Creekmur was a former offensive lineman for the Detroit Lions and eighttime Pro Bowler. Louis Creekmur played ten seasons for the Lions and was famous 

for suffering at least 13 broken noses and 16 concussions. Beginning at the age of 

58, he began to show increasing cognitive and behavioral difficulties including memory loss, problems with attention and organization, and outbursts of anger and aggression. He died from complications of dementia at the age of 82. The brain of Mr. 

Creekmur showed advanced GTE including marked shrinkage of medial temporal 

lobe structures that control memory, shrinkage of the frontal and temporal lobes, 

and marked dilation of the spinal fluid cavities that line the brain’s interior. There 

was widespread and severe tau deposition as NFTs throughout the frontal and temporal lobes, amygdala, hippocampus, thalamus and brainstem in the unique pattern 

that is only found in GTE. In Mr. Creekmur’s case, the abnormalities were extremely severe. There was absolutely no evidence of beta amyloid, Alzheimer’s disease or any other neurodegenerative disorder, and the findings again indicated that 

if Mr. Creekmur had not sustained repetitive head trauma during the play of football, he would be alive and well and enjoying his family and grandchildren today. 

Figure 3. Coronal sections of the brain of Louis Creekmur stained for phosphorylated tau protein show dense abnormalities throughout the brain. Bottom row: microscopic views of abnormal 

tau deposits. There was extensive nerve cell loss and advanced neurodegenerative changes 

throughout the brain. 

Case 4. Dave Duerson, former defensive back Chicago Bears 

Dave Duerson began playing football at age 8 and played a total of 24 total seasons as a safety in college and as a defensive back in the NFL He experienced more 

than 10 concussions in his 11-year NFL career, several with loss of consciousness, 

although he was never admitted to hospital. After retiring from the NFL, he was 

very successful in the food supply industry (Duerson Foods), active in NFL Players 

Association and Benefits Board; he had a loving family with three sons and a 

daughter and was considered in generally good health. In 2007, he began to experience business and financial difficulties that culminated in the loss of his business 

and the dissolution of his marriage. He was known to be smart, charming, kind and 

gentle but he became progressively more hot-tempered, physically and verbally abusive. He began to experience memory lapses; mood swings, piercing headaches on 

the left side of his head, difficulty spelling simple words, and blurred eyesight. On 

February 17, 2011, Duerson killed himself inside his Florida apartment at age 50. 

He left a note that carried a request: ‘‘Please, see that my brain is given to the 


1019MCKE3.eps
43 

NFL’s brain bank’’ (The VA CSTE brain bank). The request was accompanied by an 

unusual method of suicide; he shot himself in the heart. At autopsy, his brain 

showed extensive changes of moderately advanced CTE, without evidence of any 

other disorder including Alzheimer’s disease (Figure 4). 

Figure 4. Coronal sections of the brain of Dave Duerson stained for phosphorylated tau protein 

show dense abnormalities throughout the brain. Bottom row: microscopic views of abnormal tau 

deposits showing extensive abnormalities of tau in nerve cells and support cells. 

Case 5. Owen Thomas. defensive end University of Pennsylvania 

Owen Thomas was a University of Pennsylvania defensive end who loved football 

and had played football since age 9. He was considered to be the life of the team 

and was unanimously voted team captain. There was no history of documented or 

undocumented concussion, depression or psychiatric difficulties, and no evidence of 

substance abuse. One day in the spring of 2010, he called his parents and told them 

he was stressed by school and having trouble with several of his subjects, two days 

later he hanged himself in his off campus apartment. Neuropathological examination of Owen’s brain showed the unmistakable changes of early CTE with focal collections of NFTs in multiple areas of his frontal cortex and evidence of spread of 

the NFTs to adjacent cortical regions (Figure 6). Comparison of the brain of Owen 

Thomas to the brain of Dave Duerson shows remarkable similar pathology and suggests that if Owen Thomas had lived another 30 years, his CTE would have progressed to the moderately severe stage demonstrated by Dave Duerson. 


1019MCKE4.eps
44 

Figure 5. Coronal sections of the brain of Owen Thomas stained for phosphorylated tau protein show dense abnormalities throughout the brain. Bottom row: microscopic views of abnormal 

tau deposits. There was extensive nerve cell loss and advanced neurodegenerative changes 

throughout the brain. 

Case 6. 18-year-old high school football player 

I also have had the opportunity to examine the brain of a high school football 

player who died at the age of 18. He had played football and other sports for 4 years 

and suffered several concussions. The brain of an 18 year old should be pristine; 

there should be no abnormalities whatsoever. But in the brain of this young man, 

there were several areas of damage in the frontal lobe that you could see even looking at the slides with your naked eye (Figure 6, top row). In those areas, there were 

hundreds of degenerating nerve cells containing tau NFTs and disordered nerve cell 

processes indicative of early CTE. 

Figure 6. Brain sections from an 18 year old high school football and rugby player showing 

areas of damage in the frontal lobe (top row, red boxes), and microscopic views of views of 

phosphorylated tau containing NFTs in nerve cells and their processes in lower row. 


1019MCKE5.eps 1019MCKE6.eps
45 

Case 7. 17-year-old high school football player. death from Second Impact Syndrome 

(SIS) 

A 17-year-old high school football player suffered a concussion 3 weeks before the 

day of his death and was cleared to return to play 2 days earlier. During the game, 

the running back and linebacker intercepted a pass and hit the ground. Nothing 

seemed exceptional about the tackle; it was considered a routine play. Yet as he 

walked to the bench, he complained of a severe headache and then collapsed to the 

ground unconscious. He died the following day. Neuropathological examination 

showed a thin subdural hemorrhage entirely consistent with Second-Impact Syndrome (SIS) and very early changes of CTE. He is the youngest player ever known 

to have changes of CTE on neuropathological examination. 

Summary 

I have now examined the brains of 58 individuals with neuropathologically 

verified CTE—including 40 professional and amateur football players, 5 hockey 

players and 15 military veterans.Ihave found changes of early CTE in several college and high school football players, including early changes in players as young 

as 17 and 18 years. We know that CTE is a tauopathy and TDP–43 proteinopathy 

associated with repeated mTBI that most commonly occurs early in life, usually an 

individual’s teens and early twenties. We know that once CTE is triggered, the 

neurodegeneration progresses slowly over decades to involve widespread degeneration of many brain structures. We know that the symptoms of CTE are often insidious and begin in mid-life with prominent early personality and behavioral changes, 

including irritability, short fuse, depression, suicidal ideations, impulsivity, and 

memory loss. We know there is a slow deterioration that may progress to include 

dementia, parkinsonism, gait and speech disorders. However, there remain many 

things that we do not understand about CTE. An autopsy case series will never establish incidence and prevalence of this disorder, even though we now clearly understand that CTE exists—and that it is surprisingly common. What factors determine 

who will develop CTE—how many concussions or how many subconcussive injuries, 

how close together the injuries are, how severe, and at what age—all of these are 

aspects of this disease that are unknown at this time. Most importantly, we do not 

know how to diagnose this disease in living individuals, how to stop its progression 

or how to reverse its course at the present time. But we can make important 

changes to prevent this disease from developing in young athletes, and those 

changes include understanding what a concussion is, recognition of concussion when 

it occurs, and proper medical management of concussion after it happens. We can 

also teach our young athletes to play smart and to keep their head out of the game 

as much as possible. Rule changes to protect athletes from dangerous styles of play, 

rule enforcement and player and coach education will go a long way towards reducing the frequency of concussion. With these changes in the way sports are played, 

continued education, increased scientific research into the mechanisms of CTE 

pathogenesis, and the development of diagnostic tools and therapeutic strategies to 

interrupt disease progression, we can make an enormous improvements to protect 

the mental health of millions of young athletes and military service members for 

many years to come. 

References 

1. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, 

Santini VE, Lee H–Y, Kubilus CA. Stern RA. Chronic Traumatic Encephalopathy 

in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropath 

Exp Neurol, 2009 68(7): 709–735. 

2. McKee A, Gavett B, Stern R, Nowinski C, Cantu R, Kowall N, Perl D, HedleyWhyte E, Price B, Sullivan C, Morin P, Lee H–S, Kubilus C, Daneshvar D, Wulff 

M, Budson A. TDP–43 Proteinopathy and Motor Neuron Disease in Chronic Traumatic Encephalopathy, Journal Neuropathol Exp Neurol, 2010, 69: 918–929. 

Authors’ reply: McKee AC, Budson AE, Gavett BE, Stern RA, Daneshvar D, 

Nowinski CJ, Cantu RC, Kowall NW, Perl DP, Hedley-Whyte ET. J Neuropathol 

Exp Neural. 2011 Jan; 70(1): 98–100. 

3. Gavett, B, Stern R, Cantu R, Nowinski C, McKee A. Mild traumatic brain injury: A risk factor for neurodegeneration, Alzheimer’s Research and Therapy, 2010, 

Jun 25; 2(3): 18. 

4. Gavett B, Stern R. McKee A. Chronic Traumatic Encephalopathy: A Potential 

Late Effect of Sport Related Concussive and Subconcussive Head Trauma. Clinics 

in Sports Medicine, 2011 Jan; 30(1):179–88, xi. 

5. Daneshvar D, Nowinski C, McKee A, Stern R, Cantu R. Helmets and Mouth 

guards: The Role of Personal Equipment in Preventing Sports Related Concussions. 

Clinics in Sports Medicine, 2011 Jan; 30(1): 145–63, X. 

46 

6. Cantu RC, Gean AD. Second-Impact Syndrome and a Small Subdural Hematoma: An Uncommon Catastrophic Result of Repetitive Head Injury with a Characteristic Imaging Appearance. J Neurotrauma 2010 27:1557–1564. 

7. Chaiwat 0, Sharma D, Udomphorn Y, Armstead WM, Vavilala MS. Cerebral 

hemodynamic predictors of poor 6-month Glasgow Outcome Score in severe pediatric 

traumatic brain injury. J Neurotrauma 2009 26(5): 657–63. 

The CHAIRMAN. That was excellent. 

And so, we then finish with Mr. Mike Oliver. Let me repeat, Executive Director of the National Operating Committee on Standards for Athletic Equipment. And having read my preparation for 

this hearing, I am still a little bit confused about what you all do 

and what you don’t do. 

Mr. OLIVER. I think I can cover that. 

The CHAIRMAN. OK. 

STATEMENT OF MIKE OLIVER, EXECUTIVE DIRECTOR AND 

LEGAL COUNSEL, THE NATIONAL OPERATING COMMITTEE 

ON STANDARDS FOR ATHLETIC EQUIPMENT (NOCSAE) 

Mr. OLIVER. Thank you, Mr. Chairman, Ranking Member Boozman, and members of the Committee. 

I appreciate the invitation to come here today and provide some 

testimony and answer questions of the Committee on a topic that 

is extremely important to me personally, as well as to the organization I represent. 

My name is Mike Oliver. Since 1995, I have served as the Executive Director and General Counsel for NOCSAE. NOCSAE is the 

National Operating Committee on Standards for Athletic Equipment. We are a nonprofit corporation which develops and publishes 

standards for athletic equipment, including helmets, faceguards, 

safety balls, and even soccer shin guards. 

We operate as a board of 18 directors representing a wide variety 

of national sports, sports medicine, and other interested organizations. Each organization, by definition through our bylaws, selects 

one or two of its members to sit as a director on the board. And 

in addition to the 18 voting directors, NOCSAE has 2 nonvoting positions, representing the national sports governing bodies of the 

NCAA and the National High School Federation, the NFHS. 

There is no single controlling interest or interest group on the 

NOCSAE Board, and a balance of interests and nondominance is 

inherent in the operational structure and function that is provided 

through our bylaws. NOCSAE is not a trade organization. There is 

no membership category. Funding for the operations and research 

that we undertake is received through licensing fees that we 

charge to manufacturers who want to certify equipment to our 

standards and to use our trademarked and registered logos, properties, and phrases. 

Although NOCSAE is not a certifying body—we do not certify 

equipment independently of the manufacturers—we do engage in 

market surveillance of certified equipment, and we monitor product 

performance through mandatory third-party laboratory validation 

testing as required by our standards, as well as direct product testing through an A2LA accredited testing laboratory with whom we 

contract to provide technical support and services. 

47 

Decisions regarding changes to standards or the creation and 

adoption of new standards are driven exclusively by science and 

motivated by the desire of all board members to protect athletes, 

not by issues of manufacturer liability, profit, market share, or any 

other interests. 

The mission of NOCSAE since its inception in 1968, is to commission research and establish standards for athletic equipment 

where feasible and to encourage the dissemination of research findings on athletic equipment and sports injuries. In fulfilling that 

mission, NOCSAE has funded more than $6 million in research 

grants since the first grant was issued in 1994, and that number 

includes more than $5 million dedicated to concussion-related research. 

To be certified as meeting our standards, helmets, whether they 

are football helmets or batter’s helmets, must score less than 1,200 

severity index units on each of 16 impacts conducted at 12 miles 

per hour, including 2 high-temperature impacts and impacts on 2 

randomly selected locations. In addition to those, there are four impacts at lower speeds, which have lower threshold requirements. 

Although the standard for helmets that NOCSAE publishes are 

not concussion specific, the NOCSAE standard does directly address linear forces that are involved in most concussive events, and 

a helmet that passes the NOCSAE standard does provide some 

level of protection against those concussions caused primarily by 

induced linear accelerations to the brain. We do not promote helmets as being concussion preventive or anti-concussion because 

there is no way to accurately measure the extent of protection provided. 

What the NOCSAE standard does not yet address and cannot yet 

address, and is a subject that is not addressed by any other helmet 

standard in the world, is how to establish and incorporate a threshold for rotational accelerations of the head that result from impact 

forces not directed through the center of gravity of the head. These 

rotational accelerations are directly involved in causing a significant number of concussions, and these types of accelerations can 

occur even without a blow to the head. 

There is no protective equipment standard available today from 

any source that specifically addresses concussion prevention, and 

the development of a concussion-specific standard for any protective equipment requires substantial scientific support that compliance with the standard would, in fact, further eliminate or reduce 

the severity of concussions without increasing the risk of injury in 

other areas. 

While helmets certified to the NOCSAE standards play a very 

important role in protecting athletes on the field of play, certainly 

helmets are not the only solution to providing better protection 

against concussion. Prevention, diagnosis, treatment, and management decisions about when athletes should return to play are 

equally important and, in fact, in some circumstances may be more 

immediately effective in reducing the number of concussions. 

Education programs that have been referenced earlier today address these issues and are underway for coaches, and in fact, 

NOCSAE has entered into a partnership, as mentioned earlier, 

with the CDCP to create a specific Heads Up to Parents program 

48 

as an educational resource to promote this education among those 

who are certainly motivated to provide the best level of protection 

and education to their children. 

NOCSAE recognizes that concussions are complex events, both 

biomechanically and physiologically. And scientists are working 

hard to understand these issues so that improvements might be 

made in protection, prevention, and treatment. 

We are one of the primary funding sources for this research, and 

we are hopeful that answers will be found that will permit an 

amendment to our standards that will effectively and specifically 

address concussions. Any device, including helmets, promoted as 

being able to prevent, diagnose, or cure a concussion must be supported by scientific data and peer-reviewed research. The same is 

true with regard to standards for athletic equipment. 

We fund concussion research with the intent to advance the 

science so that changes can be made to standards that will reduce 

concussions without increasing risk in other areas, and we have 

taken specific steps to be ready to do that when the answers are 

found. But without solid scientific support for a concussion-specific 

change to an existing helmet standard, any changes made to address concussions becomes nothing more than a hopeful experiment, turning players into involuntary test subjects. And that is 

something that we will not do. 

I look forward to the Committee’s questions and the discussion 

today on a topic that we consider to be extremely important. 

Thank you. 

[The prepared statement of Mr. Oliver follows:] 

PREPARED STATEMENT OF MIKE OLIVER, EXECUTIVE DIRECTOR AND LEGAL COUNSEL, THE NATIONAL OPERATING COMMITTEE ON STANDARDS FOR ATHLETIC EQUIPMENT

(NOCSAE) 

Parents, athletes, and coaches, are becoming more aware and informed regarding 

concussion prevention, diagnosis, treatment, and the importance of following recognized return-to-play criteria. This increased awareness and public discussion is vitally important to advancing athlete safety, but it also creates a demand for quick 

solutions. Unfortunately, there are quick solutions offered for sale which have neither scientific nor medical support, and which carry the potential for creating a false 

sense of security and reliance on a level of protection that does not exist. 

The neurobiology and biomechanics of sports concussions present complex and 

rapidly evolving areas of expertise both as to cause and prevention. Through its 

grant research funding program, NOCSAE has been one of the international leaders 

in helping to advance the scientific and medical knowledge relating to concussions. 

Despite the dedication of more than $5,000,000 in research grants since 1994, directed specifically towards the issue of understanding and preventing sports concussions and to developing protective equipment performance standards that could 

eliminate concussions or reduce their frequency and severity, scientific support for 

such standard does not yet exist. 

NOCSAE, the National Operating Committee on Standards for Athletic Equipment, is an independent and nonprofit standard-setting body with the primary mission to enhance athlete safety through scientific research, education, and where feasible, the creation of performance standards for protective equipment. NOCSAE efforts include the development of helmet performance and test standards for football, 

baseball and softball, ice hockey, and lacrosse, as well as faceguards and face protectors used in connection with these helmets. NOCSAE bylaws provide that the Board 

is comprised of representatives selected by national organizations representing a 

broad base of interested parties and expertise. Broken into three general categories, 

NOCSAE directors representing end-user or direct athlete involvement include two 

new members from the National Athletic Trainers Association (NATA), the Athletic 

Equipment Managers Association (AEMA), and the American Football Coaches Association (AFCA). NOCSAE directors representing sports medicine and related sciVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00052 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
49 

entific research include representatives from the American College of Sports Medicine (ACSM), the American College Health Association (ACHA), American Orthopedic Society for Sports Medicine (AOSSM), the American Academy of Pediatrics 

(AAP), and the American Medical Society for Sports Medicine (AMSSM). NOCSAE 

directors representing product and manufacturing interests are selected by the 

Sporting Goods Manufacturers Association (SGMA) and the National Athletic 

Equipment Reconditioners Association (NAERA). In order to maintain balance between the interests represented and to preclude dominance or control by any group 

or interest, some organizations have one seat, while others have two. Currently 

there are 18 voting directors, five of which represent manufacturing and retail interests, 7 represent the athlete and end user interests, and 6 representing medical and 

scientific interests. NOCSAE also has two non-voting directors, one representing the 

National Federation of State High School Associations (NFHS) and one representing 

the National Collegiate Athletic Association (NCAA). 

In support of its mission, the NOCSAE board utilizes a Scientific Advisory Committee consisting of independent leading experts in the areas of neurology, neurosurgery, orthopedics, biomechanics, and epidemiology. This committee meets as 

needed, and provides support, guidance, and advice in the areas of standards development as well as identifying areas for directed or targeted research. 

NOCSAE also maintains an ongoing independent contract with an A2LA accredited and ISO 17025 certified testing laboratory, and a contract with Fred Mueller 

PhD who, as the Director of Research, oversees and administers the NOCSAE research grant application and funding program. 

History of NOCSAE 

NOCSAE was created in 1968 through the combined efforts of the NCAA, the 

American College Health Association, the NFHS, and the Sporting Goods Manufacturers Association to develop a football helmet standard that would be effective in 

reducing or eliminating fatalities from head injuries such as skull fractures and 

subdural bleeding that were occurring in organized football. 

The standard which resulted from the efforts of the original NOCSAE directors 

and scientists mandated that football helmets meet a specific injury threshold criteria, commonly referred to as the Gadd Severity Index, Severity Index, or simply 

SI. The SI threshold in the NOCSAE standard works by limiting the magnitude of 

linear head accelerations that result when the helmet is hit. The first NOCSAE football helmet standard was originally published in 1973 and new helmets began to 

appear on the market certified to this new standard shortly afterwards. Eventually 

a requirement of compliance with the NOCSAE standard was incorporated into the 

rules of play by the NCAA and the NFHS in 1978 and 1980 respectively, and within 

a few years, helmets certified to the NOCSAE standards became required in all 

rules of play for governing bodies controlling football, even extending to the United 

States Military through the Department of Defense-Education Activity (DoDEA). 

To be certified as meeting the NOCSAE standard, helmets must score less than 

1200 SI on each of 16 impacts at 12 mph including two at high temperatures and 

two randomly selected locations, plus 4 additional impacts at two different lower 

speeds which have lower SI threshold requirements. Although not concussion specific, the NOCSAE standard directly addresses linear forces that are involved in 

most concussive events, and a helmet that passes the NOCSAE standard does provide some protection against those concussions caused by induced linear accelerations. 

What the NOCSAE standard cannot yet address, and which is not addressed by 

any other helmet standard in the world, is how to establish and incorporate a 

threshold for rotational accelerations of the head that result from impact forces that 

are not directed through the center of gravity of the head. These rotational accelerations are directly involved in causing a significant number of concussions, and these 

types of accelerations can occur even without a blow to the head. Even less is known 

scientifically about concussion threshold values when the blow to the head results 

in a combination of linear and rotational accelerations occurring at different points 

in the same impact and with different magnitudes. 

There is no helmet standard available today from any source that specifically addresses concussion prevention, and the development of a concussion specific standard for any protective equipment requires substantial scientific support that compliance with such a standard will in fact further eliminate or reduce the severity of 

concussions without increasing the risk of injury and other areas. 

Protecting Against Concussions 

While helmets certified to NOCSAE standards play an incredibly important role 

in protecting athletes in the field of play, improved protective equipment is not the 

50 

only solution to providing better protection against concussion. Prevention, diagnosis, treatment, and management decisions about when athletes should return to 

play are equally important, and prevention can be enhanced by enforcing the rules 

of play in a particular sport. 

• Teaching and enforcing proper tackling techniques, which include not using the 

head as a weapon or primary contact point. These types of changes can make 

an immediate and likely measurable impact on the number and severity of concussions. 

• Teaching athletes and active children at all ages that the signs and symptoms 

of a potential concussion should not be ignored, and should be followed up with 

an evaluation by someone properly trained and skilled in evaluating concussions. 

• Adopting and enforcing return to play criteria that will prevent an athlete from 

returning to play until a complete and objective evaluation is completed. 

• Helping parents, coaches, and players understand that although helmets provide a substantial level of protection, no helmet can prevent all head injuries, 

including concussions. 

The Centers for Disease Control (CDC) estimates approximately 1.6 to 3.8 million 

sports-and recreation-related concussions occur each year in the United States, and 

children and teens are at highest risk. Parents, coaches and trainers must exercise 

caution in deciding when athletes can and should return to play. The Center for Injury Research and Policy at Nationwide Children’s Hospital, funded in part by 

grants from NOCSAE, found that in 2008, more than 40 percent of high school athletes were allowed prematurely to return to play after suffering concussions. And, 

of those players, 16 percent of concussed football players were actually allowed to 

return to play in the same game after losing consciousness. 

NOCSAE ongoing efforts to address concussions 

As stated earlier, there are currently no helmet standards published in the world 

which contain performance thresholds specific to concussions. Helmet standards 

which limit linear accelerations do provide a level of protection for those concussions 

where linear acceleration may be the primary cause, but a concussion specific helmet standard to be effective must incorporate not only limitations to linear accelerations, but also reflect and incorporate an understanding of injury thresholds associated with rotational accelerations and strong scientific support for the concussion 

injury thresholds utilized. For many years, NOCSAE has dedicated its resources to 

answering those questions NOCSAE’s first concussion research grant award of 

$49,000 was given in 1996 to Dr. Kevin Guskiewicz at the University of North Carolina to study the ‘‘Effect of Mild Head Injury on Cognition and Postural Stability’’ 

in evaluating potential concussion diagnostic modalities. In the past 10 months, 

NOCSAE has funded specific targeted concussion research grants totaling 

$2,319,000 to scientists and biomechanical researchers at Dartmouth Medical 

School, Dartmouth Department of Engineering, Wayne State University School of 

Engineering, Ottawa University Bioengineering Laboratory, and the Southern Impact Research Center. From that first concussion grant in 1996 through today’s 

date, NOCSAE has dedicated over $5,000,000 to the study of sports related concussions to advance medicine and science in that area to the point that concussion specific changes to the NOCSAE standards can be adopted. These concussion specific 

grants are in addition to other NOCSAE funded research in the areas of sports medicine and science, including research that eventually identified the biomechanics 

and physiology of which may be preventable through the use of an appropriately 

tested chest protector that meets an impact standard currently being developed by 

NOCSAE. 

As early as 2002 and 2003, NOCSAE was becoming aware through its sponsored 

research and from the research of others that any performance standard that might 

effectively address injury thresholds from rotational accelerations would require a 

new testing methodology in addition to the drop test which is utilized by all existing 

helmet performance standards. To that end, NOCSAE advanced funding for the fabrication of five prototype horizontal ram impactor devices, sometimes referred to as 

a linear impactor. This impactor is designed in such a way as to permit a testing 

apparatus to induce rotational accelerations into a helmet and headform in unlimited magnitudes, direction, and orientation, which no existing helmet impact drop 

tests are able to accomplish. NOCSAE decided in 2004 that the validation of such 

a testing component was necessary so that there would be no delay in incorporating 

rotational acceleration thresholds and testing in the NOCSAE standards once those 

thresholds were identified. A proposed revision to the NOCSAE standard incorVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00054 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
51 

porating this new testing protocol was published in 2004, and work has continued 

to this day in validating and refining the linear at five different laboratory locations 

around the country. 

Public Education programs 

In addition to regular public speaking engagements, daily interaction with the 

public to telephone calls and e-mails, and providing and disseminating research and 

educational information through the Internet, NOCSAE has entered into a partnership with the CDC National Center for Injury Prevention and Control to develop 

and disseminate a concussion awareness and educational campaign called ‘‘Heads 

up to Parents.’’ This national campaign utilizes multiple informational outlets, including social media, to present parents and athletes with concussion information, 

building on the CDC’s already-successful ‘‘Heads Up’’ initiative, featuring free tools 

that provide important information on preventing, recognizing and responding to a 

concussion. Materials can be found on the CDC’s website, www.cdc.gov/concussion/ 

sports/. These tools are an invaluable resource for parents as their athletes take 

the field, and NOCSAE is proud to be a partner with the CDC Foundation to provide financial and substantive support for the program. 

