Brain Injuries in American Football: Understanding the Injury, Difficulty in Helmet Optimization, and Current Communication Practices – A Narrative Review

Kali M. Sebastian, Reuben F. Burch V, Preston “Stick” Rogers

Abstract


Background: Over 2.7 million people suffer traumatic brain injuries (TBIs) annually in the United States. TBI involves the application and generation of external forces and impulse loads respectively to the head whereby the brain moves relative to the skull. Despite numerous studies, further understanding of TBIs is necessary, requiring consistent attention. Objective: The purpose of this article is to investigate the history of American football helmets and provide an academic and practitioner review as it relates to TBIs. This study is a literature review that also considers perspectives from an autoethnographic frame. Method: An extensive literature review was performed to assess the history of TBI as it relates to American football. This article evaluates helmet design optimization and American football safety as well as an exploration into the sports’ education methods for players and staff alike. Results: Despite developing helmet designs that can better attenuate impact forces, reducing linear and rotational movement, the skull and brain move very differently relative to one another. Helmet designs and tools for measuring forces require further validation techniques to determine resultant forces and movement for the brain. Current biomechanics research lacks sufficient methodology for defining TBI thresholds, making helmet optimization difficult. Conclusion: According to past research, no helmet can eliminate all TBI risk; however, processes are in place lead by the National Football League (NFL) and NFL Players Association to educate players, coaches, and staff at all levels of competition of the protective capabilities of available helmet options.

Keywords


United States Football, Traumatic Brain Injuries, Brain Concussion, Biomechanics, Safety Management, Athletics Injuries

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References


Bailey, A., Funk, J., Lessley, D., Sherwood, C., Crandall, J., Neale, W., & Rose, N. (2018). Validation of a videogrammetry technique for analysing American football helmet kinematics. Sports Biomechanics, 19(5), 678-700. https://doi.org/10.1080/14763141.2018.1513059

Bain, A. C., & Meaney, D. F. (2000). Tissue-level thresholds for axonal damage in an experimental model of central nervous system white matter injury. Journal of Biomechanical Engineering, 122(6), 615–622. https://doi.org/10.1115/1.1324667

Bartsch, A., Benzel, E., Miele, V., & Prakash, V. (2012). Impact test comparisons of 20th and 21st century American football helmets: Laboratory investigation. Journal of Neurosurgery, 116(1), 222–233. https://doi.org/10.3171/2011.9.JNS111059

Bayly, P. V., Black, E. E., Pedersen, R. C., Leister, E. P., & Genin, G. M. (2005). In vivo imaging of rapid deformation and strain in an animal model of traumatic brain injury. Journal of Biomechanics, 39(1), 1086–1095. https://doi.org/10.1038/jid.2014.371

Boden, B. P., Tacchetti, R. L., Cantu, R. C., Knowles, S. B., & Mueller, F. O. (2007). Catastrophic head injuries in high school and college football players. American Journal of Sports Medicine, 35(7), 1075–1081. https://doi.org/10.1177/0363546507299239

Broglio, S. P., Surma, T., & Ashton-Miller, J. A. (2012). High school and collegiate football athlete concussions: A biomechanical review. Annals of Biomedical Engineering, 40(1), 37–46. https://doi.org/10.1007/s10439-011-0396-0

Budday, S., Ovaert, T. C., Holzapfel, G. A., Steinmann, P., & Kuhl, E. (2019). Fifty Shades of Brain: A Review on the Mechanical Testing and Modeling of Brain Tissue. Archives of Computational Methods in Engineering. Springer Netherlands. https://doi.org/10.1007/s11831-019-09352-w

Burch, R. F., Strawderman, L., Piroli, A., Chander, H., Tian, W., & Murphy, F. (2019). The Importance of Baselining Division 1 Football Athlete Jumping Movements for Performance , Injury Mitigation , and Return to Play. In International Conference on Applied Human Factors and Ergonomics (pp. 332–344).

