Beyond the Helmet: Protecting the Brain of Your Athlete

For kids, there are many benefits to playing sports. They teach valuable lessons such as sportsmanship, discipline, goal setting and teamwork—not to mention, they’re fun.

But sports and physical activities also carry the potential for injury.

Sports medicine expert Aaron Leininger, MD, says although there’s no way to guarantee your child won’t be injured playing sports, protective headgear can help guard against bleeding on the brain and other traumatic brain injuries.

“Wearing the correct protective gear and playing the right way can make an injury less likely,” Dr. Leininger says. “Protective headgear helps to mitigate the forces on the head.”

So how do you know what gear is right for your child?

Dr. Leininger breaks down the protective headgear used in different sports and tells us their limitations.

Activity: Bicycling

Protective headgear: Vented hard plastic over hard foam bike helmet

Limitations: Using a vented bike helmet can decrease the risk of serious head injury by 69 percent, but it decreases the risk of a face injury by only 33 percent. That’s because there’s only 1 to 2 inches of helmet material to protect the forehead. “This is worse if helmets are poorly fitted, as is commonly the case with younger children,” Dr. Leininger says.

Bike helmets are designed for a single hit, so they should be replaced if any impact occurs—even if you just drop your helmet.

Vented bike helmets also don’t protect against mouth and teeth injuries. “After two mouth and facial injuries in our cycling family, we use full-face helmets with good venting,” he says.

Bike helmets are designed for a single hit, so they should be replaced if any impact occurs—even if you just drop your helmet.

Activity: Skating, Skateboarding or Scootering

Protective headgear: Helmet with a hard-plastic shell over hard foam

Limitations: The limitations of skating helmets are the same as bicycle helmets; they don’t protect your mouth or teeth. Full-face helmets are recommended for complete face and mouth protection, and they should be replaced after any impact.

Activity: Skiing or Snowboarding

Protective headgear: Helmet with a hard-plastic or aluminum shell over hard foam

Limitations: It’s important to use skiing and snowboarding helmets to prevent head injuries and skull fracture, but these helmets won’t prevent concussion.

Unlike bicycling helmets, skiing and snowboarding helmets are designed to protect against multiple impacts, so you should not use a bicycling or skating helmet for skiing or snowboarding. However, skiing and snowboarding helmets should also be replaced if there’s any sign of damage after impact.

Activity: Football

Protective headgear: Helmet with a hard-plastic shell with faceguard and mouthguard

Limitations: There’s not a lot of research that says football helmets protect against concussion, but helmets are vitally important to protect against brain injury and skull fracture. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) certifies helmets, so kids should wear any NOCSAE-certified football helmet that fits well and is in good condition.

“Some helmets do better in certain types of lab testing, but there hasn’t been quality evidence that any particular helmet use results in less injuries,” Dr. Leininger says. “Mouthguards are extremely important to prevent mouth lacerations and tooth fracture or loss but don’t significantly prevent concussions.”

Activity: Men’s Lacrosse

Protective headgear: Helmet with a hard-plastic shell with faceguard (including protection for the front of the neck) and mouthguard

Limitations: Lacrosse helmets don’t prevent concussion. However, they do prevent traumatic head injuries and skull fractures.

Activity: Women’s Lacrosse

Protective headgear: Wire goggle eye protector and mouthguard are standard, but soft foam helmets are also an option

Limitations: Dr. Leininger says that although goggles do not protect against head injury, they do help “prevent catastrophic eye injuries.” Generally the soft helmets would be recommended, he says, though there isn’t necessarily scientific data backing up that recommendation at this time.

Activity: Women’s Field Hockey

Protective headgear: Goggles, mouthguards and hard plastic helmets with faceguards for goalies

Limitations: Like women’s lacrosse, goggles offer protection only to a player’s eyes. They do not protect against brain injury.

Activity: Soccer

Protective headgear: Most players don’t wear headgear, although some wear a thin soft foam helmet

Limitations: Soft helmets offer limited protection and don’t prevent concussion. But Dr. Leininger says they are “the only legal means of head protection for soccer.”

Activity: Rugby

Protective headgear: Mouthguard and soft foam helmets

Limitations: With rugby, some players choose to wear soft helmets. But those don’t always offer full protection.