Changes to the NOCSAE helmet standards 

The NOCSAE helmet standard, unique among all existing helmet standards for 

the use of a biofidelic headform, the use of a pass fail criteria which incorporates 

both impact force and time duration (SI), and the requirement of low-speed and 

high-speed certification impacts, has undergone significant and substantial revisions 

and improvements since it was first adopted and published in 1973. 

• In 1992, NOCSAE undertook a multi-factor revision to its testing protocol, 

which included implementation of a scientifically proven calibration method of 

the NOCSAE headform using a specially designed impact surface, added a requirement that headform calibration be performed rigid, and the air craft cable 

guide wires were replaced with smoother music wire. This decreased friction in 

the drop system and increased stability of the carriage assembly throughout the 

drop impact. The test impact pad was hardened from a 36 Shore A hardness 

natural rubber surface to a 43 Shore A hardness urethane to produce a more 

consistent impact surface. These changes resulted in significantly higher impact 

velocities and increased impact energies to the helmet, a more demanding test 

than in the previous standard. The increased impact energies now required in 

the testing were so significant that the impacts began to break expensive head 

forms and attachment assemblies, which required a redesign of those components. 

• In 1996, NOCSAE amended its helmet standards by toughening pass fail criteria for helmets. The original SI value of 1500 was reduced to 1200, making 

it is 20 percent more demanding, and bringing the pass fail threshold in line 

with Federal Motor Vehicle Safety Standards. 

• In 1999 an anthropometrically correct size medium testing headform was introduced along with other design changes to allow the headforms to withstand the 

new impact energies that resulted from the changes in 1992 and 1996. 

• In 2003, a proprietary data acquisition system and standardization of data collection was developed by NOCSAE and implemented with all licensees, requiring that the pretest and posttest system checks be performed correctly or all 

helmet test data performed between these system checks becomes invalid. A 

temperature sensor incorporated in the software automatically invalidates all 

test data generated when the temperature of the test lab is outside the specified 

range. Additionally, the results of all impact certification tests are stored in 

encrypted files and available to NOCSAE by direct download or electronic exchange. 

• In 2011, the football helmet standard was revised to add low level pass/fail 

thresholds for drop impacts at 7 miles per hour This low speed impact threshold 

is in addition to the 1200 SI pass/fail for drops of 12 mph. 

NOCSAE enforcement of its standards 

The NOCSAE name, and the various sport specific logos, phrases, and designs 

that are incorporated into the NOCSAE standards are registered and trademarked 

properties, and NOCSAE controls the use of those properties through a license 

agreement. Any manufacturer which intends to certify equipment to the NOCSAE 

standards must first sign a license agreement to do so. This agreement obligates the 

manufacturer to not only comply with the specific requirements of the standards, 

but also requires that each licensee provide certification testing data, quality assurVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00055 Fmt 6633 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
52 

ance and quality control program documentation, and annual reports from third 

party independent testing laboratories certified compliant with ISO 17025 requirements proving compliance with the NOCSAE standards for every piece of equipment 

certified by that licensee in the previous 12 months. In exchange for permitting the 

manufacturer to use the intellectual property of NOCSAE, a license fee is also 

charged. This license fee is non-negotiable, and is assessed on a per unit basis. The 

fees per unit are extremely small, but generate the revenue used by NOCSAE to 

fund the scientific research grant program which supports the content of standards. 

The license agreement also obligates each licensee to obtain prior approval of proposed advertising which uses the NOCSAE name or references NOCSAE as part of 

its advertising. 

Although NOCSAE is not a certifying body, we do engage in market surveillance 

of certified equipment, and we independently investigate certified equipment performance through mandatory annual third party laboratory validation testing, and 

direct product testing through our own contracted and A2LA accredited testing laboratory. 

Recertification of reconditioned equipment 

In addition to the standards that apply to the certification of new athletic equipment, NOCSAE has also published standards that permit previously certified equipment to be recertified as part of a formal reconditioning process. NOCSAE standards for the recertification of previously certified athletic equipment provide schools, 

clubs, universities, and even professional teams with a way to economically maintain the performance and integrity of their certified helmets, and provide NOCSAE 

with the opportunity to reevaluate helmet performance even after they have been 

in use for one or more seasons. The recertification standards require that reconditioners test a statistically significant number of helmets submitted for reconditioning and recertification. These helmets must be tested first in the condition they 

are in ‘‘as received from the field’’ before any repair or reconditioning is undertaken. 

Following completion of the reconditioning process which includes a thorough and 

complete inspection of every individual helmet for cracks and defects, and the replacement of worn or damaged padding and fitting components, these same randomly selected helmets are retested utilizing a proprietary data acquisition software 

program developed for NOCSAE by engineers at the University of Tennessee. The 

test results of the nearly 50,000 helmets from both pre-and post reconditioning tests 

are collected and evaluated every year. 

Conclusion 

Concussions are complex events both biomechanically and physiologically, and scientists are working hard to understand these issues so that improvements can be 

made in protection, prevention, and treatment. Any device or supplement promoted 

as being able to prevent, diagnose, or cure a concussion must be supported by scientific data and peer reviewed research. The same is true with regard to standards 

for protective equipment. Without solid scientific support for a concussion specific 

change to an existing helmet standard, any changes made to address concussions 

becomes nothing more than a hopeful experiment, turning players into involuntary 

test subjects. 

The CHAIRMAN. Thank you for that excellent testimony. 

We have been joined by Senator Klobuchar from Minnesota, 

where they are having quarterback difficulties. 

[Laughter.] 

Senator KLOBUCHAR. We do have a team, however. 

The CHAIRMAN. Yes, you do. That is true. 

Senator KLOBUCHAR. Thank you. 

The CHAIRMAN. I am from West Virginia. I deserve that. 

What is interesting—that is good, Amy. 

[Laughter.] 

The CHAIRMAN. I have spent a lot—my mother spent I think 

about 12 years dying from Alzheimer’s. Actually, you couldn’t really 

be sure. But die she did. My wife’s father died from Alzheimer’s. 

There are so many—there are 5 million people that have Alzheimer’s in this country. 

53 

And one of the stunning things about Alzheimer’s, which, incidentally, if you are working in that traumatic brain injury area, 

you can do that while you are working on Alzheimer’s because 

there is a lot of sort of common threads in there. The stunning 

thing is the New York Times came out with an article 6 or 8 

months ago basically saying that the last 30 years of research at 

the great institutes of research in this country had produced absolutely no progress whatsoever on finding out the cure for Alzheimer’s. 

Not for preventing and not for slowing it down, not even yet for 

testing to find out whether you have it, although that may be on 

the way. But that doesn’t cure it, which is what we want. That is 

a stunning figure. 

Now comes along the injuries that are sustained by concussions, 

made more poignant by the fact that they come so early in life and 

can have such terrible consequences that you, Mr. Threet, and you, 

Ms. Ball, decided not to do what you had spent your whole life preparing to do. It is not necessarily typical. I mean, it was a very mature, wise decision to make. 

So I just want to kind of throw this at all of you. You could develop a 50-pound helmet and all it would do is more securely, I 

think—unless I am wrong—it would just more securely make sure 

that your head doesn’t get split open. But it wouldn’t do one thing 

for the movement of the brain, to stop the movement of the brain. 

Which then, if you say that emphatically enough, it raises the 

question of what can you do medically? You can analyze. We do 

that with Alzheimer’s. People—you have a registry of Alzheimer’s 

brains. People leave their brains to be studied just like you have 

had, and you learn from that, from the synapses and all those 

kinds of things, the tangles. You can tell. 

But that doesn’t do them any good. And so, I want to raise two 

questions. One is to the medical side of this. Do you think I am 

wrong? I mean, do you think that this is just because it is a relatively early discovery? 

To be quite honest, I didn’t know at all that somebody who 

played soccer could get this until I watched that movie about the 

winning when we beat China back in 19—whatever it was, in 1980. 

And that incredible, powerful back that the Chinese all stayed 

away from because she just flattened them, she had chronic fatigue 

syndrome. She didn’t have a brain concussion of any sort. 

And you see soccer a lot now. All of us watch soccer a lot more, 

and you see people using their heads and you don’t notice whether 

bands are on there or not. But just the amazingness of the ignorance of the American people about this problem, even though we 

now know much more than we did know about it. 

I want to know just right off the bat how hopeful you all are realistically about being able to find a solution to this so that the brain 

is not thrown off of its axis, you know, electric stimulus and all the 

rest of it. Can this happen? 

Dr. MCKEE. Well, I personally am very hopeful. We didn’t know 

about this disease 5 years ago in any real way, and what we have 

learned in the last 5 years has been extraordinary. We have just 

made enormous gains in understanding how it affects the disease, 

54 

what the disease looks like, how it progresses through the nervous 

system. 

And now we understand this disease exists. We can try to model 

it in experimental systems and come up with those therapies that 

might help us treat living patients. 

And I actually think that this disease may ultimately be a window or provide insight into the diseases like Alzheimer’s disease. 

Alzheimer’s disease is characterized by a buildup of this protein 

tau as well, and maybe by understanding how this disease starts 

and how it progresses, we may actually have insight into Alzheimer’s disease and how it starts. 

One of the most difficult things about Alzheimer’s disease is we 

don’t have any idea. It starts silently. Maybe in a person’s 50s. We 

can never identify it precisely, how it exactly starts. But this is a 

disease we know has a time course, and we know what to expect, 

and it develops over time. And I think it is going to give us an 

enormous opportunity for intervention. 

The other thing about Alzheimer’s disease is most of those therapies—— 

The CHAIRMAN. Do you mean a prevention of the disease because 

of helmets or other—— 

Dr. MCKEE. No. I think understanding the actual pathologic 

process and intervening there, intervening maybe at the start of 

the disease where it is triggered or preventing it from progressing 

through the nervous system. There appears to be a transmissibility 

through the nervous system that it develops in one nerve cell, and 

then it causes the disease to be propagated in another nerve cell. 

If we could interrupt that progression, we could make an enormous difference in this disease, and that may be applicable to Alzheimer’s as well. One of the issues with Alzheimer’s is we were focused on the beta amyloid protein, and that has really come up 

pretty—we haven’t come up with much. But we haven’t focused on 

tau that much, and maybe that is the cellular element we really 

need to start paying attention to. 

The CHAIRMAN. Can I ask one of you two athletes, is it the prevention of something that you now know you already have from becoming worse that interests you the most? Well, the answer has to 

be yes. Or is it the absolutely vast amount of change in the way 

everybody in this country thinks about the playing of sports, the 

carrying out of sports, the responsibility that people have? 

I mean, there are a lot of coaches in rural states that are also 

math teachers. That probably isn’t very good for either coaching or 

math. But that is the way that works. People don’t know. 

So if you are talking about not letting it happen in the first 

place, that means you have got to tell the person to keep their head 

up. Well, try telling that to an NFL player who has just been chopblocked by somebody, and he has a chance to get back at them. You 

know, human behavior is very hard. Human behavior under stress 

is very hard to control. 

And so, I don’t know what the chances are or if we have enough 

time, or maybe if the shock of what people are learning or if we 

do more of this that coaches and parents—and parents are often 

a lot less helpful than they think they can be in this. Have a lot 

less influence on their kids because kids just want to go ahead and 

55 

do it. ‘‘I am 17. Don’t tell me I can’t do this again.’’ So, I mean, 

you do it after you know you have it, and try to prevent it from 

happening? 

Mr. THREET. I would say yes. I mean, obviously, I believe awareness would be the biggest issue. If you could just increase the 

knowledge base for the general public and for the athletes, I feel 

like recovery would—that athletes would do a lot better with recovery. They would take time to allow their brains to recover. 

I don’t think brain injury is viewed as a serious issue throughout 

athletes. It wasn’t for me until I had a concussion that changed 

what I was able to do in school on a daily basis. 

The CHAIRMAN. In your locker room—I am way over time. I 

apologize. In your locker rooms, both of you, is there any discussion 

about all of this among the athletes themselves? 

Ms. BALL. Concussions are talked about kind of lightly still, at 

least when I went through playing. It is a lot of people, even if you 

have got your concussion one day and then you are resting, players 

are like, ‘‘Well, I don’t see them hurt. Why are they sitting out?’’ 

And I think that mentality needs to change is you see that your 

fellow athlete got a concussion. You need to give them the respect 

to let them rest, and that just comes from the culture that we have 

right now about the ignorance about concussions. 

The CHAIRMAN. I will bet our doctors, do our doctors get any good 

training on this in their medical? 

Dr. KUTCHER. I would have to say not as good as I would like. 

The CHAIRMAN. It is like geriatrics, right? They study it. 

Dr. KUTCHER. Essentially. 

The CHAIRMAN. They go into it for a while, find they can make 

more money elsewhere, and they depart? 

Dr. KUTCHER. Pretty much. I mean, that wraps it up. I would 

like to make a comment on your original question, if I could, about 

am I optimistic or not? And the answer is yes. I am optimistic. 

But your story about Alzheimer’s and the lack of improvement 

and understanding for treatments is very applicable to this situation, but it is also not unique to brain pathology in general. Think 

about stroke, multiple sclerosis. We don’t have cures for these 

things either, and decades and decades and billions of dollars. So 

the bottom line is the brain is complicated. 

I do want to make a quick comment that I think we are talking 

about more than one thing here, at least two or three as far as diagnoses go. CTE, on the one hand, a degenerative neurological 

process that most likely is coming from repetitive blows to the 

head, and concussion are two different things. And I don’t think for 

a moment that these folks here are a risk—a high risk of developing CTE, the neurodegenerative disease itself. 

I think we are at a stage now where we are just starting to understand the scope of the problem. As Dr. McKee mentioned, we 

don’t know the prevalence of this. We are finding the tau more and 

more often in brains of athletes who have had impacts, and military personnel as well. But how does the tau relate to the neurological disease? We don’t know that. 

There are people that she has found tau in that had no neurological problem at all. So I don’t want to over alarm these folks 

56 

over here that because they have had concussions that they are 

going to have CTE later in life. 

The CHAIRMAN. I am way over my time. I apologize to my colleagues. 

Senator Boozman? 

Senator BOOZMAN. I am glad you mentioned that because I was 

going to ask Dr. McKee. She mentioned the 17-year-old that had 

one reported concussion then passed away. Were there other reported concussions prior to that? 

Dr. MCKEE. No. I don’t have—I don’t have any other reported 

concussions. 

Senator BOOZMAN. So we really don’t know if he played 

through—— 

Dr. MCKEE. Right. 

Senator BOOZMAN.—concussion or just the repeated blows of 

being in whatever position he was in. It really is a real problem. 

I think you all testified so well, Ms. Ball and Mr. Threet, the problem is to play athletics at the level that you played at, you are in 

pain every day that you go out there. 

Sometimes they are not significant injuries, but there are broken 

fingers—a fingernail that was pulled off, or something. I mean, 

these nagging things that can be very, very painful and athletes 

are taught you have got to play through that or you don’t get to 

the level that you all were able to play through. So it is very difficult. 

To follow up, you really didn’t feel like then that head injuries, 

the concussion aspect, really was talked about very much in your 

career? 

Mr. THREET. Yes, for me, it wasn’t a serious topic until my last 

concussion I had playing quarterback. I had to be out on the field, 

whether it was shoulder separation, ankle sprain, whatever it was. 

You know, shoot it up. I am ready to go. And that is not the case 

with brain injury. 

You can’t—like I said, you can’t just take something to get rid 

of the pain and then deal with it later and let it recover at a later 

time. 

Senator BOOZMAN. And sometimes not really being in horrible 

pain—— 

Mr. THREET. Right. 

Senator BOOZMAN.—compared to some of these other injuries 

that aren’t that significant. 

Mr. THREET. Right. Exactly. 

Senator BOOZMAN. Do you agree with that, Ms. Ball? You didn’t 

get much education in that regard? 

Ms. BALL. I agree completely. I think now concussions are something that is being taught in youth sports, but when I was growing 

up, playing both high school and college, it was just a concussion. 

That is all it was. 

Senator BOOZMAN. Dr. McKee, working with the VA, I have been 

on the VA Committee in the House and now in the Senate, and we 

really spend a lot of money trying to figure out the IED component 

of this, which is similar or the same. Do we have a test now that 

we can identify if somebody has gotten a pretty good blow? Is there 

an easy test to determine? 

57 

Dr. MCKEE. No. We need lots of research to determine that. And 

that is something we don’t have. We don’t have a way of identifying 

definitively a concussion, other than a series of neuropsychometric 

tests, balance tests, all sorts of things. So we don’t have an easy 

way of detecting it or monitoring it. 

And that is definitely a very important issue that the VA is addressing, as well as the Department of Defense. That is a crucial 

issue. 

Senator BOOZMAN. You two are board certified and well trained, 

and I suppose that with your licensure, you have to achieve so 

many hours of continuing education to continue your certification. 

What I am wondering in the course of this, we hadn’t really talked 

too much about the education aspect of people that are wanting, 

Mr. Threet, you are wanting to get into—you are coaching a little 

bit now, and perhaps maybe you are going to pursue that. 

Were you a PE major? 

Mr. THREET. No, sir. No, sir. I am coaching as my playing career 

ended. 

Senator BOOZMAN. What I am concerned about, and maybe we 

can visit with somebody at some point, is when you are taking the 

course ‘‘Coaching Football,’’ or ‘‘Coaching Basketball,’’ if they are 

talking about this and the importance of education. 

Dr. KUTCHER. I can speak to that. At the NCAA level, they have 

made essentially a policy that all athletes and coaches need to receive concussion education annually. You see conferences like the 

Big 10 and the Mid American Conference that I work with having 

that policy as well. 

When they started their careers, we didn’t do that. At the University of Michigan now, every year, all of our athletes get a lecture 

from me or one of my delegates on concussion. So do the coaches. 

So things are improving. 

There is a long way to go, especially as we go down the levels 

to high school and junior high school and the Pop Warner leagues. 

We have a lot more work to do, but there is sort of a push in that 

direction to make people need to get education before they participate either as a player or a coach. 

Senator BOOZMAN. No, I think that is excellent. And I do think 

that those are the little things that really are going to make a difference. 

And then, again, encouraging our teaching institutions to include 

that in the curriculum. And then, also in the State sanctions, as 

they do their continuing education, to make this something that is 

talked about every year would be very, very helpful. 

The other thing I would like to touch on very briefly, and you all 

can comment, Dr. Kutcher, Dr. McKee—and Mr. Oliver, I know 

that you are probably going to talk much more about this. But the 

idea about being able to certify a helmet as something that won’t 

prevent concussions. 

The Chairman mentioned about a 50-pound helmet. Theoretically, as you reinforce the helmet and make it heavier, if you could 

do that, then it is more of a weapon. So you actually create another 

problem in doing that. 

But can you just comment briefly about that. 

58 

Mr. OLIVER. Certainly. Senator Boozman, I appreciate that comment because I think it is very apropos of the difficulties that we 

face in trying to come up with a standard to address a specific 

issue like concussions. 

To a certain extent, the mass of a helmet is protective. The more 

the mass, the more energy it takes to move the helmet and move 

the head. In theory, the ideal helmet weighs, has an infinite mass 

at the point it is struck and then goes back to zero mass afterwards, which is clearly impossible to do. 

But there are limits to what you can do with a helmet as far as 

mass. You get to a certain point, that extra weight becomes a risk 

in other areas, and you increase the risk of neck injuries. You increase the risk of other injuries by doing that. So there is a tradeoff 

in that regard. 

I do think there is progress that can be made once science gets 

to the point where they can identify those specific forces or combinations of forces and the resultant forces that are likely responsible for some of these concussive issues. The thing that is probably 

most restrictive is the fact that right now you can’t study a living 

human brain at that level, at the molecular level or at the axonal 

level, while it is being subjected to blows to the outside to see how 

they respond. 

There are ways to collect data in the field to show how much the 

forces are and how much the head is seeing, and we just started 

a very large research project with Dartmouth University, Dartmouth School of Engineering, and Wayne State University to look 

at the use of diffusion tensor imaging, MRIs, which can look at actually the nerve fibers following an injury, to follow a football player from a concussive event. 

We know the forces. We can do the DTI imaging and then take 

that information and put it into a finite, what is called a finite element analysis program that Wayne State is creating that would 

then, hopefully, let us model what happens to the brain when it is 

struck in certain circumstances and with that model be able to 

start coming up with concepts about how to address those forces, 

how to attenuate certain kinds of forces better than they are being 

done right now. 

With the goal, and I am very hopeful that we will get there at 

some point, to be able to come up with a standard that we can confidently say if a helmet meets this standard, which would include 

these issues, then you can have a comfort level that it will provide 

against, provide protection against concussions. 

Now, not all concussions and it certainly would never be said to 

prevent a particular amount, but it would be designed to meet 

those specific issues that we know cause concussions. But having 

the science behind that is absolutely preliminary, and you can’t 

move forward without it. 

Senator BOOZMAN. Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator. 

Senator Udall? 

Senator UDALL. Thank you, Mr. Chairman. 

Dr. Kutcher, your testimony states, and I think you said this also 

orally here, there is no data in the published medical literature 

59 

that shows any particular helmet being better than any other at 

preventing sports concussions. 

Last year, however, the CEO of Riddell testified before a different Congressional committee that Riddell has ‘‘independent, 

peer-reviewed, published research in the medical journal Neurosurgery, February 2006, showing that Revolution’’—that is the 

name of their helmet—‘‘reduces the risk of concussions by 31 percent when compared to traditional helmets.’’ 

One of the authors of the 2006 study told the New York Times 

earlier this year that he disagreed with Riddell’s marketing the 31 

percent figure without acknowledging its limitations. Yet Riddell 

has extensively used this concussion safety claim in its marketing, 

and here is just one example with this poster that is behind me. 

[An image of the poster follows:] 

This is an example taken today from the website of Riddell’s parent company, and I think you can read that. 

The CHAIRMAN. I can’t read it. 

Senator UDALL. Do you think this single 2006 study provides a 

reasonable basis for Riddell to claim that the research shows that 

Revolution helmets reduce the risk of concussion by 31 percent 

compared to the traditional helmets? 


1019REV1.eps
60 

Dr. KUTCHER. No, I do not. I am aware of this study, and what 

I said was that there is no significant data to make that claim in 

the literature. I know there is data. That study is in the literature. 

There are mainly two problems with that study. First is the quality of the study itself, how it was set up in trying to look at two 

different populations, one wearing a certain helmet, one wearing 

another kind of helmet. You want those populations to be as equal 

as possible, other than which helmet they are wearing. And that 

was not very well done in that study, to the point where I would 

not really consider the study design to be acceptable scientific protocol. 

The second main critique is that the 31 percent figure is a relative percent change. So the two populations, the one that had the 

old helmet had a 7.6 percent concussion rate over the study period. 

The new helmet had a 5.3 percent rate. The change was 2.6 percent. The absolute percent change. That is a relative percent 

change. 

But when you put the 31 percent figure in front of people like 

that, they are going to think that there are 31 percent less concussions. Well, actually, it is 2.6 percent and that amount, given the 

study limitations, would more than account for sort of that noise 

in the data. 

Senator UDALL. And you can see why a parent who would be concerned about concussions with all the awareness, increasing awareness that is out there would see something like this and see 31 percent and think, ‘‘I am going to get a really protective helmet for my 

child.’’ And really, what we are talking about is something that is 

very, very misleading. 

Dr. KUTCHER. Well, I can see that, and I do see that every week 

in my clinic. I see patients coming in with their parents saying 

they want to buy the new helmet. This is the concussion helmet. 

What do you think about it? That is a very real conversation I have 

all the time. 

Senator UDALL. And they are asking you that question over and 

over again? 

Dr. KUTCHER. Correct. 

Senator UDALL. And typically, what do you tell them? And then, 

do you know what they do afterwards? 

Dr. KUTCHER. So my advice is the most important thing is to 

have a new helmet if you can get one. In other words, try to avoid 

the reconditioning situation where you don’t know whether the helmet is still up to standards provided by NOCSAE. 

But fit is really important. Make sure the helmet is fit correctly. 

And then, after that, I say look at the different manufacturers, and 

if money is not an option, buy the highest one on the line because 

what is lost in this conversation is you can’t have a concussion 

without force, right? But force is not the only thing going on here, 

right? 

So if I took 100 athletes or 100 people and gave them the same 

blow to the head I am going to get 100 different responses. So to 

say that concussion is the issue is ignoring the fact that it is forces 

acting on a brain that is very individualized and very dynamic. 

So, at the end of the day, if I am going to pick between a helmet 

that gets the least amount of force through versus one that gets a 

61 

little more force through, I am going to pick the one that gets the 

least amount of force through. I think that is a fair thing to say. 

But to say that it is going to prevent concussion is not understanding the whole complexity of the issue. 

Senator UDALL. Thank you very much. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator. 

Senator Klobuchar. 

STATEMENT OF HON. AMY KLOBUCHAR, 

U.S. SENATOR FROM MINNESOTA 

Senator KLOBUCHAR. Thank you very much, Mr. Chairman. 

And again, I heard about this really for the first time. You had 

heard stories in my State, but at the Alzheimer’s dinner, this big 

dinner they have in Minnesota. And an athlete actually came and 

spoke about the research, and I just walked away from that sort 

of blown away at some of the facts and things that are out there 

and the need for more education. 

And I then held an Alzheimer’s forum this summer, and one of 

the things that I learned was that just this early diagnosis of Alzheimer’s and the same thing what I learned was that a lot of the 

players are donating their brains, I understand, that get dementia 

to research. But how the early diagnosis of Alzheimer’s and also of 

this any advancement of problems due to a concussion could really 

help us not just help the patient, but potentially develop a cure. 

Because the Mayo Clinic is the one that diagnosed Pat Summit, 

the most winningness high school basketball coach in history—college. Thank you, Mr. Pryor. And the Mayo Clinic was able to do 

that because they have these advanced ways to now recognize early 

diagnosis. 

And I finally realized that that is part of finding a cure because 

you can’t practice different kinds of solutions and medications and 

things without knowing early on. If you wait too long, when someone is too advanced, you can’t actually tell whether things are 

working or not. And do you want to comment on that, Dr. McKee? 

Dr. MCKEE. Well, absolutely. You have to have some sort of test 

that can monitor the course of the disease in order to be able to 

tell in a living patient if it is being effective. So the first thing we 

have to do is develop diagnostic markers, biomarkers of both concussion and these other phenomenon. 

