Headgear does not help prevent concussions in football and rugby athletes
Does headgear prevent sports-related concussions? A systematic review and meta-analysis of randomized controlled trials involving 6311 players and 173,383 exposure hours.
Al Attar WSA, Mahmoud H, Alfadel A, Faude O. Sports health. May 19, 2023: 19417381231174461. doi: 10.1177/19417381231174461. E-publishing prior to printing. PMID: 37204092.
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Take home message
Headgear worn by young football or rugby players cannot reduce the incidence of sports-related concussions.
Background
Protective headgear reduces the risk of facial and dental injuries; However, there is inconsistent research supporting the rate at which they prevent sports-related concussions.
Study aim
In this systematic review, the authors identified and summarized findings from three randomized control trials evaluating whether headgear effectively reduces the incidence of sports-related concussions.
Methods
The authors systematically searched five databases to identify randomized control trials that evaluated the extent to which headgear prevented sports-related concussions. All control groups wore no headgear. The authors recorded exposure hours and number of players to calculate injury rates and document compliance.
Results
The 3 studies had an ‘average’ to ‘good’ methodological quality on the PEDro scale. The primary outcome assessed in each study was the rate of sports-related concussions per group (headgear vs. no headgear/control). The aggregated results include 6,311 players and 173,383 exposure hours. The authors found that headgear did not prevent concussions in football or rugby. Compliance was variable between studies (99.6%, 46% and not measured in one study).
Viewpoints
The authors of this systematic review concluded that the risk of sports-related concussion was virtually identical in the group with or without headgear. It should be noted that the rugby trials exclusively involved young men. While the football trials involved women, the study focused on 14- to 16-year-olds. Therefore, it is unclear how headgear performs among older athletes and female rugby players. The authors also found that compliance was quite variable. One football study had high adherence, while one rugby study had low adherence. It would be useful to understand whether differences in compliance are related to different strategies to promote compliance, differences in sport, or personal preferences for headgear styles. Understanding what worked in football but not in rugby could help identify strategies to promote good compliance.
Clinical implications
Medical professionals should not promote the wearing of headgear for football and rugby athletes to prevent concussion. Instead, medical professionals should promote concussion education on what can prevent a concussion, such as proper form (e.g., keeping head up while dribbling/being aware of surroundings) and proper tackling technique in rugby (e.g., not using head). .
Questions for discussion
Do you encourage headgear in sports such as football and rugby? Does this systematic review change your position? Why or why not?
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- Women are not only at increased risk for concussions, but also for more severe concussions
- A Closer Look at Concussions 2016-2020: Increasing Prevalence and Gender Differences
Written by Jane McDevitt
Reviewed by Jeffrey Driban
