Can Better Equipment Eliminate Concussions In Sports?

Head injuries are considered a normal risk of high-impact sports like football. Better helmets and guidelines aim to make athletes safer.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Ira Flatow?

  Science Friday is supported by MathWorks, creator of MATLAB and Simulink software for technical computing and model-based design. MathWorks, accelerating the pace of discovery in engineering and science. Learn more at mathworks.com.

• 0:17Flora Lichtman?

  Hey, it's Flora Lichtman, and you're listening to Science Friday.

• 0:23Flora Lichtman?

  Today in the show, concussions and how new science is shaking up treatment and prevention.

• 0:29Speaker 02

  I'm not telling patients now to turn down lights, turn down noises, get off their phones, off their computers.

• 0:36Flora Lichtman?

  Really? Because that is, I still have heard, you know, that I feel like that is the prevailing

• 0:41Speaker 02

  I know.

• 0:42Flora Lichtman?

  wisdom.

• 0:43Speaker 02

  It drives me crazy.

• 0:44Flora Lichtman?

  Really? Okay, tell us more.

• 0:50Flora Lichtman?

  You know, if you've ever watched a football game, and I'm sure you have, I don't have to tell you that those athletes get hit hard. And concussions have long been considered a kind of occupational hazard of the sport. But is this a risk we can engineer our way out of? With better helmets and guidelines around concussion prevention, could we expect no concussions for football players or other athletes? Joining me now to talk about the science of helmets and head injuries are my guests, Dr. Michael Collins, Clinical and Executive Director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, and Dr. Barry Miller, Director of Outreach at the Virginia Tech Helmet Lab. Welcome both of you to Science Friday.

• 1:33Ira Flatow?

  Thank you. Happy to be here.

• 1:34Speaker 02

  Thank you.

• 1:35Flora Lichtman?

  Michael, let's start with you. What physiologically is happening during a concussion? Like, how well do we understand this injury?

• 1:44Speaker 02

  We know it pretty well. You know, the word concussus literally translates from Latin to English to mean to shake violently. And just for example's sake, think about your brain as an egg yolk inside an eggshell, and the egg yolk is going to move inside the shell, even though the shell doesn't crack.

• 2:00Flora Lichtman?

  This is your brain on concussions.

• 2:02Speaker 02

  That's your brain on concussions. And what causes concussion actually happens at the cellular level, where in our brain, we obviously have billions of cells called neurons. And when the brain moves sufficiently enough in the skull, the membrane to the neuron will stretch, and this little chemical called potassium will leak out of the cell. And that increases the demand for glucose or energy in the brain. And at the same time, this little chemical called calcium will leak into the cell and it shouldn't be there, but it goes in. And when the calcium goes into the cell, we actually get constriction of our blood vessels and we get less cerebral blood flow. And of course, blood flow is what supplies energy. And so there's a mismatch between supply and demand of energy to the cell and the neuron.

• 2:45Speaker 02

  And that energy problem can affect different systems in the brain. And we've actually learned now there's different types of concussions. And there's different systems in the brain that can be affected. And the cells fortunately do not die if you manage this injury properly and make sure there's recovery before a second, you know, insult can occur. And we've made a lot of advances in terms of our treatments and understanding of this injury. And actually getting patients fully healthy before getting back to play is an absolute key message that needs to be, you know, relayed to parents, coaches, et cetera, out there.

• 3:20Flora Lichtman?

  That's so fascinating. I didn't realize that we understood what was happening on the cellular level with such granularity.

• 3:27Speaker 02

  Yeah, it's animal model work that has been done by very smart people over the years. And we have a pretty good understanding of the pathophysiology of the injury. We're really learning about the symptoms that predict outcome, risk factors. And most importantly, we actually have treatments now that can actually help to treat this injury and get patients better faster and get them healthy and get them back to play safely. And that's where the real progress, in my opinion, has been made over the last, you know, five or 10 years.

• 3:59Flora Lichtman?

  I want to come back to treatments in a minute, but before we do, you talked about risk factors. Are some people at higher risk for concussion injury than others?