So, concussion, post-concussive syndrome, and CTE, they are all 

quite different. But we definitely need the diagnostic marker so 

that we can monitor living patients. And in that way, once we develop therapies in the lab in experimental models and we get to the 

point where we are testing them in living people, we can actually 

see if they are working. Without that, we can’t tell if they are 

working or not. 

Senator KLOBUCHAR. And Dr. Kutcher, the Academy of Neurology headquarters based in Minnesota, we are proud of the work 

of the Neurology Association in our state, and could you talk about 

the work that is being done to develop meaningful, evidence-based 

clinical practice guidelines? I know that is happening. 

Dr. KUTCHER. Sure. 

62 

Senator KLOBUCHAR. So that we are able to get guidelines for 

athletes, and if there is any scientific data available on that? 

Dr. KUTCHER. Well, right now, if you look in the literature, you 

will see maybe a dozen or more consensus statements. Groups get 

together and come up with what the experts think should be the 

best way to approach concussion diagnosis and management. But 

to date, there has not been an effort that has looked at the totality 

of the literature in a critical way, looking at the quality of the data, 

sorting through the papers, and coming up with what do we have 

that is evidence based in this issue. So that is what our effort is. 

We started this 21⁄2 years ago. It is a committee of 12 people— 

5 neurologists, 7 non-neurologists. The other seven folks are from 

other medical specialties—sports medicine, physiatry, neurosurgery, neuropsychology. And the goal here was to really create a 

sense of where we are and where we need to go. 

Now there are some of our management practices that have some 

evidence, but I will tell you that most of them don’t. And so, the 

goal here, and we are hoping to be published in the spring of 2012, 

is to really set forth what are the steps we need to take to get the 

data to have a good sense that we are doing something that is evidence based. 

Senator KLOBUCHAR. Very good. Ms. Ball, Mr. Threet, thank you 

so much for being here today. 

I know that organizations like the Brain Injury Association, 

NFL, Athletic Trainers Association, Centers for Disease Control are 

working to increase awareness, educate the public. As students 

who had this happen, what do you think the best ways are to get 

the information out there to your fellow students and players? 

Mr. THREET. Well, I believe there is a lot of progress being made 

already through information, educational seminars that we have at 

the schools. I know in Arizona, I was part of Bill 1521 that implemented protocol for high school athletes that they have to attend 

a class, their parents have to attend a class, their coaches have to. 

I think just a requirement to understand what the brain is doing 

when it is injured and how serious that it is. 

Senator KLOBUCHAR. And we did that in our state this year, too. 

Mr. THREET. Exactly, yes. 

Senator KLOBUCHAR. And I would hope that is happening. 

Mr. THREET. And it is spreading, and I think it will only increase, to gain significance. 

Senator KLOBUCHAR. Ms. Ball? 

Ms. BALL. I agree with preventive measures needs to start, we 

are doing high school. But if we can even start younger, youth 

sports that are like I know within soccer, there is club soccer, 

which is very prevalent among youth. And within New Mexico, different clubs are taking initiatives to teach the coaches about concussions, and I think that needs to be spread out to the teams and 

to the parents as well. 

Because once people are aware of what a concussion is and how 

serious it can be, I think that is when we finally take that next 

step forward. 

Senator KLOBUCHAR. One last question. After you had your concussions and you decided not to keep playing, did you feel any pressure to keep playing from your peers, from other parents, from—— 

63 

Mr. THREET. I personally didn’t. All my doctors, coaches, family, 

fellow players were very supportive of my decision to stop playing. 

Ms. BALL. Yes. I think people respect your decision to stop. Obviously, they want you to keep playing because they miss you playing 

with them. But overall, people have been very supportive. 

Senator KLOBUCHAR. Very good. Thank you very much for being 

here. 

The CHAIRMAN. Thank you, Senator Klobuchar. 

Senator Pryor? 

STATEMENT OF HON. MARK PRYOR, 

U.S. SENATOR FROM ARKANSAS 

Senator PRYOR. Thank you, Mr. Chairman. 

And thank you for having this hearing. It is a very important 

issue that touches this country all over the map and also in many 

different sports. 

Let me start with you, if I may, Mr. Oliver, I would just like a 

little context on the legal framework here in terms of are there 

state laws on helmets in sports? Do athletic conferences—like high 

school athletic conferences and associations—do they have rules 

about this and standards? 

And also, the NCAA and the NFL, when it comes to football, do 

they have standards? What is the legal framework here? 

Mr. OLIVER. Well, the legal framework is actually fairly simple. 

The standards that we publish, for example, for football helmets, 

and that is the best example because it probably applies across the 

board to other sports. We publish the standards that are performance standards that indicate what helmets are supposed to do to 

meet the standard, and it is a multifactored standard. 

Then an organization, for example, like the NCAA will incorporate into their rules of play a requirement that helmets that are 

worn by those athletes meet our standard. 

Senator PRYOR. In terms of the helmet itself? 

Mr. OLIVER. In terms of the helmet itself. You cannot wear a helmet for play in the NCAA unless it has been certified as being— 

as meeting our standard. 

Senator PRYOR. And then they may also change their rules in 

terms of, like, hitting the quarterback or—— 

Mr. OLIVER. Absolutely. 

Senator PRYOR.—head-to-head contact, that type of thing? 

Mr. OLIVER. Absolutely. The rules of play then control, if you 

will, how the helmets are used. But certainly, things like spearing 

or butting or ramming an opponent using your helmet as a weapon 

are also prohibited by the rules of play. 

The same process applies to high schools through the National 

High School Federation, although because it is a federation, it 

doesn’t control directly each of the state associations. But they participate voluntarily. 

There are some states, for example, California, has a law that requires at the high school level that athletic equipment, including 

helmets, be cleaned or sanitized on an annual basis. That has been 

interpreted to mean that the helmets included in football play must 

be also reconditioned. And if they are reconditioned, then they are 

64 

going to get recertified, which means you are going to be subject 

to recertification testing and evaluation. 

Senator PRYOR. Which means new pads, no cracks—— 

Mr. OLIVER. Exactly. And it means they have to be subject to a 

fairly rigorous sample testing program. They are tested before they 

are reconditioned and tested again after they are reconditioned. 

But that is the only state to my knowledge that actually imposes 

that requirement by law. 

Senator PRYOR. But on the high school level generally, is it voluntary? 

Mr. OLIVER. For the reconditioning? 

Senator PRYOR. Yes. 

Mr. OLIVER. It is voluntary. There is no requirement that helmets be reconditioned or recertified on any frequent basis at the 

high school level. 

Senator PRYOR. And how long—in your organization’s view, how 

long—again, let us stay with the football helmet—how long is it 

good for? Is it good for one season before it needs to be reconditioned or—— 

Mr. OLIVER. That is really going to depend upon how hard the 

helmet is used and what kinds of use and abuse it has been subjected to. We strongly recommend any time I am contacted that 

helmets be subject to reconditioning and recertification every year, 

simply because there is no way to tell in advance whether a particular helmet needs it or doesn’t. 

And we know from the reconditioning data because we get this 

data back from them every year that about 90 percent of the helmets that they recondition and recertify have been in the previous 

year. So a large percentage of them are done on an annual basis. 

What is not happening, which is something we are trying to address, both through the CPSE as well as individual work, is those 

football organizations at the youth level that aren’t subject to state 

control or NCAA control, where very little is known about the nature of the population of those helmets. If they don’t voluntarily 

submit those helmets to a recertification program or replace them 

on their own, there really is no umbrella organization that is in 

charge of most of those players in those clubs. And that is an area 

that does need to be addressed. 

Senator PRYOR. One last thing, Mr. Oliver, what is the general 

life expectancy of a football helmet? 

Mr. OLIVER. You know, it depends on the manufacturer. Riddell 

has for years put what is basically a 10-year life on their helmet. 

They have said that after 10 years, no warrantees apply. They 

don’t allow helmets that are older than 10 years to be reconditioned or recertified, and that has been their policy for a long time. 

Schutt, one of the other major manufacturers, has said as long 

as the helmet is properly cared for and it has been properly reconditioned, which means parts replaced, padding replaced, shells inspected, at the end of 10 years, the only part of that helmet that 

is 10 years old is probably going to be the shell. 

And you can’t replace the shell in the reconditioning process. If 

it is cracked or damaged, the helmet is done. So it really just depends on the helmet and the company as far as how long it is going 

to last and how well it is cared for. 

65 

Senator PRYOR. Dr. Kutcher, if I may ask one more question? Dr. 

Kutcher, what is the—and you maybe covered this earlier, and I 

am sorry I was late coming to the hearing—but what is the sort 

of age scale we are looking at for concussions in sports? I mean, 

I assume you have some at very early ages, but is there—do they 

get more common and more severe as you get older, as the players 

get bigger, stronger, faster? Is that how that works, or tell me what 

the statistics say. 

Dr. KUTCHER. So the range goes down to the youngest athlete 

you could imagine, whenever they start playing organized sports. 

So 7, 8, 9 years old, I see kids with concussions that young. 

As they mature and get faster and stronger, you will see larger 

impacts and more injuries. I think as they go up, junior high, high 

school, you are going to see greater numbers of concussions. And 

actually, there is some data that shows that basically every level 

you go up from organized youth to high school, to college, to pros, 

the incidence will go up. And you can imagine why. Because the 

play is a little faster. Athletes are a little stronger. 

The other idea, though, is that the younger kids may have longer 

injuries. They may have more complex injuries, maybe more difficult to get them back as quick. So that sort of adds a different 

wrinkle to it. 

Senator PRYOR. Mr. Chairman, if I can ask just one more question? Again, maybe you covered this earlier. But when I think of 

concussions and sports, I think of football, but I may be totally 

wrong on that. Is that the most common, and sort of what is the 

list of the most risky sports for concussion? 

Dr. KUTCHER. I would say football is at the top of the list. 

Senator PRYOR. It is way ahead of everybody else or—— 

Dr. KUTCHER. So, first, it is tough to get good data that compares 

sport to sport because you have to study it in the same population. 

There are some pretty good studies that have looked at in the high 

school population. For example, in Fairfax County, Virginia, researchers did some great work there looking at the different sports. 

And football had about a double the incidence of the next highest 

sport, which I believe was lacrosse. But women’s soccer was right 

there. And then, after that, it was men’s soccer, wrestling, basketball, softball, going down the list. Ice hockey wasn’t in that study, 

but I would put ice hockey probably a little bit lower than football, 

maybe 20 percent lower than that in general. 

Senator PRYOR. Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you. 

We can start another round. Incidentally, every time the bell 

rings, what you have to understand is that is telling you precisely 

that there is nothing happening on the floor of the—— 

[Laughter.] 

The CHAIRMAN. It is only when it keeps ringing that we have to 

go vote. 

Ms. Ball, we are talking about soccer. And Mr. Threet, just like 

Tony Romo, you were slammed down to the ground. I mean, that 

is part of the deal, right? It is not just that you hit a helmet, but 

you slam the guy down. So his head has to hit the ground, which 

is often hard. 

66 

There are so many ways in football to see how a revenge hit, just 

a mean player who is famous for that and loves it and gets endorsements because of it, commercial endorsements. Soccer is extremely brutal, exhausting, on a huge field where there is usually, 

what, one, two, three, or four goals scored, and that is it. 

So in thinking about it myself, and I have watched a lot of it basically because of that 1980 triumph, it is heading the ball. Or because I don’t think that you probably are slammed down to the 

ground or tripped up, a lot of tripping up, deliberate tripping up. 

Does that mean the head hits? I don’t know. 

But what are some of the ways, if it was ranked number three 

by Dr. Kutcher, what are some of the ways that concussions come 

about in soccer other than heading the ball? And if it is heading 

the ball, is it heading the ball from any part of your head? 

Ms. BALL. Concussions come about in a lot of different ways 

while playing soccer. Heading the ball tends to be relatively safe 

if you use your forehead. The concussions come when you take the 

ball off the top of your head, most likely from a punt because of 

the ball is moving at much greater speeds, or when a ball gets shot 

and you happen to be in the way, you will take it on the side of 

your head. That is how concussions can also occur. 

For me, the most common way of sustaining a concussion was actually I hit my head to the ground. It was the type of player I was. 

I would get my legs knocked out from underneath me, and I would 

hit my head on the ground. And when you watch soccer, you are 

watching where the ball is at. 

So that play might happen, and you just don’t even see that that 

player goes down and hits their head. And so, that is why I think 

oftentimes those thoughts are bypassed is because you are not 

aware because you are following the ball, where that is going. 

And then another risky area is where you are going in confrontations against the goalie. The goalie is either going to get—I have 

seen goalies get their heads kicked, and I have also seen players 

going up against the goalie getting kneed in the head. 

And so, there are a lot of different circumstances that you can 

get a concussion. 

The CHAIRMAN. Like in hockey? 

Ms. BALL. Right. 

The CHAIRMAN. Yes. There is so much work to be done by so 

many. I think of—I am a sports fan. You know, you watch college 

and professional football, and there is almost an instinct to look, 

Mr. Threet, for the player who plays dirty. And then, if he does, 

you turn your wrath on Roger Goodell and the NFL for not having 

him ejected from the game. Referees have that responsibility. They 

can fine him or push him back 15 yards. They should be ejected 

from the game. 

How do you influence—I mean, young men who play football are 

in it to win. They don’t have long careers. 

Mr. THREET. Right. 

The CHAIRMAN. If you are a running back or if you are a quarterback, what is your career? 

Mr. THREET. Running back has the shortest, yes. 

The CHAIRMAN. Yes. So that adds sort of a desperation to succeed. How do you get at that stuff? I mean, somebody comes in and 

67 

gives you a lecture, all the athletes are gathered in a big locker 

room, somebody gives them a lecture on concussions. I will bet half 

the people aren’t listening because they haven’t had them. 

Mr. THREET. Yes, and I think it is very difficult, especially in 

football, from the defensive side of the game, violence is probably 

the biggest, the biggest characteristic you need to be successful on 

defense. You have to be able to be violent, and that is—— 

The CHAIRMAN. And known to be violent? 

Mr. THREET. Right. Yes, and that is part of—yes, exactly. 

The CHAIRMAN. You have to show your violence, right? You have 

to prove it? 

Mr. THREET. Right. Right. And that is part of the football game. 

And so, as far as that sport is considered, I feel like it is more of 

the understanding about brain injury and understanding of the recovery process, as opposed to, yes, you know, they are changing the 

game, getting rid of head-to-head contact and that aspect. But I 

think more of it is the recovery when it happens because there is 

always going to be big hits in football. 

The CHAIRMAN. And a lot of those big hits—— 

Mr. THREET. And a lot of them are legal, too. But it is not just 

like the doctors have said. Exactly. 

The CHAIRMAN. Yes, a lot of them—if another, a third person involved clobbers the second or the first. 

Mr. THREET. Exactly. And it is blows to the body just as well as 

it is blows to the head, as Dr. Kutcher noted also. So I think it 

is—— 

The CHAIRMAN. Oh, I mean, if you get clobbered in the chest or 

something, that can concuss you? 

Dr. KUTCHER. Absolutely. 

The CHAIRMAN. I am sorry. I missed that. 

Dr. KUTCHER. Yes. Anytime your head moves fast enough and 

the brain inside is moving fast enough. So you get a whiplash type 

of thing. 

The CHAIRMAN. What will do that? 

Dr. KUTCHER. What is that? 

The CHAIRMAN. What kind of hit will do that? 

Dr. KUTCHER. Hit to the body, hit from the side, anything that 

transmits enough force to stop your movement. 

The CHAIRMAN. So that means that quarterback and tight ends 

ought to be very, very large? 

Dr. KUTCHER. Right. Steve gets sacked, gets hit in the chest and 

the body hard enough, his head whips back. He doesn’t have to hit 

anything else, and that could do it. 

Mr. OLIVER. Chairman Rockefeller, a perfect example of that, 

last year we all heard about DeSean Jackson’s concussion playing 

in the game between the Atlanta Falcons and the Philadelphia Eagles, and I don’t recall whether there was a fine or a penalty for 

that hit. But if you watch that hit in slow motion, and it is available I think even on the Internet, you will see that there was no 

head-to-head contact between the tackling player and DeSean 

Jackson. 

He was hit here in the shoulder. But it snapped his head violently forward and then violently backward as he is going down, 

and that is, I think, exactly the kind of mechanics that you are 

68 

talking about. You have these concussions where you don’t have a 

blow to the head, but the head itself is moving through so many 

different planes of motion so rapidly that the brain sort of doesn’t 

have time to catch up to itself and sort of gets folded over and compressed. 

The CHAIRMAN. I am over my time once again. I thank everyone. 

I am going to have to leave. I have to go to a cybersecurity hearing. That is a different kind of threat, and Senator Udall is going 

to take over the hearing. 

But the Ranking Member? Oh, Senator Thune? He could have 

been a tight end. 

[Laughter.] 

The CHAIRMAN. Please? 

STATEMENT OF HON. JOHN THUNE, 

U.S. SENATOR FROM SOUTH DAKOTA 

Senator THUNE. I am up? 

The CHAIRMAN. You are up. 

Senator THUNE. Oh, OK. Thank you. 

Well, I appreciate that very much. Thanks for holding the hearing, and I thank our panelists for sharing your thoughts with us. 

And I kind of want to follow up on some of the line of questioning 

that was started earlier, but this is—you know, you are seeing participation at an all-time high in terms of kids, young people across 

the country participating in sports and an incredible number of 

sports-related injuries among youth. 

And sometimes they are head injuries, a lot of other injuries as 

well. And I think when most people think of concussions, as was 

mentioned, we think about football. I think there are lots of other 

sports where we are seeing that. 

We have got a lot of younger people participating in football, for 

example, and I know my—I have got an 11-year-old nephew who 

got a concussion. He is out for a month. And it was a hit where 

he went back and hit his head on the ground. 

But it just seems like we have got, with young people out there, 

more and more injury occurring at an earlier and earlier age. And 

my question relates to whether that is something that we should 

be concerned about? I mean, are we starting kids too early in 

sports like football, where they are experiencing concussions at 

higher rates than they have in the past? 

I mean, what is your perspective on the rise in the number of 

concussions? And I guess—are some of these kids developed 

enough, capable enough of taking the kind of shots that they are 

taking and the kind of hits that they are taking at that age and 

the types of injuries that they are sustaining at an earlier and earlier age? 

Dr. KUTCHER. I will start. I think concussions—the issue with 

concussions being up, we are seeing more of them. I think it really 

has three main causes. The biggest one is awareness. I think that 

would explain the vast majority of the increased numbers that we 

see over the past really 5 to 6 years. 

The second one would be kids being faster and stronger at earlier 

ages and playing perhaps more violently, but also our games have 

changed, too. If you look at how football has evolved, for example. 

69 

I had one of our ex-coaches, old-time coach, lecture me on how people have been blocking over the years and tackling over the years, 

and now we see a lot more hitting and a lot less tackling. 

When actually if you think about the point in football on the defensive side is to stop the ball, you do a much better job if you have 

got somebody up, bring him to the ground, rather than trying to 

launch yourself and cause this big, violent hit. And so, for those 

three reasons, I think the numbers are up. 

As far as concussions in the younger ages, I think there is always 

a sense for me that we have to keep track of the dose of hits that 

the kids are taking. I think the younger ages, yes, you want to be 

more careful. And do we want to postpone when you can hit in 

hockey, postpone when people can start wearing pads and playing 

tackle football? 

I think that is a very good idea, but it is more complicated than 

that because at some point, kids have to learn how to hit and how 

to be hit and how to avoid the big forces, and that can only come 

with practice. So it is a pretty complicated question there. 

Senator THUNE. Well, I think that, you know, I look at the advances in equipment—just my dad played football back in the late 

1930s. He was a senior in high school in 1937. I remember at that 

time, they had leather helmets, and he was 130 pounds. He played 

middle linebacker, and he was hitting a lot of guys coming across. 

And I know he got knocked out, got knocked cold in one game. And 

I think at that time, they treated everything with whiskey. 

But when I played in the 1970s, the helmets had gotten a lot better, and I look at the athletes today, and the equipment has improved a lot. I mean, the amount of padding in there, protective 

gear that athletes are able to wear. And so, we have made great 

advancements. 

But as you have said, these athletes are bigger, stronger, faster, 

and the contact, the hits that I watch just every Sunday watching 

the NFL, there are some real contact being made there. And so, 

you wonder if the type of equipment that we have is adequate to 

that. 

And that, specifically, might be more to football, but I am interested in knowing, too, in some of these other sports like soccer or 

rugby, water polo, that haven’t traditionally required a great deal 

of safety gear, is there additional equipment available that could 

lessen injuries and concussions in those types of sports? Anybody 

on the panel who would care to answer that? 

Mr. OLIVER. Well, I mean, I can address that in general. Whatever you can do to reduce the severity of concussions or the frequency or perhaps even eliminate some concussions in one sport 

would be the same in the other. I mean, you are talking about the 

same brain responses, the same input forces, the same accelerations. 

And if you can determine how that can be done from a biomechanical standpoint and a biophysical standpoint in football, you 

can probably figure out how to do that in other sports. So I think 

the key is first finding those answers that would let you to address 

it in a particular sport, and then you can extend those by reference 

to other sports, if you can get to that point. 

70 

Senator THUNE. Anybody else want to add to that, soccer player, 

no? 

OK. I see my time has expired, Mr. Chairman. So thank you. 

Senator UDALL [presiding]. Thank you, Senator Thune. 

And Senator Boozman, you want to—— 

Senator BOOZMAN. Just very quickly. 

Senator UDALL. Yes, you have some things that—— 

Senator BOOZMAN. It seems that 99.9 percent of the injuries that 

are suffered are not due to current equipment failure. You guys, 

when you were hurt, your pads were there. Something didn’t break 

and sustain. Now I don’t know about through the little leagues, but 

in the stuff that is being tested, most of that is working pretty well. 

I don’t worry so much about the big hits that we see where somebody is actually having to be helped off the field because we all 

know something is wrong. I worry more about the injury where you 

tackle somebody, and as you tackle them, he knees you in the face 

and smacks you pretty good. And you are able to get up. 

We are conditioned or you guys were conditioned, we were all 

conditioned to play through injury, and you go ahead and stay out 

there. The way I would like to close, as we have a lot of moms and 

dads and coaches and players watching this is with any messages 

that you can send out to the parents, how they can be better prepared to deal with this if it does come up? And chances are, it probably will. 

Mr. THREET. Yes. Well, I mean, I think from the athletes’ standpoint, just increasing their ability to be honest with coaches and 

parents and athletic trainers and understanding for themselves 

when something doesn’t feel right. Light-headedness, dizziness, any 

of the symptoms. If the symptoms are known and they start feeling 

those, then it needs to be required that they make that known because it can happen on any hit. 

I have had ones that happened on not severe hits, and the 

Riddell helmet is 30 percent less. 

Ms. BALL. I think it is important not only to address your symptoms when you have them, but even once you finish having the 

symptoms is give yourself the little bit of extra time because that 

can prevent you from maybe not having to end your career is if you 

give yourself those few extra days of leeway, then you can prevent 

the long-term injury. 

Dr. KUTCHER. I will add to that. I think the recognition of the 

injury issue is huge, and athletes hide their injuries. I know that. 

I see that every day. But acutely concussed people also don’t know 

they are concussed often. They are not aware of it. 

And what that means is that falls on the responsibility of everybody else around—their teammates, the coaches, parents, whoever—to look after them. And when a kid says, ‘‘Oh, I am fine. I 

am straight. I can go,’’ you have to question that a little bit. So recognizing the injury, and I am actually starting to see teammates 

coming to me and saying, ‘‘Hey, I think he is not right. Go check 

him out.’’ 

And as Steve said, once it has been recognized, you have to report that to the medical staff, to whoever, and have that patient 

or that athlete removed from participation and then allow them to 

71 

recover fully before they get back to play. So, actually, it is four Rs. 

It is recognition, reporting, removing, and recovering. 

Senator BOOZMAN. Very good. Dr. McKee? 

Dr. MCKEE. I guess what I would say is that I don’t see this— 

I think I would say that I don’t see this problem going away with 

equipment. I think equipment is going to improve this issue, but 

it is not going to solve this issue. 

And we really have to address the way sports are played, the nature, the style of play, the amount of hitting that we allow, the 

amount of contact we allow in the play of the sport. And that is 

what is going to make a tremendous difference, I think, down the 

road. But I don’t see, even a perfect helmet, there is always going 

to be those acceleration, deceleration sort of whiplash forces that 

we can’t control. 

Senator BOOZMAN. Mr. Oliver? 

Mr. OLIVER. I think I would simply echo the panel’s comments. 

There are a number of interventions that need to be enforced and 

encouraged. And depending on the circumstances, one may be more 

important than another. But overall, you can’t avoid any of them. 

And to the extent that you shouldn’t just rely on better diagnosis 

and return to play criteria, you also can’t rely on just having good 

equipment. You have to do all of those things. 

You have to change the attitudes of the players and the parents 

about reporting those symptoms. Take that stigma away from this 

need to be macho or strong or invincible. 

One of the things that I have seen, and it has been effective, is 

changing behavior based upon some of the data that has been collected at the collegiate level through the helmet instrumentation. 

They have noticed the ability to identify players who have more 

hits on the top or the crown of their helmet than other players, 

which shouldn’t be happening because there is an association with 

an increased likelihood of concussion there. 

We see schools, I know University of North Carolina specifically, 

with Dr. Guskiewicz, identifying those players and going in and engaging in behavioral modification so that they are taking that act 

out of the game. 

If you start that at the very beginning with youth players and 

teach those coaches and teach those players that you don’t hit with 

the top of your head, you don’t hit with your head at all. The helmet is there to protect you in case you get hit, and you can’t avoid 

it. You change all those things, I think you make significant reductions in the number of concussions and the severity. 

And you certainly can reduce the chance of having these catastrophic consequences of returning to play too soon or having multiple concussions that aren’t properly treated that let you heal. So 

all of them are important, and I don’t think you can ignore one or 

treat one as more important than the other. 

Senator BOOZMAN. Thank you, Mr. Chairman. 

Senator UDALL. Thank you, Senator Boozman. 

I wanted to return just a little bit to some of the misleading 

claims on equipment. I know there has been a lot of discussion 

about equipment, and Dr. McKee, talk a little bit about anti-concussion mouth guards. Have you seen ads such as this one for a 

mouth guard that is sold for use by kids 11 years and under? 