“Like soccer, soft helmets offer only limited protection and don’t seem to prevent concussion,” Dr. Leininger says. “But mouthguards should be worn to prevent mouth and teeth injury.”

Activity: Basketball

Protective headgear: Mouthguard

Limitations: Head injuries in basketball are most commonly from elbows. Unfortunately, there’s no headgear used for protection. But many high-level players use mouthguards to prevent mouth- or teeth-related injuries.

Activity: Baseball and Softball

Protective headgear: Catchers wear a helmet and faceguard, while batters wear hard plastic helmets that include pitcher-side ear protection

Overall, batters may have it worse than catchers because they wear less protective gear.

Limitations: Helmets protect well against skull fracture and catastrophic brain injury, but they do not always prevent concussions.

Overall, batters may have it worse than catchers because they wear less protective gear. “Batters do not generally get eye or face protection, so there remains risk to these areas, which is worse in baseball because the smaller size of the ball makes the impact of a hit more concentrated,” Dr. Leininger says.

Activity: Wrestling

Protective headgear: Ear protectors

Limitations: These are used to protect against cuts and cauliflower ear, which happens when “a collection of blood from a hit to the ear is not treated or drained,” Dr. Leininger says. Ear protectors don’t guard against concussion or head injury. Although the soft mat that wrestlers compete on helps prevent skull fracture and catastrophic brain injury, concussions are still common in wrestling.

Activity: Horseback Riding

Protective headgear: Equestrian helmets, typically cloth covered over a hard shell

Limitations: Equestrian helmets are recommended but are not commonly used. But Dr. Leininger says they should be, because they provide some protection without limiting the activity. “Horseback riding is very dangerous, with 6 percent of riders being hospitalized for injury every year,” Dr. Leininger says. “Helmets should be considered mandatory.” Jumping activities and beginner skill level particularly increase the risk of injury.


Play for Safety: Additional Tips to Avoid Head Injury

In addition to wearing properly fitted headgear, Dr. Leininger says there are other ways to potentially prevent a head injury.

  1. Style of Play. Avoid overly aggressive play. “Parents and coaches should teach good sportsmanship and to avoid unnecessary aggressiveness,” Dr. Leininger says. “Teaching athletes how to manage heightened emotions through conflict management can help. You can still be competitive without being overly aggressive.”
  2. Strong Neck Muscles. Engage in conditioning that focuses on neck muscle strength, including isometric strengthening, where the angle of your joint and the length of your muscle do not change during contraction. “This may help prevent concussion, as strong neck muscles can mitigate acceleration and decrease head velocity after an impact,” Dr. Leininger
  3. Change the Rules. Regulations that prohibit or better enforce head impacts can help eliminate head injuries in sports altogether. “There’s now a rule against using high elbows in soccer to help prevent concussions, and in football there have been some limits to kickoff returns and more targeting fouls,” Dr. Leininger He recommends teaching your children proper tackling techniques to avoid unnecessary big hits.

This phenomenon where athletes can exhibit more aggressive and dangerous play when wearing protective gear is sometimes referred to as the “gladiator effect.”

It’s important to note that head injuries can still happen if your child is wearing a helmet. “Sometimes with equipment on, athletes leave inhibition by the wayside,” Dr. Leininger says. This phenomenon where athletes can exhibit more aggressive and dangerous play when wearing protective gear is sometimes referred to as the “gladiator effect.”

This means it’s especially important to know how to spot a concussion. Symptoms include headache, dizziness, loss of balance or concentration, light or sound sensitivity, and irritability after being hit.

These symptoms typically develop quickly, but Dr. Leininger says some people might not show signs of concussion for up to 48 hours. “Pay close attention to these symptoms if your child has had a recent hit to the head,” he says. If your child does show signs of concussion, call his or her pediatrician immediately, or seek care at the emergency department.

Need a pediatrician? Find one near you.

Aaron Leininger, MD, is a primary care physician who specializes in sports medicine at University Orthopaedics and Sports Medicine, where he runs a concussion clinic. He also is the medical director at UNC Physicians Network Johnston Primary Care Clinics.