• 4:08Speaker 02

  Absolutely. And we're talking about the human brain and we're talking about, um, there's very specific risk factors that we've been able to determine through our research that predicts not only Who might get a concussion more easily, but also who's going to have a longer time recovering? And some of those risk factors, the most identifiable ones in our research, believe it or not, motion sickness, being sensitive to motion as a youngster predicts the vestibular system in the brain will decompensate more easily from that energy problem. And that actually predicts a little more easily who gets concussed and who takes a little longer to recover. But also, a history of migraine is a very significant

• 4:49Speaker 02

  risk factor. A history of anxiety is a significant, definitely a significant risk factor. And actually, being female predicts someone who may be concussed more easily. Females are six times more likely to have motion sickness, to have migraine, and a little more at risk for anxiety. And so, we feel that females are a little more at risk to sustain an injury and have a little longer outcome because of those pre-existing risk factors. So, in terms of, you know, I know we're talking about prevention here, I really feel that work needs to interface with some of the clinical work that's being done because you're not, you're never going to have a threshold for concussion, in my opinion, because the

• 5:32Speaker 02

  human brain is so complicated, and the human being is so complicated, and it's going to be different risk levels for different people when they play sports.

• 5:41Flora Lichtman?

  One person could get hit and not get a concussion, and another person could have the same hit and get a concussion.

• 5:46Speaker 02

  We see it all day long in our clinics.

• 5:49Flora Lichtman?

  I want to stay with prevention for a second, and I want to go to you, Barry. You co-lead the Virginia Tech Helmet Lab, which, by the way, just sounds like a very cool job. But tell me how you test helmets?

• 6:02Speaker 03

  Yeah, so the Helmet Lab is actually a comprehensive injury biomechanics lab. So, we do all kinds of research. Our background's in automotive safety, but obviously, we took that information and apply it to sports world. And when we talk about helmet testing, so we figure out, how do you actually hit your head in these various sports or environments? Whether it's football, falling off your horse, or just recently, we did some stuff with construction helmets. And we take those real-world fall accidents back into the lab and create a standardized test protocol. To evaluate those helmets and you know, these test rigs include pendulum impactors, linear impactors, different types of devices. And so we just try to best mimic those real

• 6:44Speaker 03

  world accidents and then we test helmets against those real world scenarios.

• 6:49Flora Lichtman?

  I'm picturing crash test dummies in car, you know, what I'm talking about like this is dating me, but those eighties commercials where you see cars zooming into a concrete wall with like a mannequin in them. How far off am I?

• 7:03Speaker 03

  Well, we do have another part of our research. We have a lab across campus that does that. But our impactors are a little bit different.

• 7:10Flora Lichtman?

  Describe it for me. Paint me a picture, Barry.

• 7:12Speaker 03

  Okay, so for bike helmets, for example, we use what we call a drop tower. And so we have a basically a ring or a halo, if you will, that holds the head form and the helmet above an anvil at an angle. And then we drop that and the halo holds the helmet in place as it impacts the anvil at the location we're trying to to hit.

• 7:33Flora Lichtman?

  Wow. What about football? What is, how do you test football helmets?

• 7:36Speaker 03

  Football, we use something called a pendulum impactor. So we have a big pendulum arm with the, we can change out the face of that pendulum, but you know, usually for football, we use a mushroom shaped, it's hard nylon. That's basically the same shape as a football helmet. And then that arm comes down and hits a helmet, a head form, a surrogate neck, and a sliding mask that represents the torso of a football player. And then we can measure our impacts from those scenarios. And it's called a target table. And so we can orient the head pretty much in any position we want. And for football, we use four locations and three energy levels. So 12 specific test conditions to evaluate how football helmets.

• 8:14Flora Lichtman?

  What makes one helmet better than another one? Like, has the technology improved? And what are you looking for?

• 8:21Speaker 03

  The helmets have drastically improved. When we first launched our helmet ratings in 2011, there was only what we consider one five star helmet. And we just rescaled recently, because all the helmets were five star. So five star being the best, zero stars being the worst. That best helmet way back in 2011 would be the worst helmet today. So that the advancements have been huge. The star scores, which represents concussion risks in some sort of fashion, continue to drop. So the football helmets are really impressive.

• 8:57Flora Lichtman?

  Okay, we have to take a break, but don't go anywhere because after the break, we will find out whether our guests think with the right headgear, concussions in sports could become a thing of the past.