72 

And you can see the poster here in the background. This mouth 

guard was purchased last month. The product packaging states 

this mouth guard reduces the risk of concussions, and it creates 

brain safety space. Given your firsthand knowledge of the dangers 

of repetitive brain trauma, are you troubled by this type of marketing for youth sports equipment? Do you think young athletes 

who have already had a concussion might be particularly susceptible to advertising claims for so-called anti-concussion devices? 

[An image of the poster follows:] 

Dr. MCKEE. Well, I believe there is no clear evidence that any 

mouth guard or chin guard reduces either the rate or the severity 

of concussions. So I would have great objection to this claim. 

The only thing that I am aware that mouth guards and chin 

guards do is they reduce oral and facial, dental, dental injuries. 

But the nature of concussion would not be improved by the use of 

a mouth guard. 

Senator UDALL. I know you weren’t able to see the one I was 

holding up, and I think it has been produced down there just in 

case you see anything else on it you wanted to comment on. 

Dr. KUTCHER. I agree on that. 

Senator UDALL. Yes, please? 

Dr. KUTCHER. I don’t know what ‘‘brain safety space’’ really 

means. That term—that is little alarming, really. 

Senator UDALL. Well, there is a diagram on it. 

Dr. KUTCHER. Yes, I see it. 

Senator UDALL. You can see it. There is a diagram, and it shows 

a space, and it says ‘‘creates brain’’—I believe specifically it says, 

‘‘creates’’—what is the term it uses? ‘‘Creates brain safety space.’’ 


1019BPAD1.eps
73 

Dr. KUTCHER. Again, the idea from some of the work that has 

been done with accelerometers and helmets of football players and 

seeing at what forces they end up having clinically diagnosed concussions, those concussions are occurring over a wide range of 

forces. 

There are 15-g hits that do it. There are 115-g hits that don’t, 

right? And so, if you are taking amount of force that is 115 and 

you are reducing it to 110 or so—I don’t want to get the numbers 

wrong—because of a mouth guard, you might be reducing the 

forces a little bit if the hit is coming from this way, but concussions 

are occurring on a spectrum of forces that that won’t address. 

Senator UDALL. I know Ms. Ball mentioned headbands in soccer, 

and I want to ask, Dr. Kutcher, you about this one. You discuss 

in your testimony the potential harm from creating a false sense 

of security when companies falsely claim that products prevent concussions. 

This is not just about helmets, and it is not just about football. 

Here is another example. This is a protective headband sold to soccer players and other athletes. Here is an image taken from this 

company’s website that says, ‘‘This can come between you and a 

head injury.’’ 

Does this type of advertising for a protective headband trouble 

you? Is there a danger that a young athlete might put himself or 

herself at greater risk of injury if they believe that this headband 

will come between them and a head injury? 

Dr. KUTCHER. I do believe there is a problem there. This type of 

advertising is a little more vague because it just mentions head injury and not concussion. So you could make an argument that perhaps there is a mechanism there to prevent some superficial lacVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00077 Fmt 6633 Sfmt 6601 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE

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74 

erations and bruising and that kind of a thing. But for concussion, 

I don’t believe that—well, there is no data that supports that they 

decrease the risk of concussion. 

I have seen in my own practice, as I testified, athletes who have 

become more aggressive and have actually injured themselves and 

others because they have the headband on. They go up and they 

head the ball more. They get involved in head-to-head hits more 

when they would not have done that without the equipment before. 

Mr. OLIVER. Senator? 

Senator UDALL. Yes, please, go ahead. 

Mr. OLIVER. What I was going to say is there is another risk 

here. We have seen this both with helmets as well as devices like 

headbands that a player who has sustained a concussion now sees 

this or the parent sees this as the answer. My kid has had a concussion. He is just now getting over it. But if I put this on, everything is fine. 

And so, not only a false sense of security from being protected 

from the first concussion, but being protected because I just had 

one, and this will give me this extra layer. And it is incredibly dangerous. 

Senator UDALL. Did either of you as athletes experience any of 

this that we are talking about here in terms of the headband being 

protective or—yes, Ms. Ball? 

Ms. BALL. I wore headgear that is not this brand, but similar 

after I got my second concussion as a preventive measure. And I 

will say that I did adjust my play, whether I had my headgear on 

or off. 

And I didn’t really think about it critically, whether it would be 

actually doing anything for me. If I had my headgear on, I would 

head the ball more aggressively. I would play differently because 

I thought for some reason, I would like be secure from getting another concussion. And if I didn’t have my headgear on, I played 

much differently. 

Senator UDALL. Mr. Threet? 

Mr. THREET. For me, I used a variety of different football helmets. I would always get a new one after a concussion. I would alternate brands, styles. Yes, so I would try different things, but they 

all—I guess the risk is still there. 

Dr. KUTCHER. And that is really common, by the way, to college 

football or football in general. You get a concussion, go on to the 

next brand because, obviously, that brand is not the right one for 

you. 

Right? That is—— 

Mr. THREET. Yes. I mean, that is the equipment managers would 

say that, well, maybe just try a different style and be better next 

time. 

Senator UDALL. Let me return to the Riddell helmet testimonial 

claim, the one on no repeated concussions. In a July 23, 2010, 

memorandum to head coaches, head athletic trainers, and club 

equipment managers, NFL Commissioner Roger Goodell wrote, and 

this is a quote, ‘‘It is important to remember that no helmet can 

prevent concussions or reduce the risk of concussion to any specified degree.’’ 

75 

Yet one NFL head athletic trainer has made several product endorsements for the Riddell Revolution football helmet. And a 

Riddell video news release, titled ‘‘Riddell Revolution UPMC Media 

Campaign,’’ highlights Tim Bream of the Chicago Bears, states 

that, ‘‘We have had some players who have had ongoing problems 

with head injury, and we made the switch to the new protective 

headgear when it came out at its inception, and these players have 

had no problems since then or no repeated concussions.’’ 

Dr. Kutcher, do you expect a youth or high school football team 

to have no repeated concussions after switching from traditional 

helmet designs to Riddell Revolution helmets? 

Dr. KUTCHER. No, I don’t. 

Senator UDALL. Pretty straightforward in your opinion. 

Dr. KUTCHER. Yes. 

Senator UDALL. Dr. McKee, I don’t know if you have any 

thoughts? 

Dr. MCKEE. I think this is beyond my level of expertise. It is not 

my area. 

Senator UDALL. And Mr. Oliver, I want to ask about the maximum life span of football helmets. I think you talked about that 

a little bit in relation to Senator Pryor questioning you. The National Athletic Equipment Reconditioners Association announced 

that starting next year, it will no longer recondition helmets that 

are 10 years or older. 

NAERA executive director stated that he would not want his son 

wearing a helmet that old. NOCSAE’s technical director Dave 

Halstead told the New York Times that he, and this is his quote, 

‘‘would never let his kid wear a helmet that is more than 10 years 

old.’’ 

Well, Ralph Conradt’s 17-year-old son Max was unknowingly 

wearing a 20-year-old football helmet when he suffered a brain injury. Ralph wrote to me. It was after some of this came out. ‘‘How 

is it possible that our son was issued a helmet 3 years older than 

he was?’’ Why does the NOCSAE standard not set a maximum life 

span or number of years before a helmet should no longer be used? 

Mr. OLIVER. There are a number of reasons why we don’t, and 

the first reason is you have to tell me what the helmet is you are 

looking at. If it is a 10-year-old helmet that has never been used 

or has been used two seasons, should that helmet be replaced simply because it has reached a birth date of 10 years? 

There is no data that suggests that that helmet, because it has 

reached an age of 10 years, is more or less protective than any 

other helmets that are of a similar age. The other thing has to do 

with whether or not you are using a 10-year life or a 12-year life 

or an 8-year life because there has been a change in technology. 

If 10 years ago or 9 years there was a radical change in the technology of helmets such that older helmets don’t provide the same 

measurable level of protection, then it would make sense to have 

that life span cutoff. We have always relied on the manufacturers 

to specify if there is a safe life on their helmets. 

And one of the reasons we do that is because we, by intent, 

maintain our standards as design neutral. Part of the design neutral process is to not impose upon a manufacturer an obligation to 

use a particular kind of material or a particular shape of the shell 

76 

or a particular design to allow innovation and progress in those 

areas. 

If a helmet company makes a helmet and they say this helmet 

is good for 15 years as long as it is regularly reconditioned and recertified, then they must have data to support that, and it is their 

helmet, their design. What we do know, and we know this from reconditioning testing data, that helmets that are properly cared 

for—they are properly reconditioned. Their padding is replaced 

when it starts to wear. They are inspected for cracks, and they are 

properly cared for. 

When they are retested after being used in the field and after 

being reconditioned, those test numbers look very much like they 

did when that helmet was brand new. No way for us as an association or as an organization that sets the standards to say from our 

tests that a helmet that is now 8 years old or 10 years old that 

scores essentially the same as it did when it was new should be 

replaced and force schools, for example, to replace maybe a third 

or half of their helmets, when maybe the helmets don’t need to be 

replaced. 

And the other question that you have to ask yourself is, right 

now, there are Revolution helmets on the market that are approaching 8 years old. And I am not endorsing any particular helmet. But there has been a great cry, if you will, to move from older 

style helmets to newer style helmets. 

If there is a helmet on the market today or being used today that 

is 8 years old and it is a new technology helmet, and it has been 

properly cared for, padding replaced, and retested on an annual 

basis, what is it that happens at 10 years that makes that helmet 

suddenly need to be thrown away if it was safe at 9 years or safe 

at 8 years? And we don’t have the data to suggest that. 

I think the position, the decision that NAERA made with regard 

to 10-year helmets was a policy decision they made that they just 

weren’t going to do that for helmets older than 10 years. And I 

know they see some helmets that are 15 and 20 years old. 

Senator UDALL. Does NOCSAE require the helmets have a clearly visible date of manufacture and a date of last reconditioning 

label? 

Mr. OLIVER. We do. We require both of those things. 

Senator UDALL. And do you know how many high school or 

younger football players are wearing helmets that are 10 years or 

more in age? 

Mr. OLIVER. We don’t know specifically. What we know is from 

the data for helmets that come back in for reconditioning because 

we get that test data back at the end of each season. And we know 

that sample, and this is a ballpark figure. But approximately 89 to 

92 percent of those helmets are less than 10 years of age. 

Again, it is going to vary year to year, but that is the best we 

can come up with. 

Senator UDALL. And do those helmets 10 years and older still 

meet NOCSAE current helmet standards? 

Mr. OLIVER. They will if they have been through the proper program and have been properly reconditioned and had the padding 

replaced. They will. If they don’t, they get failed, and they won’t 

make it through the reconditioning process. 

77 

Senator UDALL. Yes. There is—I am shifting the issue a little bit 

here to supplements, and I think both of our physicians realize 

there has been a lot of evidence recently on supplements. And this 

has kind of surprised me. 

There is a company selling supplements which claims that they 

‘‘protect against concussions.’’ It is called Sports Brain Guard. 

What are your thoughts on these claims about supplements and 

concussions? 

[The information referred to follows:] 

And I am going to send one of these down to you, but it is a dietary supplement that is called Brain Guard. Do you have any 

thoughts on that? 

Dr. KUTCHER. I do. What are the components of Brain Guard? Is 

that the DHA, one of the DHA products, I imagine? Much like the 

other discussions we have had, there is no data that this type of 

thing will help prevent concussion at all really. 

And I just kind of go back to a conversation we had earlier in 

the hearing about the amount of time and money that has gone 

into neuroprotective agents for things like stroke. I mean, decades 

and decades and billions of dollars, and we haven’t found anything 

for a mechanism that we know much more about, cell death and 

stroke. We know that. We know how that works at the molecular 

level a lot more than concussion anyway. 


1019GUAR.eps
78 

And yet we don’t have any answer there. So I don’t see any data 

that would support the use of this, nor would I expect that we 

would be able to find any. 

Senator UDALL. Let me just briefly just say in closing, first of all, 

thank you to the entire panel. I think your testimony has been 

very, very helpful, and I think parents and families out there are 

increasingly wanting to hear more about this, and I think the way 

you have engaged this today helps them a lot. 

I think this issue of awareness, I think all of you have talked 

about raising the awareness level, and we need more education, 

and we need to start younger. And those are very, very important 

points. 

And then the second, which you can see that I am passionate 

about, is this whole idea about misleading claims when it comes to 

equipment. It just seems to me that there is so much work that we 

need to do there to educate people. And people need to realize the 

old statement that is always used, ‘‘Buyer beware.’’ I mean, you 

need to check out when you have one of these products, whether 

it is supplements or whether it is a mouth guard or a headband, 

you really need to look a little deeper than the advertising there. 

So let me thank you again, and the hearing is adjourned. 

[Whereupon, at 4:39 p.m., the hearing was adjourned.] 

(79) 

A P P E N D I X 

PREPARED STATEMENT OF HON. FRANK R. LAUTENBERG, U.S. SENATOR FROM NEW JERSEY

No parent should ever have to fear for their child’s life when they play sports. 

Minor injuries are always a risk, but no young athlete should ever walk off the field 

with life-threatening brain trauma. All it takes is one serious injury to keep a young 

person on life’s sidelines forever. 

In 2009 alone, almost 250,000 people aged 19 and younger ended up in an emergency room with traumatic brain injuries they suffered while playing sports. These 

injuries affect girls and boys alike. Girls soccer and boys football are the sports 

where most concussions occur among high school students. 

This is a problem in college sports, too. In my state, Eric LeGrand—a Rutgers 

University football player—was paralyzed from the neck down during a game a year 

ago. Mr. LeGrand is improving, but his story reminds us we have a lot of work to 

do to make sports safer for all athletes. 

I am working with Senator Tom Udall to strengthen safety standards for helmets. 

Parents are increasingly aware of the danger of concussions, and they deserve safe 

helmets that will protect their children from injury. Our bill will also make it a 

crime for helmet makers to make false or misleading claims about safety benefits. 

Parents need the straight truth about helmets—not exaggerated claims that lull 

them into a false sense of security. I look forward to working with my colleagues 

to pass this bill and help parents, schools and helmet makers work together to protect our children. 

I thank the Chairman for holding this important hearing. 

PREPARED STATEMENT OF HON. MARK WARNER, 

U.S. SENATOR FROM VIRGINIA

Thank you, Chairman Rockefeller, for calling this hearing. I’d also like to thank 

my colleague, Senator Tom Udall, who has been a leader in highlighting this important issue for our country’s student and professional athletes. Understanding the 

dangerous nature of concussions, better educating parents, coaches, trainers, and 

the athletes themselves on the symptoms and the precautions to avoid concussions, 

is critically important. Ensuring that all parties have the best, scientifically accurate information also is an important step in both the education and precaution of 

all of those involved. 

I am fortunate to represent Virginia Polytechnic Institute and State University, 

Virginia Tech, located in Blacksburg, VA, which is home to both the four-time ACC 

championship team and a group of researchers who are doing groundbreaking research into understanding how different helmet construction can impact the severity 

of the impact of concussions. Led by Steven Rowson and Stefan Duma, Virginia 

Tech and Wake Forest researchers have developed a five-star rating system to better evaluate helmet performance for football players. Similar to the current star-rating systems for cars, the National Impact Database will provide better clarity on the 

construction of helmets and how that may impact exposure and risk of concussion. 

The database’s first analysis of 10 adult helmets was published in May of this year, 

and it was first time researchers have provided the public with a bioengineering impact data study with comparative test results. The rating system was funded in part 

by the National Institutes of Health and the Department of Transportation, and this 

research is independent of helmet manufacturers. 

This research indicates that current helmet performance is not directly related to 

cost. The database can now help consumers make better informed decisions based 

on independent data that compares the biomechanical performance of these helmets. 

I hope the star-ratings may also help push manufacturers to come up with better 

designs. The researchers do note, and I believe appropriately, that no helmet can 

provide full protection against concussions. There is considerable chance involved in 

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head injuries in football and other sports, and what advanced-design helmets can 

do is lower the risk. However, transparency and information certainly can help consumers, players, coaches and trainers make better-informed decisions. 

I understand there have been concerns that some manufacturers have inappropriately marketed sports equipment, including helmets, by overstating the protections 

they provide. I share that concern, and I believe we must educate players, parents, 

coaches and trainers on the dangers of concussion and other injuries regardless of 

the equipment used. I look forward to working with the members of this Committee 

to ensure that there is minimal confusion in the marketplace over what it is that 

sports equipment can do. Helmets and other sports equipment provide one layer of 

protection, and it certainly does not eliminate the need for more awareness and public education about ways we might prevent and better manage concussions during 

sports activity. 

I do, however, continue to strongly support continued research, based on sound 

science that helps us to help better understand how we can keep our young people 

safer while competing in sports activity. This includes—but it certainly is not limited to—the groundbreaking research on concussions that is currently going on at 

Virginia Tech. 

I thank the Committee for holding a hearing on this important topic and stand 

ready to work with the Committee on possible solutions as we move forward. Thank 

you. 

PREPARED STATEMENT OF SPORTING GOODS MANUFACTURERS ASSOCIATION (SGMA) 

The Sporting Goods Manufacturers Association (SGMA) appreciates this opportunity to submit a statement for the record of this important hearing. We regret not 

being able to be represented in person but could not accommodate the hearing 

schedule due to a long-planned Board of Directors meeting in Chicago. 

SGMA is the national trade association of sports footwear, apparel, equipment 

and accessories manufacturers, distributors and marketers. Our membership consists of hundreds of brands which produce and sell sports products in the United 

States and around the world. SGMA believes sports and physical activity enhance 

people’s lives. Our industry’s products make sports, fitness, recreation and exercise 

accessible, enjoyable, fulfilling and healthy for millions of Americans every day. Our 

member companies are proud of the role they play in supporting healthy, active lifestyles for all. 

The primary business for many SGMA member companies focuses on designing, 

building, selling and maintaining protective sports equipment. We all recognize that 

participation in sports activities carries some risk of injury. While our products are 

designed to reduce that risk, no protective equipment can completely eliminate the 

risk. No helmet, regardless of design, material construction or technology can prevent all concussions or for that matter, all injury. With that realization, our companies strive through research, innovation, testing, refinement and consumer education to deliver products with improved protective qualities and properties, thereby 

enhancing the sport experience for the participant. 

From its very inception, SGMA has been a leader in bringing the industry together to face challenges around reducing risk of injury. When SGMA was founded 

in 1906, national concern over football related injuries dominated the sports landscape. SGMA’s original member companies banded together and joined forces with 

the newly formed National Collegiate Athletic Association (NCAA) to change the 

way football was played. Among the major rule changes implemented at that time 

were the prohibition of the Flying Wedge blocking technique and re-design of additionally protective football pants, rule changes that brought virtually immediate reduction in football injuries. The complementary nature of problem identification, 

rules modification, product innovation and culture change is a recurring theme in 

successful action to reduce sports injury, and one that bears thoughtful analysis as 

we address the urgent need to comprehensively address concussions in sport. Our 

experience tells us reducing sports injury requires a multi-disciplinary approach 

that engages the views and expertise of athletes, parents, coaches, trainers, sports 

league administrators, medical professionals, rules makers, standards setting bodies, scientific investigators, product developers and marketers, and the media. 

In 1931, the industry adopted 11 Trade Practice Rules, ’’ to provide new standards 

of competition, and . . . to abandon all that is unfair to the public and to one another.’’ One of those Trade Practice Rules was ‘‘to work closely with various governing bodies to assure standardization of equipment specifications.’’ This statement 

foreshadowed the need for an independent, science-based standards-setting organiVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00084 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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zation, a subject we will revisit later in this testimony when discussing the National 

Operating Committee for Standards in Athletic Equipment (NOCSAE). 

That same year, legendary Notre Dame Football coach Knute Rockne said of the 

SGMA membership: ‘‘I want to compliment the sporting goods manufacturers on the 

fine protective measures they have given football. Despite the much larger number 

of football players, there are fewer injuries now than in the past. The biggest factor 

in reducing the number of injuries has been the added protection which has been 

built into football equipment. Your industry is a fine asset to college athletics. You 

are making equipment right.’’ 

A few years later in 1934, SGMA founded its educational and instructional arm 

known as The Athletic Institute, which evolved for a time into a world leader in 

the production of educational books, films, and videos. One of the goals of The Athletic Institute was ‘‘to develop educational/training aids for athletes and coaches.’’ 

For many years, SGMA and The Athletic Institute produced and distributed more 

sports instructional materials than virtually anyone in the United States. While 

SGMA is no longer in the training video business, we do believe tremendous 

progress in reducing risk of sports injury is attainable by utilizing new media capabilities to teach coaches, players and parents about proper technique. USA Football, 

the national governing body for youth football, has created an impressive on-line 

program that provides specific guidance on teaching age and size appropriate blocking and tackling technique. Pop Warner also has an excellent coaching education 

program. These are the basic cornerstones of reducing risk of injury. Matched with 

the NFL’s concerted effort to reduce and ban head to head contact, sustainable cultural change is happening across the football community. 

The sports products industry absolutely has a role to play here. It starts with 

product design and innovation. Helmet technology is steadily improving. Our companies invest heavily in research and development exploring new materials, design, 

construction, and durability. They explore performance and protective qualities at 

extreme temperatures and repeated use, direct impacts and glancing blows, linear 

and rotational forces. Currently, a tremendous effort is being directed at managing 

energy from low impacts, reflecting the possibility that concussions may be generated from lower energy forces than have traditionally been the focus of helmet design. 

Football helmet manufacturers study videotapes of actual impacts to analyze and 

develop responses to concussive impacts. New technologies are being developed and 

implemented that measure in real time the nature and severity of impacts players 

receive on the field. There are several schools that currently employ this technology 

in their helmets, with immediate data being transmitted to sideline computers for 

trained professionals to monitor. 

These innovations are not limited to football. Technology transfers amongst lacrosse, baseball and hockey head protection are raising quality of protective products in these sports as well. 

The marketplace is vibrant. Two manufacturing brands have entered the football 

helmet business in recent years. Both have created excitement and awareness for 

their product, giving consumers additional choices of head protection. 

A reflection of the product improvements generated by the overall football helmet 

industry may be found in a recently published paper from Virginia Tech University’s 

Dr. Stefan Duma. While SGMA is not in a position to speak to Dr. Duma’s ranking 

of different helmet models, Dr. Duma’s broad conclusion merits mention. Dr. Duma 

stated, ‘‘The results clearly show that the newer technologies across all manufacturers are significantly better at reducing the risk of concussions compared to older 

models.’’ 

In addition to creating innovative products, the sports equipment industry can 

help leverage our connection to players and parents to communicate critically important pieces of information. One area the football helmet industry is exploring today 

centers on the appropriate fitting of a football helmet. Regardless of brand or model, 

one of the most important factors in the effectiveness of a football helmet is that 

it is correctly fitted to the player’s head. Correct fitting is fundamental to ensuring 

the protective properties of a helmet are maintained. All football helmets are designed to fit snugly, they should never come off in normal course of play. Yet, on 

any given Saturday or Sunday in the fall, television images of helmets flying off 

players heads are far too common. Our industry is exploring ways to work together 

in educating coaches, league administrators, parents, equipment managers—anyone 

responsible for providing helmets to players—on how to ensure the helmet is properly fitted. 

Further to the point of education, the football helmet industry is in early stages 

of discussing if there is a way to improve warnings—messages to consumers as to 

what the product can do, and perhaps as important, what the product cannot do. 

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Of course, all sports protective products currently carry warnings. The industry, in 

consultation with many partners and interested parties, is exploring whether standardized language, graphics and placement would improve the clarity of the message 

to the consumer. 

Recognizing so much that can and should be done to address concussions, it’s important also to note some of the significant and specific challenges we face in developing a successful integrated approach to reducing incidence of concussions in sport. 

Most vexing is that scientific consensus of what is a concussion and what causes 

concussions is evolving. Clearly, the medical and scientific community has gained 

a better understanding of the symptoms, proper precautions, cumulative impact and 

long term effect of concussions. The ‘‘Return to Play’’ protocols being enacted around 

the country are a great response certain to improve player health. These new understandings have led to new helmet technology and innovation, but the direct effects 

of low force impacts and their causal relation to concussive events remain unclear. 

Influences such as ambient temperature and hydration levels of players may be important, along with ‘‘g’’ forces and direction of impact. Simply put, more research 

is needed. Products innovations will continue based on available data, but helmet 

manufacturers need more conclusive data. 

The issue of a special performance standard for youth football helmets arises here. 

At one level, it may be intuitive that a specific standard for youth helmets is required. However, many in the scientific and helmet research community have raised 

concerns that creating a new standard without understanding the risks of unintended consequences is bad policy. Again, lack of scientific consensus raises a red 

flag for some. SGMA members welcome the call for additional dedicated research 

on this specific question, as soon as possible. 

The National Operating Committee on Standards for Athletic Equipment 

(NOCSAE) is the primary standards-setting body for sports equipment in the United 

States. Product performance standards are created and managed by NOCSAE, along 

with test protocols to ensure product integrity. The 20-member Board of Directors 

oversees NOCSAE operations. SGMA sits on the Board, along with representatives 

of the American College Health Association, American College of Sports Medicine, 

American Orthopedic Society for Sports Medicine, American Football Coaches Association, and the American Medical Society for Sports Medicine, amongst others. The 

organization is independent and science-based. NOCSAE ensures the sports products industry is regulated and monitored. SGMA believes NOCSAE has been effective in establishing, promulgating and enacting strong voluntary standards, with demonstrable results. 

Since the advent of the NOCSAE football helmet standard, catastrophic head injuries in the sport have declined by 85.5 percent. It is important to note this reduction 

was accomplished during a period when the number of athletes playing football 

more than tripled and the size, strength and speed of the players increased exponentially. It’s penetration of the football helmet market, for example, is total. SGMA 

believes that virtually no helmet sold in the U.S. marketplace fails to meet the 

NOCSAE Standard. 

The chart below highlights the impact the NOCSAE standard has had on catastrophic football injuries since it was introduced. 

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NOCSAE Football Helmet Standard published 1973. Reconditioner’s Standard Revised to 

NOCSAE standard, 1977. 

Source: Football Fatalities and Catastrophic Injuries 1931—2008. Dr. Fredrick Mueller and 

Dr. Robert Cantu, Carolina Academic Press. 

The NOCSAE football helmet standard has been modified more than 20 times 

since it was created in 1973. The NOCSAE Scientific Advisory Committee consists 

of many of the country’s leading researchers on helmet protection and neuroscience. 