Campolettano, E. T., Gellner, R. A., & Rowson, S. (2018). Relationship between Impact Velocity and Resulting Head Accelerations during Head Impacts in Youth Football. Proc Int IRCOBI Conf Biomech Impacts., 326–333. https://doi.org/10.1016/j.physbeh.2017.03.040

Campolettano, E. T., Gellner, R. A., Smith, E. P., Bellamkonda, S., Tierney, C. T., Crisco, J. J., … Rowson, S. (2019). Development of a Concussion Risk Function for a Youth Population Using Head Linear and Rotational Acceleration. Annals of Biomedical Engineering. https://doi.org/10.1007/s10439-019-02382-2

Campolettano, E. T., Rowson, S., & Duma, S. M. (2016). Drill-specific head impact exposure in youth football practice. Journal of Neurosurgery: Pediatrics, 18(5), 536–541. https://doi.org/10.3171/2016.5.PEDS1696

Cater, H. L., Sundstrom, L. E., & Morrison, B. (2006). Temporal development of hippocampal cell death is dependent on tissue strain but not strain rate. Journal of Biomechanics, 39(15), 2810–2818. https://doi.org/10.1016/j.jbiomech.2005.09.023

Chatelin, S., Constantinesco, A., & Willinger, R. (2010). Fifty years of brain tissue mechanical testing: From in vitro to in vivo investigations. Biorheology, 47(5–6), 255–276. https://doi.org/10.3233/BIR-2010-0576

Collins, C. L., McKenzie, L. B., Ferketich, A. K., Andridge, R., Xiang, H., & Comstock, R. D. (2016). Concussion characteristics in high school football by helmet age/recondition status, manufacturer, and model: 2008-2009 through 2012-2013 academic years in the United States. American Journal of Sports Medicine, 44(6), 1382–1390. https://doi.org/10.1177/0363546516629626

Crisco, J. J., Fiore, R., Beckwith, J. G., Chu, J. J., Brolinson, P. G., Duma, S., … Greenwald, R. M. (2010). Frequency and location of head impact exposures in individual collegiate football players. Journal of Athletic Training, 45(6), 549–559. https://doi.org/10.4085/1062-6050-45.6.549

Crisco, J. J., Wilcox, B. J., Beckwith, J. G., Chu, J. J., Duhaime, A. C., Rowson, S., … Greenwald, R. M. (2011). Head impact exposure in collegiate football players. Journal of Biomechanics, 44(15), 2673–2678. https://doi.org/10.1016/j.jbiomech.2011.08.003

Daneshvar, D. H., Nowinski, C. J., McKee, A. C., & Cantu, R. C. (2011). The Epidemiology of Sport-Related Concussion. Clinics in Sports Medicine, 30(1), 1–17. https://doi.org/10.1016/j.csm.2010.08.006

Daniel, R. W., Rowson, S., & Duma, S. M. (2014). Head impact exposure in youth football: Middle school ages 12-14 years. Journal of Biomechanical Engineering, 136(9), 1–7. https://doi.org/10.1115/1.4027872

Duma, S. M., Manoogian, S. J., Bussone, W. R., Brolinson, P. G., Goforth, M. W., Donnenwerth, J. J., … Crisco, J. J. (2005). Analysis of real-time head accelerations in collegiate football players. Clinical Journal of Sport Medicine, 15(1), 3–8. https://doi.org/10.1097/00042752-200501000-00002

Elkin, B. S., Gabler, L. F., Panzer, M. B., & Siegmund, G. P. (2019). Brain tissue strains vary with head impact location: A possible explanation for increased concussion risk in struck versus striking football players. Clinical Biomechanics, 64(2017), 49–57. https://doi.org/10.1016/j.clinbiomech.2018.03.021

Elliott, M. R., Margulies, S. S., Maltese, M. R., & Arbogast, K. B. (2015). Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves. Journal of Biomechanics, 48(12), 3059–3065. https://doi.org/10.1016/j.jbiomech.2015.07.026

