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Nancy Armour, @nrarmour, USA TODAY Sports

With millions of parents and players from Pop Warner to the NFL worrying about concussions and their potentially devastating effects, the claims sound reassuring.

Wear this mouth guard, and you'll be helping to protect yourself from concussions. This skullcap absorbs blows that can lead to traumatic brain injuries. And that helmet adapts to each hit, minimizing the risk of injury.

There's just one problem: There's no one to verify that those statements, and many others, are true.

While government agencies monitor the safety and effectiveness of food, drugs and automobiles, there's no such group keeping an eye on football helmets or the increasing number of add-on products.

"It feels very much like a lot of companies are coming up with these ideas and they're making money off the fear of parents, and there's no real proof that they're helping," said Emily Cohen, a Berkeley, Calif., mother of two teenage athletes and blogger on TeamSnap, an online managing service for sports teams. "I would like to know, if I'm purchasing a piece of safety equipment, that it's actually going to make a difference.

"You want to believe, because you want your kid to be safe. But you don't know."

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) formed in 1969 as a non-profit to create a standard for football helmets after 32 players died of head and neck injuries the previous year. But the NOCSAE standard is pass-fail based on drop-test impacts. And since NOCSAE certification applies only to the helmet, there's even less scrutiny of the add-on products -- sensors, padding, mouth guards, etc. -- that have exploded in popularity in recent years.

Manufacturers can make any claim they want about the effectiveness of their product and, unless they run afoul of the Federal Trade Commission's ad police, there's little to stop them.

"When you look at how products are marketed, companies are getting savvy," said Kevin Walter, director of pediatric and adolescent sports medicine at Children's Hospital of Wisconsin and author of a 2013 article in the American Academy of Pediatrics magazine titled "No evidence that helmet add-ons reduce concussion risk."

"It's kind of like (dietary) supplement companies," Walter said. "They're not coming out and saying, 'We prevent concussions.' But they phrase it in a way that consumers think that."

No helmet or piece of equipment can prevent concussions or eliminate the risks of them and other head injuries in sports. Almost every website carries a disclaimer that states that, and some are more thorough or blunt than others. But the warnings pale in comparison to the claims of what the products can do.

"The biggest misconception in the market today is there's a silver bullet or there's something out there that will protect everybody from concussions," said Gregg Hartley, a consultant for the Sports and Fitness Industry Association. "Unfortunately, that's not the case."

That's not to say all manufacturers are trying to take advantage of consumers' fears. Or even that the products don't do what they claim. But there's no way to tell the difference.

"As a parent, that number looks really good, 'Reduces risk by whatever percent.' But I want more information," Cohen said. "How do I know that it's real?"


What is real is the concussion problem in sports, particularly in football. Research has shown that repeated blows to the head can lead to brain trauma, and a 2012 study found that NFL players were unusually prone to dying from degenerative brain disease. This week the Journal of the American Medical Association published a study by the University of Tulsa that found college football players had less volume in the region of the brain that relates to memory and emotion.

Those dry academic findings have been starkly illustrated by the suicide of retired NFL star Junior Seau, whose brain showed signs of disease when he killed himself at age 43, as well as the lawsuit filed by more than 4,000 former NFL players, many of whom are suffering from the effects of concussions during their playing days.

The NFL agreed to a $765 million settlement last fall, but a federal judge has questioned whether that will be large enough to cover all of the claims.

In hopes of limiting future on-field damage, professional leagues and colleges have toughened reporting standards and return-to-play protocols. USA Football created "Heads Up Football," a program that includes an emphasis on proper tackling technique. Pop Warner has reduced contact in practice and also is emphasizing tackling.

Off the field, the race is on to develop equipment that can prevent the blows that lead to concussions. A poster of Virginia Tech's STAR ratings for football helmets, which combines results of the NOCSAE standard tests with data on hits absorbed by high school and college players, hangs in every NFL locker room.

"A lot of us say the concussion-reducing helmet is the Holy Grail," Walter said. "If you can actually find medical proof that your protective equipment reduces the risk, holy cow. Everyone will be buying that helmet."

But football helmets are designed to prevent skull fractures, not concussions. So companies have developed add-ons they say will help cushion the blows: sensors to track the number and severity of hits; padded skullcaps and headbands; padded helmet covers; mouth guards.

And they all claim to help in the fight against concussions.

"I think their hearts are in the right place," said Hartley, who also has been a NOCSAE board member for the last 10 years. "They've come up with a new product that they think is a step forward, and they'll make a claim that hasn't been substantiated by any scientific testing or measurement."

Therein lies the problem.

Senators Tom Udall, D-N.M., and Jay Rockefeller, D-W.Va., have repeatedly proposed toughening standards for youth sports equipment and allowing the FTC to impose fines for using false claims to sell protective gear. (And it's not just football. Unverified claims are made for protective gear in other sports, too, such as chest protectors in baseball.)

But the legislation has gone nowhere. Udall did not respond to repeated requests for comment, and Rockefeller declined to comment.

"I'm not sure an ombudsman would have any more ability to (oversee the industry)," said Mike Oliver, NOCSAE's executive director. "Right now, there isn't science you can apply to products to say yes they will, no they won't."


The current NOCSAE standard weighs only whether a particular helmet can withstand a certain amount of force in an impact test and makes no judgment about the effect of add-on products. Instead, use of an add-on device could void the helmet's NOCSAE certification, with the group warning manufacturers last fall that such products create a "new, untested model."

That led the Colorado High School Activities Association to ban Guardian Caps, a soft-shell helmet cover its manufacturer says reduces impact by 33%.

The Guardian Cap, which arose from Erin and Lee Hanson's business developing materials and technology for the military, has been used by almost 300 football and lacrosse programs, including football teams at South Carolina, Clemson, New Mexico and Syracuse.

"We took seven different helmets and tested them to the NOCSAE standard, with and without a Guardian Cap. And all showed they worked better with the Guardian Cap," Lee Hanson said. "We improve every helmet, but then can't sell it because NOCSAE says, 'Buy this product and (the manufacturer) will void the warranty.'"

That leaves the FTC, which has played a similar watchdog role with diet supplements.

The FTC brought a case against Brain-Pad mouth guards in 2012 after the manufacturer claimed its product could reduce the risk of concussions. It also has sent warning letters to more than a dozen other manufacturers "that we thought might be making claims for which they didn't have substantiation," said Richard Cleland, assistant director for the FTC's division of advertising practices.

He declined to name the companies because the letters were only warnings.

NOCSAE is in the process of revising its standard to account for rotational forces, which doctors and scientists now believe play a role in concussions. But the new standard wouldn't be implemented until the fall of 2015 at the earliest, and it wouldn't address add-on products.

And there are some who no longer trust NOCSAE to set the standard. The private group has financial ties to the helmet manufacturers, and Hanson said he thinks everyone would be better served by government oversight instead.

"I'm all for having standards. I'm all for having a product do what it says it's going to do," Hanson said. "(NOCSAE) is like the fox guarding the henhouse. So it does need some kind of government oversight out there, because it is a serious issue."

Regardless of who does it or how, Cohen said parents and players need something that can help them decipher the various claims.

"I think we're still in a grass-roots movement, but I think it's going to get done," said Gretchen Rose, a blogger for MomsTeam, a website that provides information on youth sports. "It has to, because football is not going away."


May 16, 2014




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