They have a primary responsibility for recommending changes to the standard. Unfortunately, the science of preventing concussions is limited. The science of severity 

of concussions is constantly changing. The industry believes NOCSAE has brought 

together the best thinking on the prevention of sport concussions in the NOCSAE 

Scientific Advisory Committee to formulate leading edge approaches to concussion 

management. NOCSAE has made, and continues to make, substantial grants to 

these and other researchers to do concussion-related research. SGMA and its members support this use of NOCSAE funds. 

Though we have focused much of this statement on football-related matters, it is 

important to note that concussions are not limited to football, and a variety of protective products are being created to offer protection across many sports. 

Mouthguards have evolved from a simple piece of plastic to a more malleable product intended to better absorb the shock from a blow to the chin, knee braces are 

more common now due to lighter and stronger materials, eyewear is required in 

field hockey and girls’ lacrosse and the use of face-masks for fielders in fast-pitch 

softball has increased. The growing use of these products is evidence of the sports 

equipment’s industry’s commitment to reducing injuries in sports. Although participating in sports comes with the inherent risk of potential injury, equipment manufacturers and governing bodies work hard to reduce injuries through innovations in 

protective equipment and rules changes to better protect players. 

In closing, the industry is aware of the need to work aggressively to address concussions in sports. We also know, until there is more definitive medical science, 

there is a limit in what a helmet can do to eliminate concussions in sports. Until 

there is a consensus in concussion science, the helmet industry is taking a multidisciplinary approach working with trainers to insure equipment is fit correctly, 

sport governing bodies to create rules for protecting players from unnecessary helmet to helmet contact and working with coaches to adopt proper sport play techniques changing the current football culture to understand the seriousness of the 

concussion issue. Through NOCSAE, the industry is working with the Center for 

Disease Control providing educational materials to consumers, helping them understand and evaluate the concussion risk in sports. 

Thank you. 


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PREPARED STATEMENT OF SCOTT HALLENBECK, 

EXECUTIVE DIRECTOR, USA FOOTBALL

Chairman Rockefeller and Members of the Committee: 

My name is Scott Hallenbeck. I am the executive director of USA Football, the 

sport’s national governing body in the United States. 

Approximately 3.0 million American children age 6–14 and 415,000 adult volunteers power youth tackle football, making it one of our country’s most popular youth 

sports. USA Football is an independent non-profit organization with members residing in all 50 states and the District of Columbia. Our members are youth football 

coaches, players, league commissioners and football game officials. Within our spectrum of responsibility is to lead and serve the youth football community. We do this 

in several ways, including giving information in the area of health and safety 

through our work with the Centers for Disease Control and Prevention (CDC) and 

other experts. 

USA Football was endowed by the National Football League (NFL) and the NFL 

Players Association (NFLPA) in 2002 through the NFL Youth Football Fund. The 

NFL Youth Football Fund is a non-profit foundation created by the NFL and 

NFLPA in 1998. I have served as USA Football’s executive director since 2005. 

Twenty-six (26) youth sports organizations, including USA Football, began working with the CDC since 2007 to educate the youth sports community on concussion 

awareness and management. Fortunately, this number of youth sports organizations 

has increased in recent years. Player health and safety, including concussion education and management, is a point of emphasis for USA Football. 

USA Football’s CDC-approved concussion awareness work has garnered national 

media attention. This underscores the public’s thirst for additional knowledge and 

education on this topic. 

Summary of USA Football’s CDC-Approved Concussion Awareness 

Information 

USA Football’s coaching education curriculum, football training events, and resources provide youth football players, parents, coaches, league commissioners, and 

game officials with a strong knowledge base of football’s fundamentals. Although no 

physical activity is injury-proof, coaches who understand how to properly teach 

blocking and tackling within the rules will foster a positive football experience and 

will likely lessen the chance of injury. 

The following summarizes how USA Football, with CDC-approved practices, educates the youth football community on how to recognize a concussion and how to 

respond if one occurs. This information is promoted on our website— 

www.usafootball.com—and is available without cost. 

USA Football’s online tackle and flag coaching courses were bolstered in April 

2010 with 35 minutes of video addressing concussion (11 minutes), heat and hydration (13 minutes), proper helmet fitting (7 minutes) and proper shoulder pad fitting 

(4 minutes). USA Football earned national publicity for these courses promoting 

player safety (Associated Press, 4/28/10). All videos may be viewed at 

usafootball.com at no cost at usafootball.com/health-safety/videos-and-downloads. 

Each of the tackle football coaching course’s 15 chapters are followed by a quiz 

to strengthen comprehension. A coach’s progress within the course can be tracked 

by a league’s commissioner. A coach must correctly answer at least 80 percent of 

the questions in a chapter quiz in order to advance to the next chapter. 

More than 75,000 youth football coaches have been educated by USA Football in 

our organization’s history. Of these 75,000 coaches, more than 43,000 have been 

trained by USA Football in the past 18 months, illustrating the increasing value 

that youth leagues place in our educational resources. USA Football does not operate youth leagues nor does it have the ability to mandate youth coaches to complete 

its coaching courses. Leagues independently decide to employ USA Football’s 

courses and resources on a value-based proposition. 

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USA Football’s online coaching course, successfully completed by more than 61,000 youth football coaches, teaches how to properly coach football fundamentals. 

Following each USA Football coaching course chapter, coaches are quizzed on what they 

learned. A cumulative score of at least 80 percent on each chapter quiz is needed to advance 

through the course. 

Youth sports leagues—not only those pertaining to football—are encouraged to 

adopt USA Football’s CDC-approved concussion awareness and management policy 

(below). USA Football recommends that every youth sports league employs a policy 

such as this: 

Prevention and Preparation for Coaches (Primary Source: CDC) 

(1) Educate athletes and parents about concussion 

(a) Talk with athletes and parents about preventative measures, symptoms, and 

proper action to take relative to concussions. 

(b) Emphasize the dangers of playing through a concussion. 


1019HALL1.eps 1019HALL2.eps
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(2) Insist that safety comes first 

(a) Teach athletes safe playing techniques and good sportsmanship 

(b) Review the ‘‘Concussion Fact Sheet for Players’’ found at usafootball.com 

with players and their parents 

(3) Teach athletes and parents that it is not safe to play with a concussion 

(a) Explain that it is not ‘‘courageous’’ nor does it show strength to play with 

a concussion 

(4) Prevent long-term problems 

(a) ‘‘When in doubt, sit them out.’’ Keep athletes with known or suspected concussion off the field until an appropriate health care professional clears them 

to return. Returning to play must be a medical decision. 

Signs & Symptoms of Concussion (Primary Source: CDC) 

Observations made by Coaching Staff Symptoms reported by Athlete 

• Appears dazed or stunned • Headache or ‘‘pressure’’ in the head 

• Is confused about assignment or position • Nausea or vomiting 

• Forgets plays • Balance problems or dizziness 

• Unsure of game, score, or opponent • Double or blurry vision 

• Loses consciousness (even briefly) • Sensitivity to light or noise 

• Shows behavior or personality changes • Feeling sluggish, hazy, foggy, or groggy 

• Can’t recall events prior or after the hit or fall • Concentration or memory problems 

What a Coach Should Do When a Concussion is Suspected (Primary Source: 

CDC) 

(1) Remove the athlete from play 

(a) Look for signs and symptoms of concussion if an athlete experienced a bump 

or blow to the head 

(b) ‘‘When in doubt, sit them out’’—athletes with signs or symptoms of concussion must not return to play 

(2) Ensure that the athlete is evaluated immediately by an appropriate health care 

professional 

(a) Do not try to judge the severity of the injury yourself 

(b) Coaches recording the following can help a health care professional in assessing the athlete: 

(i) Cause of the injury and the force of the hit or blow to the head 

(ii) Any loss of consciousness and if so, for how long 

(iii) Any memory loss or seizures immediately following the injury 

(iv) Number of previous concussions (if any) 

(3) Inform the athlete’s parents/guardians of the possible concussion and give them 

the concussion fact sheet for parents found on usafootball.com 

(a) Ensure at parents know the athlete must be seen by an appropriate 

healthcare professional 

(b) Provide formal documentation of the injury and notify the league commissioner 

(4) Allow the athlete to return to play only after an appropriate healthcare professional clears his or her return 

(a) A repeat concussion that occurs before the brain recovers from the first can 

slow recovery or increase the likelihood of having long-term problems 

USA Football Educational Resources & Initiatives 

The following outlines USA Football’s educational resources and initiatives, including information distribution channels. 

Education 

• USA Football Events: Knowing the game’s fundamentals and how to teach them 

fosters a positive football experience 

» AUSA Football Coaching Schools: youth coaches are instructed how to teach the 

sport’s fundamentals properly 

» USA Football Player Academies: youth players (aged 7–14) are taught proper 

football fundamentals 

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» Football State Leadership Forums: commissioners learn best practices, including 

insight on concussion 

• USA Football stresses that athletes who have or are suspected to have suffered 

a concussion must not return to play until an appropriate healthcare professional clears them to do so. 

• USA Football’s Online Coaching Education Program for Youth Tackle and Flag 

Football 

» Concussion awareness and management information is part of USA Football’s 

basic online coaching courses for both tackle and flag football 

• USA Football’s concussion-related course content is created by its Football & 

Wellness Committee, the CDC, and the National Athletic Trainers’ Association (NATA) 

• USA Football’s Football & Wellness Committee is composed of experts in several areas, including concussion, hydration, and nutrition 

• National Federation of State High School Associations (NFHS) ‘‘Fundamentals of 

Coaching Football’’ Course 

» Produced by USA Football, this course teaches proper coaching fundamentals to 

America’s high school football coaches 

» High school head football coaches in Arkansas and Massachusetts are mandated 

by the high school athletic associations in those states in order to successfully 

complete the NFHS’s three-part online coaching curriculum; USA Football’s 

coaching course accounts for one of these three parts. 

Rules 

• USA Football Youth Football Rulebook 

» USA Football’s Youth Football Rulebook, made available to all youth football 

leagues in the United States, is written with assistance from the National Association of Sports Officials (NASO) and the NFHS to establish important youth 

football standards 

» Work done by USA Football’s Rules Committee in Nov. 2010 enlarged the scope 

of illegal contact made to a player’s helmet to increase player safety. The rule 

change earned coverage from The Associated Press (Nov. 10, 2010). 

Research 

• Youth Football Participation and Safety Surveillance Studies 

» USA Football continues youth football’s most accurate participation study monitoring players, coaches, and teams 

» USA Football will invest to execute a study to learn more about youth football 

injury rates and how they are affected by varying standards of play (Age & 

Weight, Age and Grade-based) 

• Data collection will begin during the 2012 football season 

USA Football Equipment Grant Program 

USA Football, through financial support provided by the NFL Youth Football 

Fund, has awarded more than $4 million in football equipment based on merit and 

need to youth and high school programs across the United States since 2006. More 

than 700 youth and high school football programs in 44 states were assisted through 

USA Football grants awarded in 2011 alone. 

USA Football equipment grants make youth and high school football safer and 

compliments programs’ existing fundraising endeavors for new equipment. Selected 

youth leagues choose one of 14 equipment packages, each valued at $1,000. Selected 

high school programs also choose one of 14 packages, each valued at $1,500. 

Dozens of football program leaders have expressed appreciation for equipment 

grants awarded by USA Football: 

‘‘This is going to enable a lot more kids to play. This grant keeps kids on the field. 

It’ll definitely help us and we are so very grateful.’’ 

—Cassandra Jetter-Ivey, Newark (N.J.) North Ward Scorpions Youth Football 

Program 

‘‘We appreciate USA Football’s help. This allows a sense of relief that we’re keeping our children safe from injury by placing them in new and sturdier helmets. 

Since we are supporting children who are predominately underprivileged, this assistance is especially valuable as it keeps our registration fees as low as possible.’’ 

—DeAndrea Singleton, Westbury Redskins; Houston, Texas 

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‘‘The equipment grant we were awarded from USA Football will provide equipment and uniforms to young athletes in low-income, inner-city neighborhoods. Most 

of the youths are between the ages of 5–12 years and the majority of them are financially disadvantaged. USA Football helps us make a difference in the lives of 

our kids and we appreciate their non-profit office’s support.’’ 

—Steve Billingslea, Middle Tennessee Bulldogs; Nashville, Tenn. 

USA Football’s Football and Wellness Committee 

USA Football has assembled a Football and Wellness Committee to further promote best practices for America’s youth football community. The committee, composed of 26 experts spanning football coaching, player health, and other areas, share 

insight with youth football coaches, game officials, league commissioners, youth 

players, and parents to lead the game’s development and foster a positive football 

experience for youth and amateur players. The committee’s expertise will be shared 

with USA Football members through www.usafootball.com, our quarterly USA Football Magazine, and our football training events, which are conducted in more than 

two dozen states. 

This committee roster represents a variety of organizations including the American Red Cross, the Andrews Institute, the National Center for Sport Safety, and 

several medical centers from across the United States. USA Football’s Football & 

Wellness Committee Members: 

Name Expertise Organization 

Tom Bainter Football expert, running backs Bothell (Wash.) High School 

Tom Bass Football advisor USA Football 

Marcus Boyles Football expert, receivers Wayne County (Miss.) High School 

Jody Brylinsky Coaching performance Western Michigan University 

Ron Courson Sports medicine University of Georgia 

Ted Crites First aid, CPR/AED, injury prevention American Red Cross 

Jeremy Gold Football expert, defensive line Chicago Morgan Park High School 

Dr. Ann Grandjean Medical and nutrition education University of Nebraska Medical 

Center 

Dr. Brad Hatfield Kinesiology University of Maryland 

Dr. Stan Herring Concussion awareness and management University of Washington 

Kirk Heidelberg Football expert, offensive line Rockford (Ill.) Christian High 

School 

Kent Johnston Football expert, physical skills Cleveland Browns 

Dr. David Joyner Medical expert, orthopedic physician Penn State University 

Chuck Kyle Coaching performance Cleveland St. Ignatius High School 

Dr. John Lehtinen Family medicine Peninsula Medical Center 

Dr. Larry Lemak Sports Medicine Lemak Sports Medicine 

George Maczuga Equipment Riddell 

Chris Merritt Football expert, defensive backs & sp. 

teams 

Miami Christopher Columbus High 

School 

Dr. Joel Morgenlander Neurology Duke University Medical Center 

Dr. Lonnie Paulos Orthopedics The Andrews Institute 

Mike Price Insurance Essix Insurance 

Dr. JohnEric Smith Hydration Gatorade Sports Science Institute 

Steve Specht Football expert, linebackers Cincinnati St. Xavier High School 

Gary Swenson Football expert, quarterbacks West Des Moines (Iowa) Valley 

High School 

Kim Schwabenbauer Nutrition Corporate dietitian, Super Bakery 

Dr. Dave Yukelson Sport psychology Penn State University 

Player Progression Development Model 

America’s youth football community is learning how to coach and play the sport 

in a way never done before. 

Developed throughout 2010 and 2011, USA Football introduced a Player Progression Development Model (PPDM) earlier this year. Youth football coaches in 15 

states completed USA Football’s age-appropriate teaching and learning approach to 

the game prior to the start of the 2011 football season. 

USA Football’s PPDM develops youth football players by having them learn the 

game, increase their skills and build confidence at age-appropriate levels. It directs 

youth coaches how to teach the game in a progression based on a player’s age and 

physical abilities as well as the player’s mental, emotional and social maturity. 

Player age segments within USA Football’s Player Progression Development 

Model: 

• Under-6 (flag football) • Under-10 (tackle) • Under-14 (tackle) 

• Under-8 (tackle) • Under-12 (tackle) 

USA Football’s Player Progression Development Model is woven into all USA 

Football programming—more than 80 football developments events for coaches, 

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players and commissioners and its online educational and skill-strengthening resources for coaches and players. 

USA Football created its Player Progression Development Model (PPDM) under 

the direction of the following experts: 

Name Area of Expertise 

Tom Bainter, Bothell (Wash.) H.S. Football Coach Running Backs 

Jeremy Gold, Chicago Morgan Park H.S. Football Coach Defensive Line 

Kirk Heidelberg, Rockford (Ill.) Christian H.S. Athletic Director Offensive Line 

Kent Johnston, Cleveland Browns Strength and Conditioning Coach Physical Abilities 

Chuck Kyle, Cleveland St. Ignatius H.S. Football Coach Principles of Coaching 

Larry Lauer, Ph.D., Michigan State University Exercise & Sport Science, Sport Psychology 

Chris Merritt, Miami Christopher Columbus H.S. Football Coach Defensive Backs and Special Teams 

Anne Pankhurst, Independent Consultant Physical Abilities, Growth and Maturation 

Cathy Sellers, United States Olympic Committee Principles of Coaching 

Steve Specht, Cincinnati St. Xavier H.S. Football Coach Linebackers 

Gary Swenson, West Des Moines (Iowa) Valley H.S. Football Coach Quarterbacks 

Dave Yukelson, Ph.D., Penn State University Sport Psychology 

‘‘A structured player development model is good—and needed—for football, particularly youth football,’’ said Cleveland St. Ignatius head football coach Chuck Kyle, 

a 10-time Ohio state champion coach and member of the Ohio High School Football 

Coaches Association Hall of Fame. ‘‘This is a game of innovation, rooted in fundamentals,’’ Kyle adds. ‘‘USA Football’s Player Progression Development Model is 

an extraordinary example of how these two dynamics work together and form the 

foundation of an exceptional team sport of the mind, body and spirit.’’ 

USA Football Tackle Advisory Committee 

Head football coaches with NFL, collegiate, high school and youth experience as 

well as a leading sport psychologist were selected for USA Football’s Tackle Advisory Committee in June 2011, the first committee of its kind to benefit America’s 

youth football community. 

The group of experts helps youth coaches teach tackling fundamentals and 

strengthen player safety on a national level through USA Football resources. 

The five-member committee has assisted in developing a tackle progression 

model—a step-by-step process for youth coaches to teach tackling fundamentals in 

proper order. The tackle progression and its drills were created by USA Football. 

USA Football’s tackle progression model further strengthens player safety and identifies ways to build confidence in youth players by appropriately introducing them 

to contact. 

USA Football’s Tackle Advisory Committee Members: 

Name Position Organization 

Pat Fitzgerald Head Football Coach Northwestern University 

Merril Hoge Youth Football Coach and NFL Analyst ESPN (NFL Alumnus) 

Chris Merritt Head Football Coach Miami Christopher Columbus High 

School 

Jim Mora Youth Football Coach and Former NFL Head Coach Atlanta Falcons and Seattle Seahawks 

David 

Yukelson 

Sport Psychologist Penn State University 

A series of 12 instructional videos within USA Football’s Tackle Progression 

Model divides tackling into five fundamentals—breakdown position, buzz, hit position, rip and shoot—providing drills to teach each step, beginning in a non-contact 

environment and progressing to player-to-player contact. The instruction is designed 

to improve tackling skills, increase safety and limit helmet-to-helmet contact, lessening the chance for injury, including concussion. 

Within the model, a USA Football-produced Level of Contact video directs youth 

coaches on how they may incrementally introduce their players to contact to build 

their confidence and help them learn the game’s fundamentals. Drills can be run 

at varying speeds, starting slow when they are first introduced and accelerated as 

players master skills and techniques. The video introduces contact in the following 

ways: 

Level of Contact Definition 

Air Players run a drill unopposed without contact. 

Bags Drill is run against a bag or another soft-contact surface. 

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Level of Contact Definition 

Wrap Drill is run between two players until the moment of contact; one player is pre-determined 

the ‘‘winner’’ by the coach. Contact remains above the waist and players stay on their 

feet. 

Thud Drill is run between two players until the moment of contact; no pre-determined ‘‘winner.’’ 

Contact remains above the waist, players stay on their feet and a quick whistle ends the 

drill. 

Live-Action Drill is run in game-like conditions and is the only time that players are taken to the 

ground. 

‘‘Directing youth football teams to incrementally incorporate contact into their 

practices lessens the amount of incidental contact that players receive through their 

helmets,’’ said Dr. Stanley Herring of USA Football’s Football and Wellness Committee and the NFL’s Head, Neck and Spine Committee. ‘‘This is a strong step forward for player safety in youth football that any youth sport should consider emulating.’’ 

Concussion-Related Education 

USA Football works with the CDC to promote concussion-related education materials for its members and the entire youth football community at 

www.usafootball.com. In addition to the CDC, USA Football is advised by Dr. Stanley Herring on concussion awareness and management. Dr. Herring is a member 

of USA Football’s Football & Wellness committee and is a board-certified physical 

medicine and rehabilitation specialist who has been in practice for more than 27 

years. Dr. Herring also is a clinical professor in the departments of Rehabilitation 

Medicine, Orthopaedics & Sports Medicine, and Neurological Surgery at the University of Washington. 

Dr. Herring is USA Football’s internal advisor on concussion awareness material 

for our coaching course, which was shared with the CDC for review prior to being 

made available to the youth football community. USA Football informs coaches of 

the CDC-approved message that athletes who are even suspected of having suffered 

a concussion must not return to play until an appropriate health care professional 

clears them to return. Returning to play must be a medical decision. 

In September 2010, USA Football introduced a national campaign called ‘‘Put 

Pride Aside for Player Safety’’ to emphasize concussion awareness in youth sports, 

particularly football. 

‘‘Put Pride Aside for Player Safety’’ is the only national youth sports initiative promoting concussion education and management uniting a sport’s national governing 

body (USA Football), collegiate athletic conferences (Atlantic Coast Conference, MidAmerican Conference, The Patriot League) and a professional sports league (NFL). 

Through television, radio and website media placements, ‘‘Put Pride Aside for 

Player Safety’’ continues USA Football’s commitment toward youth sport concussion 

education and management. ‘‘Put Pride Aside for Player Safety’’ challenges and instructs coaches, parents and youth players to make the right decision when a concussion is suspected, which is to remove an athlete from play the day of the injury 

and not allow him or her to return until a medical professional deems the athlete 

symptom-free and gives clearance for a return to play. 

Key components of USA Football’s ‘‘Put Pride Aside for Player Safety’’ campaign: 

• Television PSA airing on NFL team, ACC, Mid-American Conference and Patriot League programming as well as on usafootball.com 

• Radio PSA airing on NFL team-owned inventory 

• Player safety videos (12) covering proper equipment fitting, tackling techniques 

and concussion management on websites of NFL teams, the ACC, the MAC, the 

Patriot League and usafootball.com 

• Banner ads on websites of NFL teams, the ACC, the MAC, the Patriot League, 

and usafootball.com 

Legislation 

USA Football has joined other sports and medical organizations across the country in testifying in person or via letters of support for state legislation to foster 

greater awareness and management of concussion. 

Many of these state laws, most of which have been passed since August 2010, require: 

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• Information handouts to parents and players on the signs and symptoms of concussion; returned and signed by parents and youth athletes acknowledging the 

risk of concussion and head injuries prior to practice or competition. 

• Removal of a youth athlete who is suspected of or sustains a concussion or head 

injury from play—‘‘When in doubt, sit them out.’’ 

• Written clearance prior to returning to play from a licensed health care provider 

knowledgeable in the diagnosis and management of concussion for a youth athlete who has been removed from play. 

• Compliance from private, non-profit youth sports associations with the policies 

adopted in that state. 

Such laws cannot prevent an initial concussion from happening on a football or 

soccer field, a basketball court, a baseball diamond, or a hockey rink, but they can 

help prevent damaging repeated concussions from happening in all of these places. 

USA Football is committed to concussion awareness and management and would 

encourage other sports’ national governing bodies to join us. 

Concussion is not relegated to football—or even boys’ athletics. According to a 

study titled, ‘‘Concussions Among United States High School and Collegiate Athletes’’ in the Journal of Athletic Training in 2007, concussion rates per 1,000 athlete 

exposures were as follows (an ‘‘athlete exposure’’ is one practice or one game): 

• Football: 0.47 

• Girls Soccer: 0.36 

• Boys Soccer: 0.22 

• Girls Basketball: 0.21 

• Boys Basketball: 0.07 

These numbers underscore the need for all sports to recognize the seriousness of 

concussions and the need for further education among our coaches, league administrators, game officials, athletes, and parents. 

More Education Needed 

Concussion awareness, even within the medical community, is limited. The CDC 

has even created a concussion fact sheet for physicians in addition to the general 

public. This drives the point that consistent nomenclature and the coordinated cooperation of all youth sports stakeholders is necessary to continue this positive 

change that we are experiencing in youth sports relative to concussion. 

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APPENDIX

Created by the CDC for USA Football, this information was placed on a clipboard sticker and 

distributed at more than 35 full-day USA Football Coaching Schools in 25 states in 2010. This 

image can be downloaded at no cost at usafootball.com. 


1019HALL3.eps
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The above four-page Concussion Education brochure with content from the CDC 

was distributed at single-day USA Football Coaching Schools in 2011. 

PREPARED STATEMENT OF STANLEY HERRING, MD, CLINICAL PROFESSOR

DEPARTMENTS OF REHABILITATION MEDICINE, ORTHOPEDICS AND SPORTS

MEDICINE, AND NEUROLOGICAL SURGERY UNIVERSITY OF WASHINGTON; 

CO-MEDICAL DIRECTOR SEATTLE SPORTS CONCUSSION PROGRAM; TEAM PHYSICIAN

SEATTLE SEAHAWKS AND SEATTLE MARINERS; AND MEMBER, NATIONAL FOOTBALL

LEAGUE’S HEAD, NECK AND SPINE COMMITTEE

Chairman Rockefeller, Ranking Member Hutchison, and members of the Committee: 

My name is Dr. Stan Herring. I am the Co-Medical Director of the Seattle Sports 

Concussion Program and a Clinical Professor at the University of Washington. In 

addition, I serve as a Team Physician for the Seattle Seahawks and the Seattle 

Mariners. I submit this statement to you today as a Member of the National FootVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00097 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE

1019HALL4.eps
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ball League’s Head, Neck and Spine Committee and the Chairman of the Subcommittee on Education and Advocacy. 

Mr. Chairman, thank you for calling this hearing to bring greater awareness to 

the important topic of concussion in sports. As a medical advisor to the NFL, I believe that the NFL values its leadership role on the issue of concussions, not only 

for professional football players, but for all sports at all levels. I appreciate the opportunity to submit a statement summarizing some of the NFL’s work on this important matter. 