Emery, C. A., Black, A. M., Kolstad, A., Martinez, G., Nettel-Aguirre, A., Engebretsen, L., … Schneider, K. (2017). What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. British Journal of Sports Medicine, 51(12), 978–984. https://doi.org/10.1136/bjsports-2016-097452

Forbes, J. A., Zuckerman, S., Abla, A. A., Mocco, J., Bode, K., & Eads, T. (2014). Biomechanics of subdural hemorrhage in American football: Review of the literature in response to rise in incidence. Child’s Nervous System, 30(2), 197–203. https://doi.org/10.1007/s00381-013-2318-y

Forbes, J. A., Zuckerman, S. L., He, L., McCalley, E., Lee, Y. M., Solomon, G. S., … Sills, A. K. (2013). Subdural hemorrhage in two high-school football players: Post-injury helmet testing. Pediatric Neurosurgery, 49(1), 43–49. https://doi.org/10.1159/000355121

Ford, J. M., Campbell, K. R., Ford, C. B., Boyd, K. E., Padua, D. A., & Mihalik, J. P. (2018). Can Functional Movement Assessment Predict Football Head Impact Biomechanics? Medicine and Science in Sports and Exercise, 50(6), 1233–1240. https://doi.org/10.1249/MSS.0000000000001538

Goriely, A., Geers, M. G. D., Holzapfel, G. A., Jayamohan, J., Jérusalem, A., Sivaloganathan, S., … Kuhl, E. (2015). Mechanics of the brain: perspectives, challenges, and opportunities. Biomechanics and Modeling in Mechanobiology, 14(5), 931–965. https://doi.org/10.1007/s10237-015-0662-4

Greenhill, D. A., Navo, P., Zhao, H., Torg, J., Comstock, R. D., & Boden, B. P. (2016). Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players. Sports Health, 8(3), 238–243. https://doi.org/10.1177/1941738116639027

Hernandez, F., Shull, P. B., & Camarillo, D. B. (2015). Evaluation of a laboratory model of human head impact biomechanics. Journal of Biomechanics, 48(12), 3469–3477. https://doi.org/10.1016/j.jbiomech.2015.05.034

Hicks, J., Wall, E., Shelly, Z., Jones, P., Burch, R., & Reimann, W. (2019). Signal detection in American football play calling : A comprehensive literature review. Cogent Psychology, 6(1), 1703471 (1-15). https://doi.org/10.1080/23311908.2019.1703471

Kelley, M. E., Kane, J. M., Espeland, M. A., Miller, L. E., Powers, A. K., Stitzel, J. D., & Urban, J. E. (2017). Head impact exposure measured in a single youth football team during practice drills. Journal of Neurosurgery: Pediatrics, 20(5), 489–497. https://doi.org/10.3171/2017.5.PEDS16627

Kuo, C., Wu, L., Loza, J., Senif, D., Anderson, S. C., & Camarillo, D. B. (2018). Comparison of video-based and sensor-based head impact exposure. PLoS ONE, 13(6), 1–19. https://doi.org/10.1371/journal.pone.0199238

Levy, M. L., Ozgur, B. M., Berry, C., Aryan, H. E., & Apuzzo, M. L. J. (2004). Birth and Evolution of the Football Helmet. Neurosurgery, 55(3), 656–662. https://doi.org/10.1227/01.NEU.0000134599.01917.AA

Lloyd, J., & Conidi, F. (2016). Brain injury in sports. Journal of Neurosurgery, 124(3), 667–674. https://doi.org/10.3171/2014.11.JNS141742

Luczak, T., Burch, R., Lewis, E., Chander, H., & Ball, J. (2019). State-of-the-art review of athletic wearable technology : What 113 strength and conditioning coaches and athletic trainers from the USA said about technology in sports. International Journal of Sports Science and Coaching, 15(1), 26–40. https://doi.org/10.1177/1747954119885244

Manoogian, S., McNeely, D., Duma, S., Brolinson, G., & Greenwald, R. (2006). Head acceleration is less than 10 percent of helmet acceleration in football impacts. Biomedical Sciences Instrumentation, 42, 383–388.

