The Association of the Type of Football Helmet and Mouth Guard With the Incidence of Sport Related Concussion in High School Football Players
Authors: McGuine Timothy , Brooks Alison , Hetzel Scott , Rasmussen Jessica , McCrea Michael 
Published: September 2013

Objectives: Approximately 40,000 Sport Related Concussions (SRC) occur annually in high school football in the US. Football helmet and mouth guard manufacturers cite laboratory research to claim that their models will absorb and lessen impact forces associated with SRC greater than their competitors models. Therefore, players who utilize their equipment may reduce the likelihood they will sustain a SRC. However, there are limited prospective data detailing how specific types of football helmets and mouth guards affect the incidence and severity of SRC in players actually participating in high school football. The objective of this study is to determine which types of football helmets and mouth guards are associated with the incidence and severity of SRC in high school football players. Methods: This prospective study collected data at 36 public and private high schools in Wisconsin during the 2012 high school football season. A convenience sample of N = 1,332 football players (grades 9 - 12, age: 15.9 + 1.8 yrs) enrolled in the study. During the pre-season, subjects completed a demographic questionnaire. Athletic Trainers (ATCs) at each high school recorded the incidence and severity (days lost) of SRC throughout the season. Chi-square tests were used to compare the incidence of SRC in players with their non-injured peers. SRC severity (median days lost, IQR) was analyzed by the Kruskal-Wallis test. Relative risks [RR, 95% CI] were calculated for variables with significant tests (p <.05). Results: Two hundred fifty-one (19%) reported at least one SRC within the last 6 years while 171 (13%) reported SRC within the previous 12 months. The helmets worn by the players were manufactured by Riddell (52%), Schutt (35%) and Xenith (13%) and were purchased in 2011-2012 (39%), 2009-2010 (33%), 2002-2008 (28%). Mouth guards worn by players included generic models provided by the school (61%) and specialized mouth guards (39%) custom fitted by a dental professional or specifically marketed to reduce the risk of SRC. A total of 115 (8.6%) players sustained 116 SRCs. There was no difference in the rate of SRC {%, 95% CI} by the type of helmet worn [p = 0.454], (Riddell {9.5, 7.4 -12.0}, Schutt {8.1, 5.9 -11.1} and Xenith {6.7, 3.7 -11.8}), as well as the year the helmet was purchased [p = 0.745], (2011-2012 {9.3, 7.0 -12.3}, 2009-2010 {7.9, 5.7 -11.0} and 2002-2008 {8.8, 6.2 -12.3}. The severity (days lost) of SRC was not different (p = 0.883) for players wearing Riddell (13.5: 8.8, 19.0), Schutt (13.0: 10, 21.5) and Xenith (13.5: 10.8, 21.3) helmets. The SRC rate for players who wore a specialized or custom-fitted mouth guard (12.5, 9.8 - 15.8) was higher [RR = 1.9, 1.36 - 2.70], than for players who wore a generic mouth guard provided by their school (6.4, 4.8, 8.3), [p <0.001]. Conclusion: Contrary to equipment manufacturers' claims, lower risks of sustaining a SRC or the severity of a SRC were not associated with a specific helmet brand. In addition, the rates of SRC were similar for players wearing newer helmets as compared to players wearing older helmets. Notably, players who wore a generic mouth guard provided by the school had a lower rate of SRC compared to players who wore more expensive mouth guards marketed to reduce the incidence of SRC. Sports medicine providers need to carefully assess equipment manufacturer’s claims that their products will reduce the likelihood of high school football players sustaining a SRC.