As a physician who has worked on the sidelines of Seattle Seahawks games for 

many years, I know there is nothing more important to the NFL than the health 

of its players. Effective safety equipment is one important component in protecting 

the health of athletes. Among the many equipment related initiatives pursued by 

the League was a recent study into the effectiveness of the helmets worn by NFL 

players. The results of this study were shared not only with the players, but also 

the equipment manufacturers and made available to the public. The more information people have about equipment safety, especially as it relates to head injuries, 

the safer sports will be. 

Additionally, last December the NFL hosted a symposium in New York to discuss 

the performance of safety equipment, including helmets. Invited stakeholders included helmet and accelerometer manufacturers, the Department of Defense, the 

National Operating Committee on Standards for Athletic Equipment, the NFL Players Association, and researchers, among others. The daylong meeting allowed the 

most informed and knowledgeable individuals working on helmet safety to share 

ideas and learn from each other’s work. All of those invited shared the same goal— 

making the game as safe as possible for those who play it. 

There currently are no products on the market that can make an athlete concussion-proof. Equipment technology will continue to evolve over time. The NFL is encouraging the pace of this change. In the meanwhile, we cannot look to equipment 

to replace the critical role of medical evaluation and treatment. 

We need not wait for the development of new technology to protect children from 

the dangers of concussions. Greater awareness and education can protect athletes 

of all ages, in all sports. The NFL promotes broader education about concussion in 

all levels of sport. Through collaboration with the CDC, educational posters now 

hang in NFL training rooms. I was personally involved in developing a similar poster to be used by youth athletes and made available through the CDC. Additionally, 

with support from the NFL, I have been involved in developing educational materials for coaches and clinicians so they can be better informed in treating athletes 

who have suffered a concussion. All of these materials are available, for free, on the 

CDC’s website at www.cdc.gov/concussion. 

The NFL invests in research, and our medical committee works to examine the 

latest developments in technology. In the NFL’s most recent collective bargaining 

agreement with the NFL Players Association, there is an agreement to dedicate 

$100 million over the next ten years to medical research, the majority of which will 

go toward brain injury research. 

Youth athletes who have suffered a concussion will routinely recover and return 

to play eventually if properly treated. For this reason, it is important that appropriate protocol is followed when children suffer concussions. One way to ensure that 

parents, coaches and others involved in youth sports are aware of the best possible 

way to treat concussions is through the adoption of laws with internationally accepted guidelines for how to treat youth concussions. A year ago, the NFL announced 

a campaign to advocate for the passage of youth concussion laws across the country. 

The laws all contain at least these three key principles: 

1. Student athletes and a parent or guardian must sign an education sheet that 

provides them with information about the signs and symptoms of concussion; 

2. Any youth athlete who appears to have suffered a concussion in any sport 

is removed from play or practice at that time; and 

3. That athlete must be cleared by a licensed healthcare provider trained in the 

diagnosis and management of concussions before returning to play or practice. 

Laws containing these provisions have been enacted in thirty states, as well as 

the District of Columbia. Twenty-two have become law in the last year alone. The 

NFL has pledged to continue its advocacy until every state has adopted a way to 

protect youth athletes. 

The importance of these laws is personal for me. In October 2006, Zackery Lystedt 

was a 13-year-old star football player who suffered an undiagnosed concussion with 

a few minutes left in the first half. An injury time-out was called. After resting during halftime, Zackery returned to play in the second half while still having sympVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00098 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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toms from his injury. He sustained further head blows during the second half of the 

game, and at the end of the game collapsed in his father’s arms. He lapsed into a 

coma suffering from life-threatening injuries. Zackery survived, but continues to face 

a long road of rehabilitation. In the meanwhile, a coalition in Washington State 

began work on a law designed to prevent the next child and the next family from 

suffering the way Zackery and his family did. The adoption of the Zackery Lystedt 

law in Washington is already making a difference in our state. Thanks to the fine 

work of advocates across the country to promote this law, many more kids will play 

sports safer. 

I am proud that the NFL is a leader to the benefit of athletes at all levels of sport. 

As more is learned about concussions, I believe that the NFL will continue to make 

the necessary changes to best protect its players and to lead and serve as a model 

for all sports. 

Thank you again for this opportunity today. 

RALPH & JOY CONRADT

Bend, OR, October 29, 2011 

Chairman JAY ROCKEFELLER, Senate Committee on Commerce, Science, and Transportation, 

Washington, DC. 

RE: FOOTBALL HELMET SAFETY

Dear Senator Rockefeller, 

Having viewed the October 19th Senate Hearing, I have a number of comments 

regarding the statements made by equipment-industry-representative Oliver. First 

though it is ironic that the 10/19/11 hearing occurred on the ten-year anniversary 

of my son Max’s catastrophic brain injury while wearing a twenty year-old football 

helmet. 

1. At the time of Max’s injury, we had no reason to question the reconditioning 

process. We just assumed all helmets were tested every year and reconditioning consisted of more than deodorizing, painting and checking for cracks. Mr. Oliver stated 

that an old helmet, properly reconditioned, offers the same protection as a state-ofthe-art helmet. Our experience is that this is not the case. Max’s helmet was droptested at the NOCSAE lab and failed over 50 percent of the standards of the year 

2000. Oliver says a helmet should not necessarily have an established shelf life 

since it may sit unused for several seasons. Clearly Mr. Oliver clearly has never 

owned a product made of polycarbonate, commonly known as plastic. If he did he 

would recall that while exposed to air, polycarbonate becomes brittle and no longer 

effectively absorbs shock. 

2. Oliver further stated an older helmet would meet current standards if ‘new 

parts were installed’. This position is ridiculous, as the primary component of a helmet is the shell. Since helmet shape has changed over the years the older shells 

will not accommodate new padding, bladders, head-sizers etc. Only parts made exactly to fit the old technology will work. Thus, even in the best-case scenario, such 

a helmet could only meet old standards, not recent standards. 

3. It troubles to me that children are allowed to play with these older products 

once newer standards are established. Why then have new standards? A reporter 

asked Max’s principal, Von Taylor of Waldport High School in Oregon, how Max, 

the quarterback of his team and arguably the most valuable player, be assigned a 

20-year-old helmet?? Taylor replied that Max’s was not the only helmet of that vintage. 

This sort of justification explains why young players continue to suffer life-altering injuries and death—the most recent death just a week ago in New York. In 2008 

I attended a coaches’ conference where a coach questioned why he should be so concerned about examining and fitting helmets and sitting out players that felt a little 

dizzy when in fifteen years he had never had a player suffer a major injury. I was 

happy to explain to him that Max’s coach tearfully expressed similar sentiments to 

me in the ICU while we stood over my son’s comatose body. 

4. Max assured me that in his junior year he was using a ‘‘new’’ helmet. Had I 

known that in his senior year he would be issued a 20-year-old helmet, which was 

three years older than he was, I would not have let him step onto the field. Max 

and I used to race our track car. It was mandatory, in that sport, that helmets be 

replaced every ten years, even if they were never worn in an accident. Helmets that 

had been dropped or which showed signs of minor impact also required replacement. 

5. Oliver stated that a helmet’s age could be readily determined from a stamp in 

the shell. There are three problems with that statement. (A) Most schools do not 

allow players to take helmets home for parents’ inspection; (B) the date stamp is 

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usually disguised in a code and (C) the code is usually obscured by padding, which 

only coaches may remove. 

6. Coaches have only recently begun to take the issue of head protection seriously. 

Les Totten is CEO of SportsSoft, a company that offers teams a product to track 

all the conditioning and parts replacement for equipment. Les stated to me on-camera that he has never been in a school’s equipment room and not found a helmet 

that was clearly ineffective by date of manufacture or reconditioning. 

Lastly, shortly after my 3.95 GPA son slipped into a four-month coma I was contacted by Riddell representative Mark Elmblade. He was concerned that one of his 

helmets might have been worn by Max. I assured him that it was a Bike helmet 

made by Schutt. Elmblade was relieved, but said he had recently visited Waldport 

coach Donald Kordosky. During their conversation Elmblade picked up one of the 

helmets in Waldport’s stock and exclaimed ‘‘These are a brain injury waiting to happen!’’ Kordosky justified the use of out-dated helmets because he had no budget to 

replace them. Parents were not notified of this dangerous situation and had I known 

of the dire budgetary situation I would have gladly bought new helmets for the 

starting players. 

Lincoln County School District saved a few dollars and my son paid with his life. 

He will never work, never again join me in car racing. He will not provide me with 

grandchildren or contribute to our society with his once-exceptional brain power. 

Had Max’s antiquated helmet been relegated to the trash heap there is every reason to believe that I would still have a whole son. Hopefully in your next Hearing, 

Mr. Oliver will be asked to respond to the issues raised here. 

Lastly as a filmmaker I have on tape almost every game Max played in. This footage became a major source of visuals for my film ‘‘What Happened, Dad?’’ 

RALPH & JOY CONRADT

RESPONSE TO WRITTEN QUESTION SUBMITTED BY HON. FRANK R. LAUTENBERG TO

ALEXIS BALL

Question. Parents normally associate concussions with football, but the CDC reports that soccer has the second highest incidence and rate of concussions. Do you 

believe that parents and coaches are aware of the concussion risks related to sports 

like soccer? 

Answer. I do not think that parents/athletes tend to associate concussions with 

sports like soccer. Much of the attention generated about concussions in sports is 

centered on football and thus I believe that other sports get overlooked. With the 

high number of young kids playing sports like soccer, it is essential to educate 

coaches, parents, and athletes about frequency of concussions occurring in sports 

other than football such as soccer. 

RESPONSE TO WRITTEN QUESTION SUBMITTED BY HON. FRANK R. LAUTENBERG TO

STEVEN THREET

Question. Do you have advice for young athletes who may have suffered a concussion? 

Answer. My advice for young athletes who believe they have suffered a brain injury is to report it. It is better to speak to a trainer or a doctor and have them be 

able to rule out the possibility that a brain injury has occurred rather than the 

worst-case scenario where an athlete would stay quiet because they don’t think their 

injury is significant enough to be reported and subsequently return to play before 

their brain is ready. This reporting process is significant because the brain is at a 

much greater risk for serious or permanent injury as a result of a second impact, 

known as Second Impact Syndrome. 

RESPONSE TO WRITTEN QUESTION SUBMITTED BY HON. JOHN THUNE TO

STEVEN THREET

Improper Tackling Technique and Concussions 

Question 1. I’m aware that NFL and college football teams today have significantly reduced the amount of time devoted during practice to proper tackling and 

other football fundamentals. I recognize that coaches are limiting some of the physical contact during practice to prevent injuries. However, my concern is that less 

time devoted to teaching proper tackling technique may be contributing to an increase in concussions during games. Specifically, players these days seem to lead 

with their head rather than wrapping a player up with one’s arms and body, and 

97 

keeping their head up. Do you see any connection, at all levels of football, to improper tackling technique and an increase in concussions? 

Answer. I do believe that there is a connection between tackling technique and 

concussion. I believe that this is an issue being addressed by the NFL as well as 

in the college game. There has been a concentrated effort to lower the strike zone 

and to enforce it with penalties and in the NFL with fines as well. There is difficultly in this area because the speed of the game. Often times it appears that a 

player will tackle with proper technique but then the offensive player will make a 

last second adjustment in his body position in anticipation of the impact and subsequently bring their head lower and back into the striking zone for the defensive 

player. 

Question 2. Do you think this improper tackling technique is caused by less time 

being devoted to teaching good technique in practice? 

Answer. I believe that as players get older less time is spent teaching proper technique. At elite levels of the game coaches either assume it is known or do not feel 

they can spend the time focusing on technique. I think this is because there are 

such strict rules by the NCAA about the time that coaches can spend with their 

players. The off-season would be a great time for position players to teach their 

players but contact between coach and player in this way is currently not allowed. 

Because of time constraints the emphasis of practice is learning the defensive 

scheme in the spring and the preseason and preparing for the opponents during the 

season. 

Question 3. As part of the campaign to highlight concussion awareness, how much 

emphasis is being placed on educating coaches and players about using proper tackling technique to reduce concussions? 

Answer. I believe that there is some emphasis being placed on how proper technique can help reduce the frequency of brain injury. However the greatest emphasis 

on the awareness front is getting athletes to appreciate the seriousness of brain injury. I believe that as more people begin to recognize the problem, it will be possible 

to switch the focus of the awareness effort to include partial-solutions like a greater 

emphasis on tackling technique. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. FRANK R. LAUTENBERG TO

JEFFREY KUTCHER, MD 

Question 1. Concussions and other traumatic brain injuries pose a serious and increasing risk for our youth. In 2009, emergency rooms treated an estimated 248,418 

sports and recreation-related concussions and other brain injuries among children 

and adolescents. These injuries have increased by 60 percent over the last decade 

even though school sports participation has fallen. What more can be done to prevent these injuries? How can we ensure that kids who experience concussions don’t 

suffer long-term consequences? 

Answer. The increase in emergency room visits for sport and recreation related 

brain injury is very likely multi-factorial. First, although school sports participation 

may be trending down, the overall exposure to activities with an inherent risk of 

brain injury is more difficult to quantify. It may be, for example, that overall exposure is up, once we factor in those activities that are not school organized. Second, 

increased awareness of head injury has almost certainly led to a higher percentage 

of head injuries presenting to an emergency room. Thus, the 60 percent increase in 

ER visits over the last decade may not necessarily represent an increase in the absolute number of injuries. 

That being said, there is no question that a serious problem exists and injury prevention is key. A significant number of injuries could be prevented through proper 

education and awareness campaigns that address known high-risk activities. These 

efforts should stress the use of well-fitted and certified equipment, proper technique, 

and adherence to the rules of whatever sport or activity is being considered. As is 

the nature of the concussion issue, what we don’t know puts a limit on our ability 

to make a difference. To truly prevent concussion, we need to understand much 

more about the injury itself, how a traumatic force acts to insight the injury, how 

the brain responds to the injury, and what additional factors may influence the clinical outcome. 

Currently, we do not know enough about concussion or traumatic brain injury to 

ensure that any individual can be free of long-term consequences. The simple answer is that long-term problems likely come from a combination of intrinsic (genetic) 

and extrinsic (environmental) factors, including the total lifetime dose of biomechanical forces. Thus, the only way to truly ensure that long-term problems do not develop is to avoid exposure to biomechanical forces completely. This is clearly not a 

98 

realistic goal. Given what we know, I stress the need to let every concussion heal 

prior to returning to a contact risk environment. I also suggest that the overall exposure to contact risk be considered. For example, I advise my patients who play 

a contact sport to avoid other contact sports, giving their brains time to recover in 

the off-season. Finally, I believe that it is critical for any contact sport participant 

to undergo periodic neurological evaluation and screening for any signs of brain dysfunction that might be related to head trauma. 

Question 2. Rates of concussion and other brain injury have dramatically risen 

over the last decade as have sales of equipment that is supposed to protect our kids 

from these injuries. Are these products really protective? 

Answer. Equipment plays a critical role in injury prevention. The very nature of 

contact sports, such as football and ice hockey, is determined, in no small part, by 

the presence of protective equipment such as helmets. To this end, equipment being 

an integral part of the game means that it is both preventive and causative. Obviously, any football player who for some reason participates without a helmet is at 

a significantly higher risk of injury. The protective nature of helmets is limited, 

however. They are very good at preventing bone fracture and superficial injury, but 

are not very good at preventing concussion. Concussion can occur from direct blows 

to the head or as the result of a blow to the body causing a whiplash event. No 

helmet could ever prevent the latter. The amount of biomechanical force that is absorbed by helmets, in my opinion, is not enough to expect that they could ever significantly alter concussion risk. With that in mind, I tell my patients to make sure 

all of their equipment is properly fitted and certified. I also advise them that while 

newer generation helmets might not be able to greatly reduce concussion risk, they 

may lower the absolute amount of force that their brain will experience. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

JEFFREY KUTCHER, MD 

Question 1. Helmet requirements for high school football. The National Federation 

of State High School Associations (NFHS) sets football playing rules and equipment 

guidelines that are adopted by many state athletic associations. The 2010 NFHS 

Football Rules book requires players to wear a football ‘‘helmet and face mask which 

met the NOCSAE test standard at the times of manufacture’’ (see page 17). However, these NFHS rules allow a football helmet that is no longer in compliance with 

NOCSAE standards to be worn by a high school player as long as the helmet met 

NOCSAE standards when it was originally made. NFHS also does not require that 

an older helmet be reconditioned and recertified to NOCSAE standards. Should high 

school football players wear helmets that meet current NOCSAE requirements when 

they are actually being worn—and not just on the day their helmets were manufactured? 

Answer. Absolutely. I believe it is critical that high school football players wear 

helmets that meet current NOCSAE standards while they are in use. Every reasonable effort should be made to ensure that this is the case. Allowing helmets to be 

worn that no longer meet standards defeats the purpose of having standards in the 

first place. 

Question 2. NOCSAE drop test and helmet quality. My understanding is that the 

NOCSAE safety standard for football helmets is primarily a drop test method that 

requires helmets to score less than a 1200 severity index (SI) level. Is there a difference in the level of protection offered by a helmet that tests at a 1199 SI level 

and a helmet that tests at a 300 SI level? 

Answer. Theoretically, yes. The difficulty resides in trying to quantify the level 

of protection that any helmet offers. When speaking about injuries that are easy to 

document objectively, such as skull fractures or bleeding events inside the skull, one 

can make a reasonable estimate of risk. When speaking about concussion, however, 

as well as possible long-term effects of brain trauma such as chronic traumatic 

encephalopathy, it is much more difficult, if not impossible, to quantify the risk in 

a way that’s precise enough to allow for comparisons between helmet types. First, 

we need to advance the science of concussion to a point that we have a consistent 

and well-defined clinical outcome to study, and one with an objective confirmatory 

test. Then, helmet types could be studied to see how they differ in preventing these 

outcomes. As it stands now, our estimates of risk, and therefore the amount of protection that any helmet can provide, is little more than guesswork. 

That being said, it certainly makes sense from a neuropathological perspective 

that brains would rather experience less force than more, especially over the course 

of a lifetime. For that reason, it would seem to be an axiom that a helmet with an 

SI level of 300 would be preferable to one with an SI of 1199. Although we cannot 

99 

expect this difference to significantly mitigate the risk of experiencing a clinical concussion, it is more plausible that it could account for some amount of decreased risk 

of developing long-term neurological effects. If this effect does exist, however, it likely represents a very small proportion of the overall risk, and, therefore, we should 

not expect advancing helmet technology alone to solve the problem. 

Question 3. Concussions tests. Dr. Kutcher, we hear more and more in the media 

about ‘‘concussion tests’’ used to diagnose athletes and determine if they are fit to 

return to play. Yet we also hear reports that some athletes may intentionally fail 

or ‘‘sandbag’’ their baseline neuro-cognitive tests in order to reduce the chance of 

being removed from play following a concussion later in the season. How effective 

are computerized neuro-cognitive tests in diagnosing concussed athletes and determining when it is safe for them to return to playing sports? 

Answer. Computerized neuro-cognitive tests cannot diagnose concussion. Actually, 

there is no test currently available that can do so. Concussion is a diagnosis that 

is made clinically. Computerized neuro-cognitive tests provide information on brain 

function that an experienced physician can use, together with other pieces of information, to help make the diagnosis of concussion and help determine when the injury is over. I am very concerned with the degree to which computerized neuro-cognitive tests are being used inappropriately in our country. The problem stems from 

the fact that an abnormal result on these tests is not specific for concussion. An athlete who is in pain for any reason, or one who is sleep deprived, distracted, or 

unmotivated can produce abnormal results, whether they are concussed or not. 

Furthermore, having a result on one of these tests that falls within a populationbased norm does not mean that the person in question is not concussed. The best 

use of these tests comes when there is a pre-injury baseline result for comparison. 

The trick is that producing a baseline neuro-cognitive study truly representative of 

that individual’s ability is more difficult than it sounds. Environmental and motivational factors frequently act to set a ‘‘false baseline’’ that is then used for comparison later. 

Computerized neuro-cognitive testing is, potentially, a very useful concept. Used 

incorrectly, however, it can be misleading at best and dangerous at worst. I strongly 

encourage any clinician who uses this modality in their practice to understand the 

strengths and weaknesses of the individual tests and to use them as extensions of 

their physical examination, and never as a diagnostic test. In the end, diagnosing 

concussion and making a return to play decision not only involves clinical decisionmaking, but is very much a medical decision that should only be made by a physician. 

RESPONSE TO WRITTEN QUESTION SUBMITTED BY HON. JOHN BOOZMAN TO

JEFFREY KUTCHER, MD 

Concussion Education 

Question. Are educational campaigns, such as the CDC’s Heads Up campaign, effectively reaching parents and coaches across the country? Do you feel they are reducing the number of concussions that occur and/or changing the way people react 

when someone sustains one? Should anything be done to make these education campaigns more effective? 

Answer. The publicly available concussion education programs, such as the CDC’s 

Heads Up campaign, are helping, but only to a degree. They are part of the larger 

changing landscape of increased concussion awareness and, as such, do have some 

impact on moving the issue forward. I do not believe they are significantly reducing 

the number of concussions, nor do I see a significant change in how concussed athletes are being treated. We can, and certainly should, do better. There are four main 

reasons that I see for this overall lack of effectiveness: 

First, I have found that the value of any educational resource depends on how 

specifically the material is designed for a particular audience. Most available concussion resources take a generic approach that appeals to the public at large. Granted, this may be a result of the need to produce materials that cover a wide audience 

with limited resources. Concussion education, however, needs to address every 

stakeholder in the issue. We need programs that are designed for each population 

specifically, speaking to their concerns, using their language, and engaging them in 

the learning process. We need to have programs that are created for athletes of different age groups, coaches of all levels of sport, parents, administrators, officials, 

and medical staff. 

Second, most concussion education materials I have seen are fairly average in 

quality. They provide superficial content in a non-stimulating way. Successful eduVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00103 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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cation programs use creative instructional design and an interactive format that 

motivates and challenges the learner. 

Third, there is a significant issue with lack of quality control and consistency between programs. In some cases, information is outdated, incorrect, or contradictory. 

Much of this may be due to the fact that our understanding of concussion is evolving 

quickly. I’m afraid, however, that in an age when anybody can produce an educational tool using electronic media, that many programs are designed for the purpose of marketing a product or service. The public is thirsty for knowledge and deserves information that is accurate, current, and not driven by ulterior motives. 

Finally, while having these materials available to those who are actively seeking 

knowledge is a wonderful start, I believe the majority of athletes, parents, and 

coaches would not seek these programs out voluntarily. Whenever possible, we need 

to make concussion education a mandatory activity prior to playing, coaching, or 

consenting for a child to participate in contact sports. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. FRANK R. LAUTENBERG TO

ANN C. MCKEE, MD 

Question 1. Concussions and other traumatic brain injuries pose a serious and increasing risk for our youth. In 2009, emergency rooms treated an estimated 248,418 

sports and recreation-related concussions and other brain injuries among children 

and adolescents. These injuries have increased by 60 percent over the last decade 

even though school sports participation has fallen. What more can be done to prevent these injuries? How can we ensure that kids who experience concussions don’t 

suffer long term consequences? 

Answer. The primary way to reduce the number of concussions suffered by children and adolescents is to raise awareness and educate the public—coaches, parents, medical doctors, psychologists and kids—about what a concussion is, what 

kind of activities increase the risk of concussion, and how to properly manage a concussion after it occurs. A concussion properly recognized and medically managed is 

the best protection against the long-term consequences. Ensuring that the child or 

adolescent rests sufficiently (including cognitive rest) after a concussion and not allowing the resumption of play of the sport or other activities until fully recovered 

is the best way to reduce complications down the road. Other prevention measures 

include wearing proper protective gear when bicycling, skiing, skateboarding, etc 

and avoiding activities that are associated with repetitive brain trauma, e.g., leading 

with your head or tacking with your head in football and other sports. 

Question 2. Rates of concussion and other brain injury have dramatically risen 

over the last decade as have sales of equipment that is supposed to protect our kids 

from these injuries. Are these products really protective? 

Answer. There is no product marketed today that prevents concussion, including 

helmets, although helmets make sports safer by reducing catastrophic injuries. Reducing the incidence of sports-related concussion will require changing the way 

many of our popular sports, including football, soccer and hockey, are played. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN BOOZMAN TO

ANN C. MCKEE, MD 

Risks in Concussions/Death 

Question 1. Last month, a 16-year-old high school football player died from a head 

injury after collapsing during a game. I understand the possibility of further injury 

due to multiple concussions, yet according to the news report, there was no evidence 

of any pre-existing injury or condition that would have contributed to his death. 

How can a seemingly healthy 16-year-old with no previous head injury history die 

after what appeared to be an ordinary football play? 

Answer. While I’m not certain I know what specific case you are referring to, it 

sounds as though it may be a case of second impact syndrome or SIS. SIS occurs 

when a young athlete sustains an initial head injury and then suffers a second head 

injury before the symptoms associated with the first impact have cleared. There are 

many times when the athlete does not report the initial injury—he may not realize 

that he had a concussion, he may be minimizing the symptoms or his desire to return to the playing field may cloud his judgment. Before the first injury completely 

resolves, which may take days or weeks, the athlete returns to competition and receives a second blow to the head—which may be remarkably minor—as in an ordinary football play. Yet the second impact produces sudden brain swelling, high 

intracranial pressure, and results in death or severe neurological disability. The 

101 

pathophysiology of the SIS is believed to be dyregulation of the cerebrovasculature, 

which young brains are more susceptible to. SIS occurs only in young athletes and 

has never been reported in an athlete over the age of 24 years. 

Another possible cause of sudden collapse and death on the football field is bleeding into the brain, such as a subdural or an epidural hemorrhage. Although these 

are very rare events and would not be expected to occur after an ordinary football 

play. 

Question 2. Are injuries such as this one preventable? 

Answer. Not playing while recovering from a concussion, even a seemingly minor 

concussion, is the best prevention against this injury. 

Question 3. How does an injury like this differ from a concussion? 

Answer. A concussion is a temporary state of neurological dysfunction accompanied by microscopic evidence of multifocal axonal injury and disordered cerebral 

metabolism. SIS occurs when there is a second concussive impact on a brain that 

has not fully recovered from the first one. The second injury produces sudden brain 

swelling that leads to brain herniation and death or severe neurological injury. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. FRANK R. LAUTENBERG TO

MIKE OLIVER

Question 1. Why has NOCSAE not substantially updated helmet standards in 

nearly 40 years? 