McCrory, P., Feddermann-Demont, N., Dvoøák, J., Cassidy, J. D., McIntosh, A., Vos, P. E., … Tarnutzer, A. A. (2017). What is the definition of sports-related concussion: A systematic review. British Journal of Sports Medicine, 51(11), 877–887. https://doi.org/10.1136/bjsports-2016-097393

Mckee, A. C., Abdolmohammadi, B., & Stein, T. D. (2018). The neuropathology of chronic traumatic encephalopathy. Handbook of Clinical Neurology, 158, 297–307. https://doi.org/10.1016/B978-0-444-63954-7.00028-8

McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-whyte, T., Gavett, B. E., Budson, A. E., … Stern, R. a. (2010). Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. Journal of Neuropathology and Experimental Neurology, 68(7), 709–735. https://doi.org/10.1097/NEN.0b013e3181a9d503.Chronic

McKeithan, L., Hibshman, N., Yengo-Kahn, A., Solomon, G. S., & Zuckerman, S. (2019). Sport-Related Concussion: Evaluation, Treatment, and Future Directions. Medical Sciences, 7(3), 44. https://doi.org/10.3390/medsci7030044

Merchant-Borna, K., Asselin, P., Narayan, D., Abar, B., Jones, C. M. C., & Bazarian, J. J. (2016). Novel Method of Weighting Cumulative Helmet Impacts Improves Correlation with Brain White Matter Changes After One Football Season of Sub-concussive Head Blows. Annals of Biomedical Engineering, 44(12), 3679–3692. https://doi.org/10.1007/s10439-016-1680-9

Mihalik, J. P., Sumrall, A. Z., Yeargin, S. W., Guskiewicz, K. M., King, K. B., Trulock, S. C., & Shields, E. W. (2017). Environmental and physiological factors affect football head impact biomechanics. Medicine and Science in Sports and Exercise (Vol. 49). https://doi.org/10.1249/MSS.0000000000001325

Nakatsuka, A. S., & Yamamoto, L. G. (2014). External foam layers to football helmets reduce head impact severity. Hawai’i Journal of Medicine & Public Health : A Journal of Asia Pacific Medicine & Public Health, 73(8), 256–261.

O’Connor, K. L., Rowson, S., Duma, S. M., & Broglio, S. P. (2017). Head-impact-measurement devices: A systematic review. Journal of Athletic Training, 52(3), 206–227. https://doi.org/10.4085/1062-6050.52.2.05

Petraglia, A., Plog, B., Dayawansa, S., Dashnaw, M., Czerniecka, K., Walker, C., … Nedergaard, M. (2014). The pathophysiology underlying repetitive mild traumatic brain injury in a novel mouse model of chronic traumatic encephalopathy. Surgical Neurology International, 5(1). https://doi.org/10.4103/2152-7806.147566

NFL. (2020). Helmet Laboratory Testing Performance Results. playsmartplaysafe.com. https://www.playsmartplaysafe.com/resource/helmet-laboratory-testing-performance-results/

Reid, B., Schreiber, K., Shawhan, J., Stewart, E., Burch, R., & Reimann, W. (2020). Reaction time assessment for coaching defensive players in NCAA division 1 American football: A comprehensive literature review. International Journal of Industrial Ergonomics, 77, 102942 (1-10). https://doi.org/10.1016/j.ergon.2020.102942

Reynolds, B. B., Patrie, J., Henry, E. J., Goodkin, H. P., Broshek, D. K., Wintermark, M., & Druzgal, T. J. (2016). Practice type effects on head impact in collegiate football. Journal of Neurosurgery, 124(2), 501–510. https://doi.org/10.3171/2015.5.JNS15573

Risling, M., Smith, D., Stein, T. D., Thelin, E. P., Zanier, E. R., Ankarcrona, M., & Nilsson, P. (2019). Modelling human pathology of traumatic brain injury in animal models. Journal of Internal Medicine, 285(6), 594-607. https://doi.org/10.1111/joim.12909

