Injury Prevention Equipment in Youth Sports: Myths ... Prevention Equipment in Youth Sports: Myths,...

© 2011 Children’s Mercy Hospitals and Clinics. All Rights Reserved. • June 2011

Injury Prevention Equipment in Youth Sports:

Myths, Marketing and Evidence

Greg Canty, MD

Medical Director, Center for Sports Medicine

Children’s Mercy Hospitals & Clinics

Kansas City

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Disclosure

• Neither I, nor any family

member, have any

financial interests with

products mentioned in

this presentation

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The “Game Plan”

1. Recognize different types of

injury prevention equipment

2. Understand the evolution of

the helmet and its purpose

3. Update on the benefits and

types of mouth guards and

ocular protection

4. Recommend evidence-

based protective equipment

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The Numbers Don’t Lie!

• 30 - 45 million children

participate in athletics

• 2.6 million ED visits

annually for youth

sports

• #1 cause of injury in

school age athletes

4

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Sporting Goods

• $35 billion spent annually

on sporting goods and

equipment

• Families are vulnerable

and willing to spend $$$

to keep kids safe

• Protective equipment=

“Gotta do something!”

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Early Protective Equipment

• Foulproof Taylor in “34

Ton Bat” by Steve

Rushkin

– Foulproof Cup

– Beanproof Cap

– Bustproof Brassiere

• Claude Berg baseball

catcher first reportedly

wore a cup in 1915

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The Football Helmet

• First reported use in 1893

during Army-Navy football

• Not required for college play

until 1939

• Skull fractures, intracranial

bleeds and TBI’s persisted

• No standards existed

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NOCSAE

• National Operating Committee on

Standards for Athletic Equipment

(NOCSAE) established in 1969

• Goal was to initiate research efforts for

head protection

• First football helmet safety standard

established in 1973

• 16 member board

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NOCSAE Standard

• Helmets placed on a

polyurethane head form

• Dropped from a height of

60 inches

• 6 different impact sites

tested

• Forces transmitted to the

head cannot exceed 1200

force units

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The Success of NOCSAE

• >100 high school and college

football players in the 60’s killed

due to skull fractures and acute

bleeding

• After NOCSAE standard, skull

fractures have mostly disappeared

and deaths each year ~3 to 4

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What about concussion?

• > 3.8 million sport-related concussions per year

• Different forces involved vs. skull fractures/bleeds?

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Helmet Designs

• Evolved tremendously

over the past decade

• Many designs now try to

protect against concussion

• Evidence behind some of

the marketing claims?

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Riddell

• Polycarbonate alloy shell

• Extended coverage of mandible

and jaw line

• Synthetic rubber foam and

cellular air pad system

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Schutt

• Dual Compression TPU™

cushioning system marketed

to absorb both high and low

velocity collisions

• “Performs well in all

temperatures”

• Large youth helmet maker

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Xenith

• “21st Century” helmet

maker

• Aware Flow Shock®

absorbers release air with

impact

• Shock Bonnet® - allows

helmet exterior to move

independently

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STAR Evaluation System

• Summation of Tests for the

Analysis of Risk (STAR)

• Developed at Virginia Tech-

Wake Forest Biomed Eng

• Introduces equation utilizing

drop testing and HIT System

• Collegiate players, large

helmets…Reproducible ?

• 5★ vs 3★ vs 1★ ??

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The Youth Helmet Challenge

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3rd Party Add-ons

Guardian Caps Unequal Technologies

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Technology ?

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Survey 2013-14

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Soccer & Rugby

• Headgear has NOT been shown to reduce

concussion rates

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Soccer

• Soccer headgear has NOT been shown to be

effective in reducing ball impact (heading)

• May be helpful in reducing non-ball related

impacts (head vs. head vs. ground)

• Does “Gladiator Effect” increase risk?

Niedfeldt MW. Head Injuries, Heading, and the Use of

Headgear in Soccer. CSMR 2011;10(6): 324-29

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• The ball is cause of most baseball injuries

• Softer balls reduce injury from impact

(commotio cordis, head injuries, etc)

• NOCSAE certified

– Level 1 = less than 10 yo

– Level 2 = children 10-12 yo

– Level 3 = >12 yo or with advanced skills

Baseballs

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• Direct impact of ball over anterior chest

wall may develop cardiac arrest

• 2nd highest cause of death in young

athletes younger than 14 years of age

• Fatality rate is 90%...AED opportunity

Commotio Cordis

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Fast Pitch Softball

• Facemask required in

high school fastpitch

since 2006 - NFSHS

• Must meet NOCSAE

standards

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• Facemask + helmet reduce the risk of

head, eye, and facial injury

• Full plastic shields reduce injury

– ? Acceptance

– Recent studies support use by infielders and

pitchers

Baseball

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• No consensus in the battle of

metal vs. wooden bats in youth baseball

• Bat composition standards developed by

NCAA, NFHS, Little League

• Injury surveillance studies do not yet

support media reports of increased injury

Baseball Bats

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• Little League mandated in 2008

• 95% reduction in foot and ankle injuries

with new break-away base technology

• Softball leagues may use a “runner’s

base”

Break Away Bases

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Protective Eyewear

• Eye injuries in sports are

largely preventable

• AAP & AAO strongly

recommended in all sports

with risk of eye injury

• Eliminate the use of “street-

wear” in sports

• ASTM standards

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Kriz study on MPE

31

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Mouth Guards

• ADA recommends use in 30 sports

• NCAA requires in football, LAX, ice

and field hockey

• 3 types: ready-made, boil & bite, and

custom

• Custom - no difference in performance

• Meta-analysis (Knapik) shows

orofacial injury 2x greater without

mouthguard Knapik JJ et al. Sports Med. 2007;37(2):117-44

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Not protective against

concussion!

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Closing Thoughts… • Establish standards and mandates for protective

equipment on good science

• Equipment must be properly fitted and in good

working order

• Sports safety policies should involve sports

medicine professionals (ATCs, physicians)

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Excellent References

• Daneshvar DH et al. Helmets and Mouth Guards: The Role of

Personal Equipment in Preventing Sport-Related Concussions. Clin

Sports Med 30 (2011) 145-63

• Website: Mom’s Team - www.momsteam.org

• Navarro RR. Protective Equipment and the Prevention of

Concussion - What is the Evidence? CSMR 2011;10(1):27-31

• Niedfeldt MW. Head Injuries, Heading, and the Use of Headgear in

Soccer. CSMR 2011;10(6):324-328

• Website: NOCSAE - www.nocsae.org

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