Answer. This is a common and persistent misconception or misunderstanding. 

NOCSAE helmet standards including football helmet standards have been updated, 

revised, expanded, and strengthened regularly over the past 40 years. Changes to 

the NOCSAE standard over time have included revisions and modifications to the 

pass fail criteria, and at other times the revisions, although appearing to be small 

simple changes in test methodology and procedures, in fact proved to be substantial 

and demanding changes that forced helmets to become more robust, more protective, 

and more durable. 

As a result of improvements and updates to the NOCSAE football helmet standard and advances in materials technology and engineering and design innovation, 

the average pass fail test scores for new helmets has dropped from 600 SI in 1998 

to just under 500 SI in 2010. Although there is no way to quantify what this reduction means in terms of injury protection and prevention, it is evidence of improvement. It also must be kept in mind that even though the pass fail threshold is 1200 

SI which threshold is based on the science behind the Gadd Severity Index (‘‘SI’’), 

in order to meet the Quality Assurance and Quality Control requirements of the 

NOCSAE standards, helmets must average 500–600 SI in certification testing. 

Football helmets certified to the NOCSAE standard and used in high school and 

collegiate play are involved in over 600,000,000 practice and game impacts during 

the course of a single football season, and sometimes they must perform across two 

and three seasons of continuous use before they are submitted for reconditioning 

and recertification. Tests performed on these helmets before they are reconditioned 

establishes that, unless padding has been removed or altered, these helmets will 

have test results that are nearly the same as when the helmet was new. Under the 

circumstances, changes to a standard which already provides an extremely high 

level of protection and performance can only be undertaken and adopted when there 

is solid and consensus scientific support for those changes. NOCSAE is one of the 

leading research funding sources for the advancement of that kind of scientific 

knowledge, in the hope that additional revisions and updates can be made to the 

standards to further enhance protection and performance. 

Some examples of changes and updates to the NOCSAE standard are listed below. 

• 1990—A random location impact requirement was added to the six predetermined impact locations contained in the standard. As a result of this change, 

helmets would not be required to be tested in locations in as many as 58 different locations not previously evaluated. This simple change prevented a helmet from being designed to meet the standard only at designated impact locations, and ensured that football helmets would meet the standard which struck 

at any location on the helmet shell and within defined limits of the edges of 

the shell. 

• 1992—Implementation of a scientifically proven calibration method of the 

NOCSAE headform using the three inch MEP is introduced. Required calibration performed before testing, produced increased repeatability between laboratories. This change was mandatory for all NOCSAE licensees. The NOCSAE 

carriage assembly was made more rigid and the air craft cable guide wires were 

102 

replaced with smoother music wire. This decreased friction in the drop system 

and increased stability of the carriage assembly throughout the drop impact. A 

tapered bolt for locating the different impact sites was introduced. The test 

MEP was hardened from a 36 Shore A hardness natural rubber surface to a 

43 Shore A hardness urethane to produce a more consistent impact surface. 

These changes resulted in significantly higher impact velocities and increased 

impact energies to the helmet, a more demanding test than in the previous 

standard. The impact energies and the velocities were increased to the point 

that sophisticated testing headforms were being broken and had to be redesigned and replaced at a cost of $350,000. 

• 1996—The pass/fail threshold was toughened by 20 percent, by changing the 

pass/fail threshold value from 1500 SI to 1200 SI. The SI value of 1200 corresponds almost directly with the Federal Motor Vehicle Safety Standard head 

injury criteria (HIC) value of 1000. 

• 1999—The new anthropometrically correct size medium headform was introduced. This change produced a more robust head model to prevent the excessive 

breaking of headforms that had resulted from the earlier changes made to the 

drop system that increased drop velocities and energies. This change created a 

head model that is less likely to break under normal use and resulted in a more 

demanding helmet test particularly for impact sites located along the rear portion of the headform. After extensive tests were carried out on the new medium 

head model, the size small and large headforms were introduced in 2002. 

• In 1994, NOCSAE introduced a proprietary data acquisition and analysis computer and software program and mandated its implementation by all licensed 

helmet recertification entities. This system has been refined multiple times over 

the intervening years, and in 2003, the entire system was replaced with a second-generation data acquisition system. One of the strengths of this test and 

data acquisition system is to prevent invalid helmet test results from being recorded. 

In the last five years, NOCSAE has clarified the zero defect or zero AQL quality 

assurance requirements of the standards, has added a third low-level impact requirement with a separate lower pass fail threshold, and has required that helmet 

impact velocities during the test be directly measured with a light activated velocity 

gate instead of utilizing mathematical calculations based upon acceleration of gravity. 

As a result of the revisions, modifications, and updates made by NOCSAE to its 

standards, football helmets certified to the NOCSAE standard outperform helmets 

certified to any other standard, whether in energy management, head coverage, durability, weight, low-energy and high energy impact performance. 

Question 2. Given the misleading claims by many manufacturers based on little 

or no scientific evidence, why has NOCSAE not developed marketing guidelines for 

products that meet its standards? 

Answer. NOCSAE is a standards development organization. The scope of our authority is limited to matters regarding compliance with the NOCSAE standards by 

licensed manufacturers and reconditioners who certified products to the NOCSAE 

standards. NOCSAE does exercise control over advertising content with regard to 

the appropriate and proper use of all registered and trademarked names, marks, 

and properties used in connection with certification to the NOCSAE standards. Unless the licensee improperly and impermissibly uses those registered properties as 

part of the objectionable content in advertising, NOCSAE has no authority to address or provide guidelines beyond that scope. The license agreement NOCSAE has 

with each manufacturer or reconditioner covers a licensee obligations with regard 

to certification and compliance with the standards is a unique and powerful control 

over the integrity and validity of the NOCSAE standards, but it cannot provide a 

legal basis for the regulation of advertising content unrelated to the proper use of 

registered and trademarked properties in compliance with the NOCSAE standards. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

MIKE OLIVER

Question 1. NOCSAE’s standard development process. Mr. Oliver, many standards 

development organizations follow a code of good practice embodied in the American 

National Standards Institute’s Essential Requirements: Due process requirements 

for American National Standards. 

These ANSI Essential Requirements include provisions for balance, openness and 

lack of dominance by any single interest category, individual or organization. DeVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00106 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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spite your description of NOCSAE’s membership and mission, your organization 

falls short of the ANSI Essential Requirements for standards development in several important respects. Will NOCSAE commit to becoming fully compliant with the 

ANSI Essential Requirements for standards development? If so, by what date? 

Answer. NOCSAE voted in June 2011, to seek accreditation as an ANSI Standards Developer, and is in the process of preparing an application for that purpose. 

It is anticipated that such accreditation will be straightforward, given the fact that 

existing NOCSAE procedures and board membership already comply with the essential due process requirements contained in the ANSI procedures. 

Being an ANSI Accredited Standards Developer signifies that standards are developed using a fair, open process that ensures a level playing field and will meet 

the needs of materially affected interests, and NOCSAE written policies and by-laws 

address those core concepts and values. 

According to published ANSI 2010 Essential Due Process provisions, the hallmarks of the ANSI due process are openness, consensus by a balance of materiallyaffected interests, consideration of views and objections, lack of dominance by any 

affected interest, transparency of the process, and provisions to provide fundamental 

fairness. The NOCSAE By-Laws define the membership of the board of directors to 

create a balanced and diverse consensus body representing materially affected interests from a variety of national organizations which represent those diverse interests 

on a broad national scale. These interest categories include medical, consumer/athlete end-user, scientific, and manufacturing interests. Membership number limits 

each category precludes any single interest group from having a controlling vote or 

veto. This defined membership structure of the NOCSAE board also satisfies the 

ANSI definition of a consensus body. 

Additionally, ANSI requirements for specific written procedures to be followed in 

adopting and publishing standards that provide for public notice and comment periods, periodic review and reaffirmation, and the use of standardized nomenclature 

have been a part of the NOCSAE procedures for many years. 

The application for ANSI accreditation will be submitted before January 30, 2012, 

but it cannot be known when the application will be approved by ANSI. 

Question 2a. NOCSAE’s market surveillance. Mr. Oliver, you state in your testimony that NOCSAE performs market surveillance. This seems to contradict what 

is written in the NOCSAE drop impact test method used for football helmets, which 

clearly states that: 

‘‘NOCSAE publishes standards but does not conduct surveillance to assure compliance to standards. It is the sole responsibility of firms that manufacture or recertify 

protective products to certify that all requirements of these standards are met, including ongoing statistically relevant QC protocols.’’ Can you explain this discrepancy between your statement and what is written in the NOCSAE standard? 

Answer. The reference in the standards that NOCSAE ‘‘. . . does not conduct surveillance to assure compliance to standards’’ refers to market surveillance that is 

typically performed by certifying bodies, such as CE Notified Bodies in Europe, and 

certifying bodies in the United States such as Underwriters Laboratories and the 

Snell Foundation as part of their product certification duties. NOCSAE is not a certifying body and so does not conduct formal market surveillance as part of the 

standards development process, and the referenced paragraph is intended to make 

that fact clear to consumers, manufacturers, and licensees. 

The purpose of a market surveillance program utilized by certifying bodies is to 

protect the integrity of the certification mark, to prevent counterfeit and non-conforming products from reaching the consumer market, and as a check on the manufacturer who is placing the certifying body’s mark on the product. ‘‘Market surveillance’’ as commonly used in this context involves the certifying body supplementing 

its own product certification testing on limited samples provided by a manufacturer 

with tests on a sample of unused certified products purchased in the market after 

the certified product has been distributed by the original manufacturer. 

But many of the policies and duties imposed by the NOCSAE standards and the 

license agreement between a manufacturer and NOCSAE involve activities that 

would fit the definition of market surveillance, and which accomplish the same goals 

as with a certifying body, although on a much more demanding and far reaching 

scope than any traditional market surveillance program maintained by a certifying 

body. 

Formal and traditional market surveillance programs test only new products purchased at retail to verify the accuracy of the certification mark, but no surveillance 

program tests used products as part of that process. The NOCSAE recertification 

standards involve testing and evaluating previously certified equipment for as long 

as the equipment is being used and submitted for recertification. To make an analogy, the NOCSAE product surveillance program would be the equivalent of UnderVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00107 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
104 

writers Laboratories going into homes and re-testing toasters that have been in use 

for years, and verifying that the toasters still comply with the original UL mark. 

Testing used helmets for the purpose of recertification is also an affirmation and 

validation of the integrity of the new helmet certification. If the helmet meets the 

standard after it has been used for several seasons, it is a given that it met the 

standard when it was newly certified. That fact alone obviates the need to purchase 

new, unused helmets at retail in order to verify the accuracy of the original certification. 

Each year, NOCSAE licensed recertifiers re-test tens of thousands of randomly selected helmets of varying brand, model, age and condition based on time elapsed 

since last reconditioned. This recertification process is regulated by NOCSAE standard, and controlled by proprietary testing and data acquisition software developed 

by and for NOCSAE. The re-testing process is randomized sample based, and involves testing a helmet both in the exact condition it was in when it last came off 

a player’s head, without any repair or modification, and then testing the very same 

helmet again after it has completed the reconditioning process. For each helmet 

tested, the program collects 28 separate data points, including brand, model, model 

year, size, test headform model and size, test laboratory temperature, date and time 

of testing, the name of the test technician and the laboratory name and location, 

and the performance test scores for 8 separate impacts across 4 different impact locations. 

In the 2009–2010 reconditioning season, there were 50,508 different football helmets tested representing over 50 different models spanning more than 10 model 

years. Additionally there were 880 lacrosse helmets tested, and over 1,500 batters 

helmets tested. 

The NOCSAE data acquisition computer and software used by each recertification 

facility forces an internal and external system function and calibration check before 

and after each batch of helmet testing. If the pre-test calibration check test fails, 

the system prohibits testing until the calibration failure is resolved. If the system 

and calibration check test fails after a batch of helmets is tested, the test results 

for those helmets is voided and dumped into a special file, and all the helmets tested in that batch must be re-tested. If the pre-and post-test calibration and system 

checks pass, the helmet test results are stored in an encrypted file which is accessible only by the NOCSAE Technical Director for review and analysis. 

This dataset provides market and product surveillance information for certified 

helmets new and old, as well as information on team and school reconditioning frequency across the country, and on the quality controls of each licensed recertifier. 

From this data an extremely detailed historical record of the performance over time 

of helmet models by year, age, and years since last reconditioned has been developed. As an example, in the 2009–2010 dataset, the before and after performance 

of several models can be compared over 15 model years to determine whether there 

is a decline in the performance of the helmet, and to what extent the reconditioning 

process has restored or even improved the helmet’s original performance levels. 

There is no other market surveillance program in the world for personal protective 

equipment that comes close to evaluating the continuing validity of the equipment 

certification. 

A combined dataset that includes testing done from 2005 through 2011 contains 

7,728,000 separate data points on 276,000 individual helmets, and includes 

2,208,000 helmet impact performance data points. 

This product surveillance process is supplemented by a mandate that each certification and recertification facility participate in round-robin system equipment calibration programs directed by an A2LA accredited laboratory at least once a year, 

and more often if indicated. 

As with many international product certification programs, the NOCSAE standards mandate that licensees submit certified products for testing and validation annually to a third party testing laboratory certified to ISO 17025 standards, and that 

new products or models must be submitted for third party laboratory validation in 

advance of distribution. In order to receive a license agreement an applicant must 

first submit a report from an appropriately accredited third party laboratory confirming that the products they intend to certify to the NOCSAE standard actually 

meet the standard. Those validation tests and reports are a check on the accuracy 

and validity of the original certification of that product consistent with the goals and 

intent of a formal market surveillance program. NOCSAE follows almost the identical third-party laboratory validation protocol requirements mandated by the CPSC 

for bicycle helmets certified to the CPSC standard. 

Additionally, if NOCSAE is made aware of a potential invalid or incorrect certification, NOCSAE does engage in a focused investigation in the form of direct helmet 

purchase at retail, and testing to determine whether the manufacturer’s certification 

105 

is void or valid. We will also demand the production of all certification testing data 

and results, including all QA and QC that the licensee uses to support its certification of helmets, both as an independent check on the certification process, and as 

part of an investigation as to a specific product. 

NOCSAE does not conduct formal market surveillance as part of a product certification program, but the requirements in the NOCSAE equipment performance 

standards result in a product surveillance and validation function which far exceeds 

traditional certifying body market surveillance programs both in scope and performance demands as it validates and verifies helmet standard compliance certification 

for new and used helmets. 

Question 2b. Did NOCSAE ‘‘market surveillance’’ efforts, if any, discover problems 

related to compliance with NOCSAE standards at any helmet manufacturer or reconditioner? My understanding is that NOCSAE did not learn of problems at a New 

Jersey reconditioning company, for example, until after they were exposed by a Federal criminal probe. 

Answer. The only reconditioner that was the subject of a Federal investigation 

was Circle System in Easton, Pennsylvania, and that investigation did not involve 

failed helmets or a failure to properly test helmets. The breach in that case was the 

fraudulent underreporting of the number of helmets recertified. There was never a 

finding by the FBI or NOCSAE, following its own separate investigation, that the 

recertified helmets from Circle System failed the recertification tests, or that the 

helmets were poorly reconditioned. From what little has been revealed by the investigators and in the press, the owners of Circle System apparently defrauded their 

insurance company and NOCSAE by intentionally underreporting the total number 

of helmets recertified, thereby saving significant premium expenses and license fees, 

while at the same time double billing school districts and customers. 

Market surveillance testing would not have discovered this type of fraud. Reconditioned helmets are not sold at retail, and the helmets reconditioned and recertified 

by Circle System had been reconditioned several times before the fraud was discovered, and there was no data to support any conclusion that he helmets had been 

improperly reconditioned or incorrectly recertified. 

Although no incidents of product failures have been discovered, NOCSAE has discovered several situations which required a licensee to revise and supplement its 

QA and QC programs, and provide supplemental testing of larger samples to meet 

those requirements. 

Question 3. No NOCSAE requirement for maximum helmet lifespan. Mr. Oliver, 

you stated during the hearing that NOCSAE relies on manufacturers regarding the 

recommended lifespan of football helmets. However, NOCSAE’s own technical director, Dave Halstead, told The New York Times he ‘‘would never let [his] kid wear 

a helmet that is more than 10 years old.’’ Another NOCSAE expert, Dr. Robert 

Cantu, wrote in review comments for the 2006 Neurosurgery study of Riddell Revolution football helmets that: 

‘‘As Vice President of the National Operating Committee on Standards for Athletic Equipment (NOCSAE), the organization that makes the certification standards for football helmets and other athletic equipment, I am aware . . . that 

new helmets test to a higher severity index level than older helmets. New helmets out of the box before receiving the thousands of hits that they will incur 

on ensuing seasons often test significantly below the 1200 severity index that 

they must pass. Then, with each year’s passage of time, their abilities to attenuate acceleration forces decline.’’ 

Dr. Cantu is also quoted in the book Head Games: Football’s Concussion Crisis 

from the NFL to Youth Leagues (page 109) as follows: ‘‘The brand new helmets that 

come right off the shelf are about 800 [SI], way better than the letter of the rule. 

Over the course of a season, or seasons, they get worse. . . .’’ 

Given that NOCSAE’s own experts believe newer helmets are safer than older 

ones, will NOCSAE commit to revising its football helmet standards to include a 

maximum lifespan for football helmets? 

Answer. Questions regarding the proper life span of a helmet, sometimes referred 

to as the useful safe life, involve considerations unique to each manufacturer such 

as design function, product liability exposure, proper care and treatment, and materials performance characteristics that are outside the authority and function of an 

independent standards setting body such as NOCSAE. Helmet performance standards developed by NOCSAE are intentionally design neutral so that engineers and 

designers are not restricted in their approach to helmet function and design. That 

freedom has resulted in the development of at least three unique engineered approaches to protecting the heads of athletes that involve different materials, difVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00109 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
106 

ferent mechanical properties, and even different physics principles. Because of these 

differences, life span issues that might be relevant to one type of system may not 

be relevant to the others. Because a standard, by definition, must apply equally to 

all products within its scope, any provision that imposes a limit on how long a helmet can be used will be an arbitrary decision which can unduly harm one brand 

while giving an advantage to another. The creation of a maximum life for a helmet 

through a standard also creates a risk that players and parents will assume that 

a helmet is safe and needs no attention as long as it is still within the defined ‘‘useful safe life.’’ Notwithstanding these concerns, what NOCSAE can do, and what it 

does, is continuously evaluate the performance of helmets over time to see if there 

are data that might indicate the need to further investigate this issue. 

I am personally familiar with each individual quoted, and based that and the actual helmet performance test data that NOCSAE has collected over the past 15 

years, I am confident that Dr. Cantu and Mr. Halstead were referring to older helmets that have not been properly and regularly reconditioned when they were commenting on helmets of a particular age. Recertification test data covering hundreds 

of thousands of helmets document a helmet’s performance over time and under various reconditioning frequencies, and the data does not support a conclusion that a 

helmet’s age, standing alone, is related to that helmet’s performance abilities. There 

is very little, if any, decline in the performance of a football helmet over the course 

of a season, absent significant abuse or intentional alteration of the padding system. 

Football helmets are designed to handle repeated impacts in quick succession over 

thousands of impacts. Current literature involving the in vivo collection of football 

helmet impacts over more than 7 seasons by researchers at upper division colleges 

and at the high school level has shown that a player’s helmet will likely be hit more 

than a thousand times per season. In 2009–2010, new 2009 helmet models tested 

after just a single football season and before any reconditioning, averaged in the 500 

to 600 SI range on the impact location which is most likely to have the highest SI 

values. That value is almost identical to the average SI values scores as new unused 

helmets, and in many cases that number is actually lower than when the helmet 

model was tested for certification as a new helmet. 

For a 10 year old helmet that has been properly reconditioned and has had the 

padding system replaced with new padding that meets or exceeds the original padding performance levels, the only 10 year old part of that helmet is the shell, and 

unless the shell is cracked, which would prevent its recertification, that helmet 

should perform as good if not better, than when it was new. And the recertification 

testing data shows that such is true. 

Tragically, catastrophic and even fatal head injuries have occurred to players 

wearing brand new helmets, which speaks more to the fact that there are some serious and even fatal head injuries which cannot be prevented by any helmet. The 

rapid and usually fatal brain swelling and auto-regulatory dysfunction that is seen 

in second-impact syndrome, which seems consistent with facts describing the injury 

to Max Conradt, can occur from very slight hits to the head and even without head 

contact through whiplash type accelerations of the head if that player has been returned to play too soon following a concussion. In those cases, the injury risk likely 

is unrelated to the age or performance of the helmet being worn. 

Question 4. Helmet requirements for high school football. The National Federation 

of State High School Associations (NFHS) sets football playing rules and equipment 

guidelines that are adopted by many state athletic associations. The 2010 NFHS 

Football Rules book requires players to wear a football helmet and face mask that 

‘‘met the NOCSAE test standard at the times of manufacture’’ (see page 17). However, NFHS rules allow a football helmet that is no longer in compliance with 

NOCSAE standards to be worn by high school player as long as the helmet met 

NOCSAE standards when it was originally made. NFHS also does not require that 

an older helmet be reconditioned and recertified to NOCSAE standards. Should high 

school football equipment rules require that any helmet used by a player meet current NOCSAE requirements when it is actually being worn—and not just on the day 

it was manufactured? 

Answer. As with any equipment or product certified as compliant with a standard 

at the time the new product was manufactured, once placed in use, the continued 

validity of that certification is dependent not only upon proper use and care, but 

also on the designed durability of all component parts, and the margin between the 

standard’s pass-fail threshold requirements and the actual helmet test performance 

when certified. From years of post-use recertification testing of all brands and models and ages of helmets, 99.86 percent of the helmets tested from the field after one 

or more seasons of use and before reconditioning will perform far below the threshold and still meet the standard by a significant margin. This extremely high percentage includes all helmet models, all ages, and all conditions, and it includes helVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00110 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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mets which may have had altered or damaged padding, since the BEFORE reconditioning test of these randomly selected helmets does not permit repair before the 

helmet is tested. When tested after reconditioning, the percentage that passes is 

99.95 percent, and the 0.05 percent that doesn’t pass is not returned to the school 

or club. So the persistence of the validity of a helmet’s certification to the NOCSAE 

standard over time and use is extremely high when helmets are regularly reconditioned. That means that it is extremely rare for a helmet to be used by a player 

that doesn’t meet the standard, even after significant use over several seasons. 

An important reason for such extremely high certification validity persistence is 

the Quality Control and Quality Assurance levels that are imposed upon NOCSAE 

licensees who certify their equipment to NOCSAE standards. In order to reach the 

zero defect or 0 AQL levels, the average passing SI value for every new helmet impact location must be substantially below the pass-fail threshold of 1200 SI. For all 

new 2010 adult and varsity helmets in size medium certified to the NOCSAE standard, the average certification SI value was 497 on the front location, which historically has the highest SI values. This same general margin has existed for many 

years. 

With the levels of Quality Assurance and Quality Control mandated by the 

NOCSAE standard, all organizations, including high schools, should have the highest level of confidence that the helmets meet the NOCSAE standard. 

Question 5. Football helmet reconditioning. The NOCSAE website FAQ page 

states that ‘‘There is nothing in the NOCSAE standard that requires any helmet 

to be recertified on any regular basis.’’ Ralph Conradt states that his son Max was 

injured while wearing a twenty year old helmet that, when tested after Max’s injury, was found to not meet NOCSAE’s safety standards. Given that some high 

school football players could be wearing unsafe helmets that are twenty years old 

and that no longer meet NOCSAE standards, will NOCSAE commit to updating its 

football helmet standards to require reconditioning on a regular basis? 

Answer. How frequently a particular helmet should be reconditioned and recertified is dependent upon many uncontrollable variables, including the level and intensity of usage and condition at the end of a season. The reconditioning and recertification process is a significant budget item for most high schools, and a standard 

arbitrarily mandates annual reconditioning where the data does not support the 

conclusion that annual recertification is necessary at every school or with every helmet simply adds additional budget and expense burdens to school districts already 

facing severe pressures. NOCSAE is committed to exploring options in this regard, 

and currently strongly recommends reconditioning and recertification every year. 

When a school or club cannot afford annual recertification of all their helmets, 

NOCSAE strongly recommends the adoption of a two-year or three-year cycle of regular reconditioning and recertification such that each year one third to one half of 

the helmets in the program are submitted for reconditioning and recertification, and 

the remainder are evaluated pursuant to a written inspection and assessment program to identify helmets with obvious damage, missing pads or components, or 

other signs that indicate the need for reconditioning and recertification, even if that 

helmet is not scheduled for reconditioning. 

Data available to NOCSAE from the recertification test datasets establishes that, 

with the exception of helmets which are missing pads or which have been altered 

or may have broken shells, there is no statistically difference in the average SI values of helmets submitted every year for reconditioning/recertification and those submitted every other year, or even every three years. As a general rule, the primary 

benefit of annual reconditioning and recertification is that it inserts an experienced 

third party into the helmet inspection and assessment process, and increases the 

likelihood that hidden problems or unrecognized damage will be discovered and addressed, and it probably would limit the swapping of pads and padding systems 

among different helmet brands and models. 

Max Conradt 

When the helmet used by Max Conradt was made and certified to the NOCSAE 

standard in 1983, the pass/fail threshold in the standard was 1500 SI. Helmets can 

only be recertified to the standard applicable to the original certification. The testing data presented to the court in the Conradt case by an accredited laboratory acceptable to the court and to each side, established that the helmet in question, when 

tested to the NOCSAE standard after Max Conradt was injured passed all impact 

test locations below the 1500 SI threshold, and even passed all impact location tests 

to the 1200 SI threshold, with one location exception, and that location was not a 

location where it was suspected that Max had been hit. The Conradt helmet was 

manufactured in 1983, just 3 years after the NFHS made compliance with the 

NOCSAE standard mandatory for high school play. As recently as 2009–2010, of the 

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48,000 randomly selected helmet sample set tested for recertification, there were 28 

helmets in the sample set made before 1991, and all tested below the 1200 threshold 

BEFORE (meaning as they were in use and on the field) reconditioning on every 

test impact location, even though the applicable threshold for those helmets was 

1500. 

