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© 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 2
Disclosure
• Neither I, nor any family
member, have any
financial interests with
products mentioned in
this presentation
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 3
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 4
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 5
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!”
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 6
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 7
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 8
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 9
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 10
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 11
What about concussion?
• > 3.8 million sport-related concussions per year
• Different forces involved vs. skull fractures/bleeds?
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 12
Helmet Designs
• Evolved tremendously
over the past decade
• Many designs now try to
protect against concussion
• Evidence behind some of
the marketing claims?
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 13
Riddell
• Polycarbonate alloy shell
• Extended coverage of mandible
and jaw line
• Synthetic rubber foam and
cellular air pad system
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 14
Schutt
• Dual Compression TPU™
cushioning system marketed
to absorb both high and low
velocity collisions
• “Performs well in all
temperatures”
• Large youth helmet maker
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 15
Xenith
• “21st Century” helmet
maker
• Aware Flow Shock®
absorbers release air with
impact
• Shock Bonnet® - allows
helmet exterior to move
independently
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 16
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★ ??
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 17
The Youth Helmet Challenge
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3rd Party Add-ons
Guardian Caps Unequal Technologies
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Technology ?
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 20
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 21
Survey 2013-14
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 22
Soccer & Rugby
• Headgear has NOT been shown to reduce
concussion rates
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 23
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 24
• 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 25
• 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 26
Fast Pitch Softball
• Facemask required in
high school fastpitch
since 2006 - NFSHS
• Must meet NOCSAE
standards
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 27
• 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 28
• 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 29
• 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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 30
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 31
Kriz study on MPE
31
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 32
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 33
Not protective against
concussion!
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 34
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)
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 35
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
©2013 Children's Mercy Hospitals and Clinics. All Rights Reserved. 03/13 36