A safer football helmet might be on the horizon, but it's unlikely there will ever be a device that can make the gridiron concussion-proof.
"To do that, you'd have to have a helmet that would not allow the head to move and, therefore, have the helmet fixed on shoulder pads or a flak jacket," prominent concussion expert Robert Cantu said. "That construct works, but it doesn't allow you to play the sport."
Still, amid increasing awareness of long-term concussion risks, the Overland Park, Kan.-based National Operating Committee on Standards for Athletic Equipment (NOCSAE) is working to revise its standards for football helmets.
NOCSAE, which was founded in 1969, develops performance and test standards for all manner of athletic equipment and has put concussions in its crosshairs.
"The standard for sports helmets are driven by the risks that the helmets are intended to address," NOCSAE Executive Director Mike Oliver said during the organization's annual standards meeting last Friday at the Sheraton Kansas City Hotel at Crown Center.
The original standard for football helmets was implemented in 1973 and primarily targeted skull fractures and subdural bleeding.
"There were 28 to 35 kids dying a year in football back in the late 1960s and early '70s," Oliver said. "At that time, the concussion definition was really narrow. Number one, if you didn't lose consciousness, you did have a concussion."
As concussion research has ramped up, especially in recent years, head trauma and its aftereffects have been redefined, but the underlying science still needed time to catch up.
Concussions result from a violent shaking of the brain, according to Cantu, but there are different causes _ some easier to address than others.
Current standards for football helmets are terrific at mitigating the impact caused by linear acceleration, a straightforward blow.
"The helmet would protect you immensely from a ball-peen hammer to the head, for instance, and, if a ball is light, it doesn't matter how much velocity it has," said Cantu, NOCSAE's vice president who also is a clinical professor in the Boston University School of Medicine's Department of Neurology and the co-founder and medical director of the Concussion Legacy Foundation. "The helmets are marvelous. What they're not very good at is the whiplashing of your head, especially if you get hit from the side."
Such rotational acceleration is much harder to mitigate without keep the head in a fixed position.
"The rotational force comes at an angle and creates a bigger stretch of the nerve tissue, which creates a greater chance to disrupt nerve tissue," Cantu said. "Obviously, if you could reduce the degree of rotation, the excursion of it, you'd reduce brain injury and concussion among it."
NOCSAE, a non-profit that generates revenue through licensing fees, has funded numerous research grants to study rotational forces and its relationship to concussions.
"The idea was to understand the biomechanics behind concussions and try to craft a helmet that would be effective ...," Oliver said. "We think (manufacturers) can develop one now that we know what the threshold is and have an idea about how they work related to concussions. We developed a test protocol so that you can test a helmet for those rotational accelerations."
Cantu, who is the senior adviser to the NFL Head, Neck and Spine Committee, is less optimistic.
"We are in our infancy of making it work and the application of those models ... but the helmets will probably never reduce rotational forces adequately to prevent concussion," he said. "Yes, they reduce and probably prevent some concussions, but certainly not a great many."
Helmets are just one piece of the puzzle.
Cantu advocates that tackle football shouldn't be played until at least 14 years old and full-contact drills should be greatly limited in high school and college.
The NFL already limits teams to 14 full-contact practices during the regular season and would like to see similar restrictions at the high school and college levels, a movement known as Practice Like the Pros.
"If you reduce the hitting in practice, you're taking out way over 50 percent of the total head impacts, a significant amount of the concussions and maybe enough of the head trauma that the football player of today largely won't see what does that played 20 or 30 years ago did see," Cantu said.
Those benefits also could mean a reduction in chronic traumatic encephalopathy (CTE), according to Cantu, who praised the Ivy League for eliminating all full-contact hitting from regular-season practices beginning with the 2016 season.
"Being tackled to the ground adds an immense number of sub-concussive blows and potential concussions," Cantu said. "That can be more significant in terms of the CTE issue."
Cantu doesn't believe the risk of CTE can ever be completely eliminated from football or any activity where there's repetitive head trauma.
Medical advancements still need to be made in determining susceptibility factors that predispose certain people to develop CTE, a degenerative brain disease characterized by cognitive problems, starting with short-term memory and progressing to dementia, behavioral problems marked by a lack of impulse control and mood problems that include depression, anxiety and panic attacks.
The first step to identifying risk factors is developing a test to diagnose CTE in living people.
"That's probably the biggest research challenge right now, because as soon as you can identify the living people then you can also start instituting protective therapies and see whether they work or not," Cantu said.
Football is along in the head-injury debate. Cantu also suggest changes in hockey, eliminating full-body checking until high school, and soccer, eliminating or severely curtailing heading the ball until a later age as well.
Still, football _ including the NFL's bungled attempt to fund concussion-related research _ draws most of the attention and finding sensible solutions remains critical to the sport's future.
"It's entirely conceivable that football can be played in a way that if it's started later, practiced differently and we eliminate intentional hits to the head, the problems that we see now will not be problems in the future," Cantu said.
Improved helmet technology could play a role as well.
"We're talking about chipping away at this part of the problem and chipping away at that part of the problem," Oliver said. "It would be nice to think you could develop a standard our product that could completely eliminate the risk, but I just don't know if it's possible."
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