The type of severe and life changing head injury sustained by Max Conradt, although very rare, has no specific association with the age or SI values of a particular football helmet. Almost identical non-fatal and fatal injuries have occurred 

to players wearing brand new 2009 and 2010 helmet models, and some epidemiological data suggest that the rate of occurrence of these types of injuries has remained 

relatively steady over time, unaffected by improvements in helmet technology, SI 

values or helmet age. 

Certainly the best level of protection any helmet can provide is a function of proper maintenance, regular reconditioning and recertification, and following warnings 

and instructions. No standard can guarantee an outcome or even a performance 

level, but compliance with the NOCSAE standard will provide the player, coach and 

parent with the highest level of protection available today, and as much assurance 

as is possible that the helmet will continue to meet that standard as long as it is 

properly maintained. 

Question 6. Football helmets in use at high school and younger level. USA Football 

estimates that there are 3 million youth football players. In addition, there are an 

estimated 1.4 million high school football players. Of this group of about 4.4 million 

football players, how many are wearing: 

(1) new helmets 

(2) helmets manufactured or reconditioned in the last year 

(3) helmets manufactured or reconditioned in the last two years 

(4) helmets that have not been reconditioned in more than two years 

(5) helmets older than two years that have never been reconditioned? 

Answer. It is impossible to know the answers with definite certainty because 

many of those players are outside the control and supervision of any national governing body. We do know that on average there are approximately 800,000 new helmets sold each year, and approximately 52 percent of those are categorized as 

‘‘youth models’’ which could include models intended for use at the middle school 

level. We also know that there are youth players who must wear adult or varsity 

helmets because the youth models are too small for them. 

(1) new helmets: approximately 800,000 are wearing new helmets 

(2) helmets manufactured or reconditioned in the last year: 2.5 million 

(3) helmets manufactured or reconditioned in the last two years: 3 million 

(4) helmets that have not been reconditioned in more than two years: it is impossible to know this number exactly. We know that each year there are approximately 250,000 helmets sent for reconditioning and recertification that have not 

been reconditioned for more than 2 years, but we currently have no way to 

know whether that number is statistically representative of the helmets in the 

field. 

(5) helmets older than two years that have never been reconditioned: unless the 

helmets are sent for reconditioning, there is no way to answer to this question. 

Question 7. NOCSAE drop test and helmet quality. My understanding is that the 

NOCSAE safety standard for football helmets is primarily a drop test method that 

requires helmets to score less than a 1200 severity index (SI) level. Is there a difference in the level of protection offered by a helmet that tests at an 1199 SI level 

and a helmet that tests at a 300 SI level? 

Answer. The answer depends on which type of injury is being analyzed. The 1200 

SI threshold is premised upon a risk analysis curve, very much the same as HIC 

values used in Federal Motor Vehicle Safety Standards. The HIC and SI plotted 

curves are logarithmic and as the values pass downward through 1200 the curve 

flattens such that measurable differences between 1200, 1100, 1000, and on down 

become very small. As to those injuries for which the 1200 SI threshold is intended 

to address, no quantitative or qualitative comparisons can be made between SI values of 300 and 1100 as to which will prevent more injuries. Certainly lower (all 

other helmet attributes like mass and shape being the same) would be better in general, but there is no linear relationship or scale than can state with any confidence 

how much more protective a lower value is over a higher value. This is particularly 

true with regard to the kinds of engineering and design changes that might be necVerDate Nov 24 2008 08:39 Mar 30, 2012 Jkt 073514 PO 00000 Frm 00112 Fmt 6601 Sfmt 6621 S:\GPO\DOCS\73514.TXT SCOM1 PsN: JACKIE
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essary to obtain lower values, and whether the impact being tested is a high energy 

impact or a low energy impact. 

An SI score of 1200 is essentially equivalent to a HIC score of 1000, which represents the ‘‘safe’’ limit of human injury tolerance, above which the risk of a fatal 

or catastrophic head injury is clear, and the probability of that type of injury rapidly 

increases with higher SI values. But because of the logarithmic characteristic of the 

scale, the converse is not true as the values decrease below 1200. The 1200 SI 

threshold is like a doorway, once you are through it you can go further into the 

room, but outside is still outside. An SI value lower than 1200 represents some reduction in risk, although very minor (negligible), but going higher represents a near 

exponential increase in risk. The importance and validity of HIC or SI as weighted 

impulse criteria is frequently debated but the criterion remains extensively used because no better formulations or thresholds have demonstrated reduced injury risk. 

For example, in the USA, Europe and elsewhere, government mandated performance requirements for automotive seatbelts, airbags and other safety devices are 

specified in terms of a ‘not to exceed’ HIC score, with no specified benefits for being 

under that limit by any percentage. 

Question 8. Clearly visible labels. Mr. Oliver, you stated during the hearing that 

NOCSAE does require clearly visible ‘‘date of manufacture’’ and ‘‘date of last reconditioning’’ labels for football helmets. However, the primary NOCSAE technical 

standard for football helmets, NOCSAE DOC (ND) 001–08m10, in section 9.4, states 

that helmets must have: 

‘‘A permanent and legible label or mark that denotes the month and year of 

manufacture that can be easily read without removing any permanent component. If this mark or label requires a ‘code’ to determine month and year, such 

code shall be made available upon request.’’ 

This contrasts with the standard’s requirements that other labels are ‘‘not obscured in any manner.’’ 

• Will NOCSAE commit to revising its standard to include a requirement for 

clearly visible date of manufacture and date of last reconditioning labels that 

are not obscured in any manner? 

• Will NOCSAE commit to revising its standard to require that the date of manufacture and date of last reconditioning be easily read and understood by players, 

coaches and parents? In other words, will NOCSAE require that such labels are 

not written in ‘‘code’’ which can only be interpreted by the manufacturer or reconditioner 

Answer. New Helmets. NOCSAE is committed to evaluating the existing standard 

requirements for the placement and visibility of a manufacturing and recertification 

date for helmets certified or recertified to the NOCSAE standard. The NOCSAE 

standards incorporate the considerations contained in ANSI Z535.4, and NOCSAE 

is committed to continued compliance for all helmet labeling and warning requirements. We are currently exploring several options for improvement, and we are committed to that process as we always are in maintaining NOCSAE standards. Deciding whether and how a specific piece of information is located and identified on the 

helmet also involves human factors consideration as to whether such information 

may dilute the effect of, or divert visual attention from, other specific hazard warnings and signal words already on the external portions of the helmet. 

ANSI warning label requirements distinguish between warning labels that address hazards and those which convey information that may be related to hazards 

and indicate matters such as location and visibility. The age of the helmet shell, 

which is all the manufactured date will reliably indicate for a used helmet, is not 

related to any identified hazard or risk of injury, nor is it a piece of information 

reasonably necessary to be accessed under emergent circumstances. There is also no 

common agreement or understanding with regard to whether the more important 

date for a consumer or user is the date the helmet was first used and not the date 

the shell was made. A helmet with a manufactured date of 2009 may not first be 

used by a player until the fall of 2011. Is the manufactured date for that helmet 

more representative of its quality and ability to perform than a helmet with a manufactured date of 2010, but which has been used for part of the 2009–2010 season 

and all of the 2010–2011 season? 

To complicate matters more, there are helmets which may have their component 

parts manufactured on different dates and not actually assembled for a year or 

more. Which date is the one which should be provided to the consumer in those 

cases? If the shell was manufactured in 2009, the various protective energy attenuating system components manufactured in 2008, 2009, and 2010, and final assembly 

of that helmet did not occur until 2012, which of those dates is provides material 

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and useful information for the consumer to know with regard to the ability of that 

helmet to perform? The issue of a manufactured date is not a simple one, and 

NOCSAE is committed to investigate and address the matter to determine if there’s 

a better or more functional way to present the model year information. 

Reconditioned Helmets 

NOCSAE recertification standards have required for many years that the reconditioning and recertification date be plainly visible and placed on the helmet. The recertification date and the identity of the entity that performed the reconditioning 

and recertification are required. All licensed recertifying companies follow the same 

format and actually use the same company to print the labels for each season. If 

the manufacturer’s original certification logo is no longer visible on the outside of 

the helmet, then a recertification label must be placed on the outside. An example 

of the outside information mandated by the NOCSAE standard is: 

Every recertified helmet must also have a label on the inside, underneath the 

padding, which includes a statement verifying recertification and indicating the year 

and name of the company which performed the recertification. Placement of this information on the inside of the helmet shell and underneath removable padding 

makes it easily accessible, while also protecting the label and information from damage and removal during usage. As with the manufacturing date of a helmet or helmet shell, the recertification date and identity of the recertifying entity is not information that would need to be accessed quickly under emergency circumstances, but 

should be easily accessible without having to remove permanent component parts. 

Question 9. NOCSAE licensing agreement and advertisements with NOCSAE seal. 

Mr. Oliver, your written testimony states that NOCSAE’s licensing agreement with 

helmet makers ‘‘obligates each licensee to obtain prior approval of proposed advertising which uses the NOCSAE name or references NOCSAE as part of its advertising.’’ 

A Riddell brochure titled ‘‘Revolution Helmet Research Findings’’ (available at: 

http://www.lohud.com/assets/pdf/BH1661391028.PDF, accessed Oct. 19, 2011) references NOCSAE in three separate places and includes the NOCSAE seal in two 

places. This advertisement prominently features Riddell’s claim that research shows 

a ‘‘31 percent reduction of the relative risk of sustaining a concussion when wearing 

a Revolution vs. a traditional helmet.’’ 

• Did Riddell obtain approval from NOCSAE to use the NOCSAE seal and name 

in this brochure? 

• If so, why did NOCSAE approve the use of its seal and name in an advertisement featuring a concussion reduction claim that NOCSAE technical director 


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Dave Halstead and NOCSAE board member Dr. Robert Cantu have publicly 

criticized? 

Answer. The authority of NOCSAE under the license agreement to review licensee 

advertising is limited to ensuring compliance with permitted uses of the name, 

phrases and certification marks which are trademarked and registered properties of 

NOCSAE. The license agreement does not provide NOCSAE with a blanket right 

or duty to review and approve all advertising content, nor to impose its own opinions as to the accuracy of claims that do not involve actual or potential misuse of 

the registered and trademarked properties. The NOCSAE seal, mark and name 

were properly used in the referenced advertising, and were not a part of or suggested as support for the other claims in the advertising. NOCSAE does not endorse 

recommend or indicate the use of any particular helmet, other than to state that 

the helmet meet the standard. 

NOCSAE board members and independent contractors, such as Mr. Halstead, are 

free to comment on matters of interest to them, including the references described 

in this question. 

Question 10. Independent Testing and Certification. Mr. Oliver, your testimony 

states that ‘‘NOCSAE also maintains an ongoing independent contract with an 

A2LA accredited and ISO 17025 certified testing laboratory.’’ 

• Is this testing laboratory also accredited to ISO Guide 65, ‘‘General Requirements for Bodies Operating Product Certification Systems’’? 

• Does NOCSAE’s testing laboratory have any commercial ties to helmet manufacturers or reconditioners that could potentially create a conflict of interest 

when certifying helmets to NOCSAE standards? If so, please clearly describe 

any such potential conflict of interest. 

Answer. It should be kept in mind that neither NOCSAE nor the laboratory in 

question certifies products or equipment to the NOCSAE standards. ISO Guide 65 

pertains only to entities which actually certify products or equipment. Certification 

of compliance with NOCSAE standards is done by the manufacturer pursuant to a 

license agreement, and annual proof of compliance with the standards through 

third-party laboratory validation testing. The procedure tracks very closely to the 

self-certification made by manufacturers under the CPSC rules for bicycle helmets, 

except that the authority of NOCSAE over the manufacturer is based on the license 

agreement, not Federal laws and regulations. 

The laboratory with which NOCSAE contracts for technical advice and testing is 

the Southern Impact Research Center, (‘‘SIRC’’). SIRC is A2LA accredited and certified as compliant with ISO 17025 standards for independent testing laboratories 

to perform testing to all NOCSAE standards, and is also an approved and accredited 

testing laboratory under the CPSC Bicycle helmet standard, and is directly approved by the CPSC for independent testing under 16 CFR Part 1203 and Part 

1501. SIRC is also A2LA accredited to perform testing under FMVSS 218 VESC– 

8, Sec 8 for motorcycle helmets eye protection and many other helmets. The lab is 

under contract with the military for independent testing of military related items. 

SIRC is not certified under ISO Guide 65, at least for NOCSAE purposes, as they 

do not perform product certification to the NOCSAE standards, but SIRC is involved 

with product certifications with the Safety Equipment Institute which is a Guide 65 

entity. 

The only commercial relationships which SIRC has with manufacturers who may 

also be NOCSAE licensees would be on a job by job basis where a licensee may contract with SIRC laboratory to conduct validation testing, or to submit products for 

evaluative testing. All board members and contractors are required to submit conflict of interest disclosure statements. 

Question 11. NOCSAE not keeping football helmet standard up to date. Mr. Oliver, 

several NOCSAE members have publicly criticized your organization for not doing 

enough when it comes to keeping helmet standards up to date. In an October 20, 

2010 New York Times article, reporter Alan Schwarz quotes Dr. Robert Cantu as 

saying that NOCSAE has been ‘‘asleep at the switch’’ and that Cantu has been ‘‘calling for a new standard to be written for football helmets for years, and NOCSAE 

has been sitting on their duffs.’’ 

The New York Times article further notes that: ‘‘Dr. Cantu. . .said that the board 

has become as concerned about legal liability as about child safety. If [NOCSAE] 

were to supplement its helmet standard in an attempt to address concussions, it 

could open itself to lawsuits brought by players saying that their helmet did not prevent the injury. . . .’’ 

Dr. Blaine Hoshizaki, from the University of Ottawa, told the The New York 

Times that he lobbied NOCSAE to strengthen its standard five or six years ago but 

112 

he says, ‘‘It was like punching a balloon; they, yes, understand, and then do nothing.’’ In the article, he goes on to say of NOCSAE: ‘‘They say they don’t know what 

the thresholds are; OK, but I can tell you that less angular acceleration is better 

than more . . . To suggest we have no idea so we’ll do nothing is not an excuse 

to me. This has become a serious impediment to making a safer football environment.’’ 

• Given this level of criticism from NOCSAE’s own experts, why should coaches 

and parents of young football players rely on NOCSAE to maintain up-to-date 

voluntary safety standards for football helmets? 

• What steps will NOCSAE take to update and maintain its helmet standards 

given new medical understanding of concussion risk and the latest state of the 

art in helmet technology? 

Answer. I have attached copies of the written responses from each gentleman addressing The New York Times assertions with regard to NOCSAE. I cannot explain 

why the quotes in the article differ markedly from what the quoted speakers have 

said in response, nor can I explain why the article contains assertions that differ 

from the documented and uncontested facts 

The quotes from The New York Times do not accurately reflect the comments and 

opinions of those who were quoted. In a letter he prepared and sent to Mr. Schwarz, 

(attached as Appendix A) Dr. Cantu took issue with the quotes attributed to him: 

‘‘Since 2000, NOCSAE has provided approximately $2.4 million to fund research 

grants looking at all aspects of concussion in sports, including validation of the 

new linear impactor. In January 2010, by motion I fully supported, NOCSAE 

created a special ad hoc committee to examine any other possible avenues to 

more rapidly advance science and research in the area of concussion. The 

NOCSAE Multi-Disciplinary Expert Task Force which met on October 23 on 

Cape Cod was one of those avenues identified by the ad hoc committee. This 

meeting was being planned and developed long before your investigation and is 

a process which NOCSAE has followed in the past. 

These activities are not those of a group that is ‘‘asleep at the switch’’ or that 

has been ‘‘sitting on its duff,’’ quotes you attributed to me. Every NOCSAE 

Board member is frustrated that there is yet no answer as to how concussions 

might be more effectively addressed in our helmet standards, but the frustration is not with NOCSAE, it is that despite our own internal efforts and substantial research funding to outside experts, science has yet to find an answer 

that we can incorporate into our helmet standards to specifically improve concussion protection.’’ 

As general counsel I can state with certainty that no decision regarding new 

standards or changes to existing standards was based or premised upon potential 

legal liability that might arise because of the differences between helmets certified 

under older standards and ones certified to the newer standards. Such a decision 

was in fact made when the first NOCSAE football helmet standard was published 

in 1973. That new standard rendered almost 80 percent of existing helmets noncompliant. And the same decision was made when the pass/fail threshold was revised from 1500 SI to 1200 SI. 

To the extent any legal liability might exist at all, it would arise from acting arbitrarily in adopting or revising a standard without the valid scientific data necessary 

to support a conclusion that the change would be effective, and that it would not 

create an increased risk of other injuries. NOCSAE has a responsibility to the public 

and to players and parents to premise its standards on science and valid data, and 

it will not abandon that responsibility to cater to the pressures and demands of nonscientists. In order for the public to have the confidence that the NOCSAE standard 

has meaning and validity, it must be premised upon sound and consensus scientific 

data. 

Regarding the quotes attributed to Dr. Hoshizaki, I asked him for clarification following the printing of the article in question. The quotes attributed to him were personally puzzling because I knew he had never contacted me to discuss any of the 

issues identified in the article. I also knew that he had not attended any board 

meetings since I became Executive Director in 1995, and I was unable to find any 

correspondence or other e-mail contacts from him on those subjects. Dr. Hoshizaki 

was kind enough to respond in writing (attached as Appendix B to these responses), 

and he explained to me: 

‘‘As for the comments recorded in The New York Times article they were the 

author’s interpretation of what I felt is a disconnect between NOCSAE and the 

broader scientific community. My previous discussions with David Hallstead 

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[sic] revolved around understanding the process for the [sic] making decisions 

regarding the development of the NOCSAE test standards and resulting implications.’’ 

Dr. Hoshizaki is certainly a well-respected scientist and biomechanical engineer, 

and has published some excellent work regarding helmet performance and biomechanics of head injury. It appears that he was frustrated with his understanding 

of the NOCSAE process, and perhaps his interactions with Mr. Halstead on other 

standards related issues with other organizations. Mr. Halstead and Dr. Hoshizaki 

have worked together on many non-NOCSAE activities and are in fact at this time 

working together on a research project in this very area. There was never any lobbying effort by Dr. Hoshizaki as the reporter described, and the board meeting minutes do not contain any references to such attempts. Any such requests by Dr. 

Hoshizaki would certainly have been seriously considered and discussed, simply because of his reputation. In fact, the NOCSAE board had contacted Dr. Hoshizaki in 

the year prior to the printing of The New York Times article to request that he serve 

on a NOCSAE sponsored Concussion Task Force expert panel that was convened in 

October 2010 to help NOCSAE map out a plan for focusing research efforts to better 

address concussions through helmet standards. 

As for his quote regarding the injury threshold levels, all that can be said is that 

almost every peer reviewed article that has considered this question in the last 10 

years has reached a different conclusion. The consensus scientific opinion on this 

issue is clearly expressed by Dr. Kevin Guskiewicz in a 2011 article describing the 

elusive injury threshold for concussions and mTBI: 

‘‘What is the relationship between clinical outcome measures from our earlier 

work and biomechanical factors? The literature has not adequately addressed 

this question. We hypothesize that within the spectrum of concussion or mTBI, 

the biomechanical threshold for sustaining the injury is not only elusive, but 

impact severity (measured in acceleration/deceleration) may be clinically irrelevant.’’ Guskiewicz, K. M. and J. P. Mihalik (2011). ‘‘Biomechanics of sport concussion: quest for the elusive injury threshold.’’ Exerc Sport Sci Rev 39(1): 4– 

11. 

The Task Force Committee, with significant input from Dr. Hoshizaki and Dr. 

Guskiewicz, agreed there was no present threshold which could be incorporated into 

a helmet standard that could effectively reduce the frequency and or severity of concussions. The Task Force committee identified specific research and work that 

would be necessary to reach a point where revisions could be made to the NOCSAE 

standards that could effectively address concussion issues. Dr. Hoshizaki is currently doing some of that very work at the present time under a focused research 

grant from NOCSAE. 

There is no helmet standard in the world which more effectively or aggressively 

addresses head injuries than does the NOCSAE standard. Apart from the Federal 

government, there is no other organization that has invested more research dollars 

over the past 10 years to address concussion protection through helmet performance 

standards than has NOCSAE. As explained by Dr. Cantu and his written response 

to the inaccurate quotes in The New York Times article, these are the actions of a 

group that is leading the way for the development of helmet standards to address 

concussions effectively, not an entity sitting on the sidelines waiting on someone 

else to do the work. 

To the extent there is a ‘‘new medical understanding of concussion risk and the 

latest state of the art in helmet technology’’ referenced in the question, such advances exist in very large part due to the financial support from NOCSAE research 

grants, and the NOCSAE board, staff, and its Scientific Advisory Committee are intimately familiar with such developments, but this ‘‘new understanding’’ has not answered the specific questions necessary to support a change to the NOCSAE standards to address concussions. 

You ask ‘‘. . .why should coaches and parents of young football players rely on 

NOCSAE to maintain up-to-date voluntary safety standards for football helmets?’’ 

In comparative testing performed on almost every type of protective helmet, 

whether sports, or otherwise, football helmets certified to the NOCSAE standard 

consistently and markedly outperform every helmet in all impact categories, whether in protecting from low-level impacts, high velocity impacts, head coverage, or durability. There is no other helmet standard in the world which demands the same 

level of quality control and quality assurance in the manufacturing and production 

process as that which is mandated by the NOCSAE standards. And although millions of research dollars have been and are being invested by NOCSAE to improve 

the standards and reduce the frequency and severity of all head injuries including 

114 

concussions, football helmets certified to the NOCSAE standard perform at the highest levels. Helmet testing data, including the testing of bare head forms without helmets, show that a helmet certified to the NOCSAE standard will reduce the resultant head accelerations in large and small impacts by almost 70 percent. Between 

high school and collegiate football players, there are more than 600,000,000 helmet 

impacts during the course of a single season which result in head accelerations exceeding 15 g’s after the helmet has done its work. It is arguable, that without a helmet certified to the NOCSAE standard, each of those blows to the head would have 

been hard enough to result in a concussion or worse. 

NOCSAE is committed to improving helmet performance standards to effectively 

address concussions, and when there is reliable consensus scientific support for a 

specific change to accomplish that goal, NOCSAE will undoubtedly be the first to 

incorporate those changes. Until then, coaches and parents can count on NOCSAE 

not to experiment with their children’s safety by making changes to the standard 

simply on the hope that a scientifically unsupported change might work. 

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APPENDIX A—LETTER FROM DR. ROBERT CANTU


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APPENDIX B—LETTER FROM DR. BLAINE HOSHIZAKI


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RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN THUNE TO

MIKE OLIVER

Question 1. Improper Tackling Technique and Concussions. I’m aware that NFL 

and college football teams today have significantly reduced the amount of time devoted during practice to proper tackling and other football fundamentals. I recognize 

that coaches are limiting some of the physical contact during practice to prevent injuries. However, my concern is that less time devoted to teaching proper tackling 

technique may be contributing to an increase in concussions during games. Specifically, players these days seem to lead with their head rather than wrapping a player up with one’s arms and body, and keeping their head up. Do you see any connection, at all levels of football, to improper tackling technique and an increase in concussions? 

Answer. In the course of a football game players will receive high energy hits to 

the head that are unavoidable and unintentional, and it is not likely those kinds 

of hits can be eliminated from the game of football. But the use of tackling techniques in which the player initiates contact with the head or targets the head of 

the other offensive player are dangerous, unnecessary, and avoidable. Not only do 

they increase the risk of sustaining a concussion or causing a concussion in the opposing player, or both, those techniques also place the tackling player at an increased risk of spinal cord injury and even death. 

Debate exists among experts in concussion epidemiology whether there is really 

an increase in the number of concussions, or whether the increase in diagnosis is 

a function of greater awareness and attention to the importance of addressing concussions. I think most believe that the actual rate is essentially unchanged, but recognition and diagnosis is much greater. But even if the rate is not higher today than 

it has been historically, the number of concussions can be significantly reduced simply by eliminating the intentional use of the head to initiate contact, and the vast 

majority of those events happen through poor tackling techniques. 

Sometimes those incorrect techniques are taught, but in many cases they develop 

from a lack of teaching and player correction at early ages. Dr. Kevin Guskiewicz 

at the University of North Carolina has been monitoring the players on the football 

team at UNC through the use of an in-helmet impact monitoring and telemetry system that records the magnitude and location of every impact to a player’s helmet 

in practices and games. One of the information gleaned from this data is that they 

are able to identify those players who record far more impacts to the top of the helmet than other players on the team. Dr. Guskiewicz and his staff are able to meet 

with these players and undertake behavior modification to try and eliminate those 

avoidable hits to the top of the head. Clearly the issue of leading with the head is 

very important in the efforts to reduce the frequency and severity of concussions, 

even with elite athletes at the collegiate level. 

Question 2. Do you think this improper tackling technique is caused by less time 

being devoted to teaching good technique in practice? 

Answer. As players mature and develop, it is natural for most coaches to focus 

more on the subtle aspects and complicated skills of the game, and spend less time 

on the fundamentals. If players don’t develop the reaction and muscle memory to 

effectively ‘‘see what you hit’’ when tackling and blocking as youth players, it is unlikely they will suddenly develop those skills in high school, and even less likely in 

college. The time to spend the time is when players have not yet developed the bad 

habits. 

Question 3. As part of the campaign to highlight concussion awareness, how much 

emphasis is being placed on educating coaches and players about using proper tackling technique to reduce concussions? 

Answer. The emphasis on concussion prevention and recognition is extensive and 

growing monthly. 

NOCSAE in partnership with the CDCP is creating a parent targeted concussion 

awareness and prevention program called ‘‘Heads Up to Parents’’ which designed 

and created to reach all parents of football players and provide access to an extensive online resource to address all aspects of concussion prevention, including proper 

tackling and blocking techniques. 

There are coaching education programs at all levels which provide the necessary 

instruction and teaching tools to help coaches instruct their players. The American 

Football Coaches Association provides such training and educational programs for 

high school through collegiate levels, and has teamed with the National Athletic 

Trainers Association to make education and training videos that address head and 

neck injury prevention, which can be accessed at http://www.afca.com/article/article.php?id=968. The National Federation of State High School Associations 

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cussion prevention as well. For youth football, USA Football in partnership with the 

NFL provides a wealth of coaching and player education programs in person and 

online that address concussion prevention through proper playing and tackling techniques. These resources can be accessed at http://www.usafootball.com/health-safety/prevention-preparation. 

Æ