• 9:08Speaker 03

  Well, we always say the helmet is the last line of defense. Best options don't hit your head.

• 9:18Speaker 04

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• 10:00Speaker 04

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• 10:34Speaker 05

  Support for Science Friday comes from the William K. Bose Junior Foundation.

• 10:44Flora Lichtman?

  Michael, will we ever get to a place where helmets can fully prevent concussions?

• 10:50Speaker 02

  I'm not so sure we can get to a place where helmets fully prevent concussions, but I applaud the work that's being done at Virginia Tech and other locations. And we really embrace that research and we're learning a lot. And if you marry engineering improvements to clinical improvements, I would say we've never been safer as a population to play football. And I really think this is the best time we've ever had to, if you sustain a concussion, the advances are real. You know, over the past decade, two decades. And there's so many people who are researching on this now, which is exciting. So, but to get to a point where you can prevent this injury from happening entirely, I don't see that occurring.

• 11:34Speaker 02

  And we also have to keep in mind, and most of these injuries occur in non-helmeted activities too. Right? I mean, so slipping falls are probably the most common reason why people have concussions and car accidents, et cetera. And there's a lot of people having concussions out there. You know, again, I really think it's exciting work that's being done. But to prevent the brain from moving inside the skull is a hard ask.

• 12:00Flora Lichtman?

  Barry, what do you think? Where are you on this question?

• 12:03Speaker 03

  Well, we always say the helmet is the last line of defense. So if you can minimize any head impacts, that's what you want to do. And granted, the helmets have drastically improved. But you know, it's a risk of concussion and some people get injured at really low energy levels. So yeah, I agree with Dr. Collins completely. Eliminate, probably not drastically reduce. We're improving. And so, but yeah, the best options, don't hit your head.

• 12:29Flora Lichtman?

  Barry, if you know, if I had a kid who played football, you know, or even I'm just like looking for a bike helmet for myself or someone I love, what should I look for? How would I evaluate whether that helmet is a five star or not?

• 12:45Speaker 03

  That's a great question. All helmets have to be certified. I don't know if your listeners would know this, but the certifications are pass fail, whether it's a football helmet, bike helmet, snow sport helmet, different organizations certify these to a standard. The threshold to pass those standards is the point of catastrophic head injury. So we're talking skull fracture or death, right? And so we supplement those mandatory required certifications with sport-specific colorings. And so there's no way for you to tell which helmet's safer than another until you use our webpage, right? Because two helmets on the shelf at Walmart, bike helmets, you don't know which one's safer. They both pass the basic certification, but that's all you know. And it's just like anything else. There's

• 13:28Speaker 03

  product differentiation. You know, some cars are safer than the others. Some helmets are safer than others.

• 13:33Flora Lichtman?

  And y'all are completely independent, right? You're not funded by some helmet maker.

• 13:39Speaker 03

  That is correct. We're a public institution, independent testing facility. That's correct.

• 13:45Flora Lichtman?

  Michael, in the case of football, I mean, I hear that what y'all are saying, which is, you know, it's never been safer. But I also wonder if the game has changed, at least in the case of football. I mean, are people getting hit harder than they ever were?

• 14:01Speaker 02

  I mean, yes. Force equals mass times acceleration. So we've never seen faster, heavier athletes. And, you know, the training that goes on for performance has improved as well. So the speeds are greater, the size of the individuals are greater in football and other sports. And so, you know, as those forces go up, you know, theoretically, we'll see more concussions, which we do. But I do think that the work that's being done with helmet technology is we're meeting those challenges with some of this research that's being done, not only in helmet technology, but also in terms of our clinical understanding of the injury. I really do feel like it has never been safer to play the sport than now,

• 14:45Speaker 02

  just because of these advances across all these different domains, clinical, helmet technology, research. And these injuries do happen in five-star helmets, and they do happen in recreational sports and all over.

• 15:03Speaker 02

  But it's it's an exciting time because the interest in this injury, the spotlight's iridescent on concussion and I really feel that the the academic community and clinical communities have have are rising to the challenge and great work is being done. I don't want to sound Pollyannaish. I mean, this is an injury that can occur, but I'm very encouraged by what we're learning in terms of, you know, how to how we evaluate, manage, treat this injury as well as the helmet technology advances that we're seeing.

• 15:35Flora Lichtman?