Rowson, S., Campolettano, E. T., Duma, S. M., Stemper, B., Shah, A., Harezlak, J., … McCrea, M. (2019). Accounting for Variance in Concussion Tolerance Between Individuals: Comparing Head Accelerations Between Concussed and Physically Matched Control Subjects. Annals of Biomedical Engineering, 47(10), 2048–2056. https://doi.org/10.1007/s10439-019-02329-7

Rowson, S., Daniel, R. W., & Duma, S. M. (2013). Biomechanical performance of leather and modern football helmets Technical note. Journal of Neurosurgery, 119(3), 805–809. https://doi.org/10.3171/2013.3.JNS121735

Rowson, S., Duma, S. M., Greenwald, R. M., Beckwith, J. G., Chu, J. J., Guskiewicz, K. M., … Brolinson, P. G. (2014). Can helmet design reduce the risk of concussion in football? Technical note. Journal of Neurosurgery, 120(4), 919–922. https://doi.org/10.3171/2014.1.JNS13916

Saulle, M., & Greenwald, B. D. (2012). Chronic Traumatic Encephalopathy: A Review. Rehabilitation Research and Practice, 2012, 1–9. https://doi.org/10.1155/2012/816069

Schmidt, J. L., Tweten, D. J., Badachhape, A. A., Reiter, A. J., Okamoto, R. J., Garbow, J. R., & Bayly, P. V. (2018). Measurement of anisotropic mechanical properties in porcine brain white matter ex vivo using magnetic resonance elastography. Journal of the Mechanical Behavior of Biomedical Materials, 79, 30–37. https://doi.org/10.1016/j.jmbbm.2017.11.045

Shelly, Z., Burch, R. F., Tian, W., Strawderman, L., Piroli, A., & Bichey, C. (2020). Using K-means Clustering to Create Training Groups for Elite American Football Student-athletes Based on Game Demands. International Journal of Kinesiology & Sports Science, 8(2), 47–62. https://doi.org/10.7575/aiac.ijkss.v.8n.2p.47

Shelly, Z., Stewart, E., Fonville, T., Burch V, R. F., Chander, H., Strawderman, L., … Bichey, C. (2019). Helmet Prototype Response Time Assessment using NCAA Division 1 Collegiate Football Athletes. International Journal of Kinesiology and Sports Science, 7(4), 53–65. https://doi.org/10.7575/aiac.ijkss.v.7n.4p.53

Teasdale, G., & Jennett, B. (1974). Assessment of Coma and Impaired Consciousness: A Practical Scale. The Lancet, 13(2), 81–84. https://doi.org/10.1080/14635240.1999.10806094

Urban, J. E., Davenport, E. M., Golman, A. J., Maldjian, J. A., Whitlow, C. T., Powers, A. K., & Stitzel, J. D. (2013). Head impact exposure in youth football: High school ages 14 to 18 years and cumulative impact analysis. Annals of Biomedical Engineering, 41(12), 2474–2487. https://doi.org/10.1007/s10439-013-0861-z

Viano, D. C., Casson, I. R., & Pellman, E. J. (2007). Concussion in professional football: Biomechanics of the struck player - Part 14. Neurosurgery, 61(2), 313–327. https://doi.org/10.1227/01.NEU.0000279969.02685.D0

Viano, D. C., & Pellman, E. J. (2005). Concussion in professional football: Biomechanics of the striking player - Part 8. Neurosurgery, 56(2), 266–278. https://doi.org/10.1227/01.NEU.0000150035.54230.3C

Zhang, L., Yang, K. H., & King, A. I. (2001). Biomechanics of neurotrauma. Neurological Research, 23(2–3), 144–156. https://doi.org/10.1179/016164101101198488

Zuckerman, S. L., Reynolds, B. B., Yengo-Kahn, A. M., Kuhn, A. W., Chadwell, J. T., Goodale, S. E., … Solomon, G. S. (2019). A football helmet prototype that reduces linear and rotational acceleration with the addition of an outer shell. Journal of Neurosurgery, 130(5), 1634–1641. https://doi.org/10.3171/2018.1.JNS172733




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