Association of Helmet Brand and Mouth Guard Type With Incidence of Sport Related Concussion in High School Football Players

Monday, October 28, 2013: 3:15 PM
Florida Ballroom A (Hyatt Regency Orlando, formerly the Peabody)
Margaret Alison Brooks, MD, MPH, Orthopedics and Pediatrics, University of Wisconsin, Madison, WI, Timothy A. McGuine, PhD, LAT, University of Wisconsin, Madison, WI and Michael McCrea, PhD, Medical College of Wisconsin, WI


Approximately 40,000 Sport Related Concussions (SRC)/year occur in US high school football. Football helmet and mouth guard manufacturers cite laboratory research that their brand/models will lessen impact forces associated with SRC greater than their competitors’ models, and further claim players who utilize their equipment may reduce their risk of SRC.   However, there is limited prospective data on how specific football helmets and mouth guards affect incidence and severity of SRC in players.  Our objective was to determine if football helmet brand and mouth guard type are associated with incidence and severity of SRC in high school football players.


This prospective study included 36 high schools and 1,332 football players (grades 9 – 12, age: 15.9 + 1.8 yrs) during the 2012 football season. Subjects completed a pre-season demographic and injury questionnaire.  Athletic trainers recorded incidence and severity of SRC.  Chi-square tests were used to compare incidence of SRC in injured vs non-injured players. SRC severity (median days lost, IQR) was analyzed using Kruskal-Wallis test.  Relative risks [RR, 95% CI] were calculated for variables with significant tests (p <.05).


One hundred seventy one players (13%) reported SRC within the previous 12 months. Helmets worn by players were manufactured by Riddell (52%), Schutt (35%) and Xenith (13%) and purchased in 2011-2012 (39%), 2009-2010 (33%), 2002-2008 (28%).  Mouth guards worn by players included generic models provided by school (61%) and specialized mouth guards (39%) custom fitted by dental professionals or specifically marketed to reduce SRC. A total of 115 (8.6%) players sustained 116 SRCs.  There was no difference in 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}), or 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}.  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 (6.4, 4.8, 8.3), [p <0.001].


Contrary to manufacturer claims, lower risk and severity of SRC were not associated with a specific helmet brand. Rates of SRC were similar for players wearing newer versus older helmets.   Players using a generic mouth guard provided by school had a lower rate of SRC compared to players with more expensive specialized or custom mouth guards marketed to reduce concussion risk.  Caution is advised when recommending specific preventive equipment based on manufacturer claims of reduced concussion risk.