  Michael, let's talk treatment. What has changed about treatment of concussions in the last 10, 20 years?

• 15:44Speaker 02

  At a very basic level, what we've learned is that rest is not the way to treat this injury. We've actually come up with targeted active rehab. I'm not telling patients now to turn down lights, turn down noises, get off their phones, off their computers.

• 16:01Flora Lichtman?

  Really? Because that is, I still have heard, you know, that I feel like that is the prevailing

• 16:05Speaker 02

  I know.

• 16:06Flora Lichtman?

  wisdom.

• 16:07Speaker 02

  It drives me crazy because

• 16:09Flora Lichtman?

  Really? Okay, tell us more.

• 16:10Speaker 02

  Yeah, it's it's rehabilitation and not rest. What happens with this injury is this energy crisis can decompensate these different systems, vestibular, ocular motor, you know, how our eyes work together, our vestibular system is a pathway in the brain that allows us to stabilize our vision. We move our head. We see patients have migraine. What we know is that the best way to treat these issues is by retraining and desensitizing. We actually use exercise now to treat concussion. Exercise helps to treat migraine, exercise rehabituates the vestibular system. We have very specific movements that we can create

• 16:52Speaker 02

  to help retrain the vestibular system. We have exercises and physical therapy that we do to retrain the ocular motor system. Anxiety is highly prevalent in this injury. So what we do is we do a lot of exercise, which increases the parasympathetic nervous system, which helps to calm down the anxiety. If you see me in Pittsburgh at UPMC, you're going to be working out and we're going to be working out in very specific ways and be giving you very specific exercises to rehab and retrain these systems. Honestly, the one of the biggest problems we have now in terms of treating concussion are patients that have rested too much, acutely and subacutely. And that leads to problems if it's not managed properly.

• 17:35Speaker 02

  And there's a lot of biology behind that. And so that's probably surprising for the listenership to hear that, but yes.

• 17:41Flora Lichtman?

  That's like a, that's a huge paradigm shift.

• 17:44Speaker 02

  Huge paradigm shift. Uh, I've never been more confident than I am right now in telling you that it's needed, a needed paradigm shift. And we're doing a lot of work on that and a lot of research has come out showing the benefits of exercise, targeted exercise. I make, want to make sure people understand that there's.

• 18:04Flora Lichtman?

  Under doctor supervision.

• 18:05Speaker 02

  Under specialist supervision, not just doctor supervision, but knowing how to work these patients out and who, who do we push harder than others. But there's a lot that goes into that from an evaluation standpoint, but yes, rest is not effective at treating concussion.

• 18:21Flora Lichtman?

  What about CTE, the neurodegenerative disease that, that can follow repeated head trauma? Does, do we have treatment that can prevent that outcome?

• 18:35Speaker 02

  In a very general sense, we have a lot to learn about CTE. And I actually was just reviewing a paper 10 minutes before I got on this call, which, which shows that, this paper showed that the prevalence of that is very, very low. And, and, and what we just saw in the research, there's a wide gamut of research out there on CTE. What I want to say at the, at the basic level is the best way to prevent problems with concussion is to manage it and treat it effectively when you have one. We do not want kids out there playing through concussions. We don't want kids going back to play before the concussions are recovered. We do not know who is at risk for CTE.

• 19:17Speaker 02

  We do not know the factors that play into patients that end up having those difficulties and issues. A lot more work is needed. I know everyone wants answers on that, but we have decades of research in front of us before we, before we better understand that construct. It's a, it's a nebulous construct that we need a lot more science on.

• 19:38Flora Lichtman?

  This was so fascinating. Thank you both for joining me today.

• 19:41Speaker 03

  You're welcome.

• 19:42Speaker 02

  Thank you.

• 19:47Flora Lichtman?

  And before we go, a heads up, if you're looking for an out of this world adventure, Science Friday's Down to Earth program returns this year on October 3 for World Space Week. We will have fun, daily activities that show you how space science makes our world better. Please join us. No spacesuit required. Register today for Down to Earth at sciencefriday.com/downtoearth. Thanks for listening. Don't forget to rate and review us wherever you listen. It really does help us get the word out and get the show in front of new listeners. Today's episode was produced by Kathleen Davis. I'm Flora Lichtman. Thanks for listening.