Should Helmets, Protective Headgear Be Compulsory in all Sports?

The tragic accidental death of a young female hockey player in Australia has highlighted the potential need for protective headgear and helmets is all sports. The ball used in field hockey is a formidable projectile.

The young promising hockey player was struck in the back of the head while playing a club game and died on the way to hospital. Helmets are compulsory for professional bicycle racing throughout the world and many countries have compulsory helmet laws for recreational cyclists. There have been many moves to make ski-helmets compulsory. Many surfers now wear helmets. There is growing concern that 'heading' the ball in soccer may lead to long term brain damage. In Australia 'soft' protective headgear is worn by many rugby players, especially children, but it is not compulsory, despite it being a contact sport. Helmets are worn by ice hockey players but not by those playing field hockey. There has been a lot of concern at the long term risks of repeated concussions for American football players who wear hard helmets. It is time to make properly designed protective headgear compulsory for all team sports where there is a risk of head injuries?

Research published in the The American Journal of Sports Medicine has shown that younger athletes, especially female athletes, displayed more symptoms and performed worse in standard neurocognitive tests and took longer to recover from a concussion than male athletes and older athletes.

The neuropsychological method tests reaction time, memory, and visual motor-speed. The test were conducted for 141 female and 93 male players ranging in age from 8 to 24 years. Soccer players who had at least one previous concussion performed much worse on the test than those who had no prior concussion. Female soccer players who reported head injuries at emergency centers showed poorer scores for neurocognitive testing, and reported more symptoms than male soccer players of the same age group and weight range.

The research study concluded that a recent previous concussion and gender, may explain some of the differences in post-concussive neurocognitive test scores in soccer players of various ages and sex. Previous concussion and gender may also play a role in the rate of recovery from concussion in terms of test performance. These differences were not due to size, weight and BMI between genders, but may be related to other gender anatomical difference that require further detailed study. 

Federals statistics in the US show that about 1.6 million players of various sports in the US suffer a sports-related concussion every year, and the numbers among college and high school athletes is growing. Federal statistics show that about 150,000 teenage athletes sustained concussions of various types on playing field from 2001 to 2005, but this figure may only be the tip of the iceberg, as it only includes those players who were taken to emergency rooms and the total number is likely to be much higher.

Previous research had suggested that girls were more prone to concussion injuries than boys playing the identical sports. The new study is one of the first to document the effect of both sex and age on a range of symptoms. The study suggests that anatomical differences may put female athletes at higher risk, particularly younger athletes. The conclusion was that young girls may need a more cautious approach after a concussion, and should be given more time to recover.

The study showed that after concussions, high school athletes performed poorer for their age on tests of visual and verbal memory, than older college athletes. Female athletes were shown to have more symptoms and showed more visual memory losses compared with male students of the same age. The cognitive impairments found in girls lasted for a longer time in high school athletes, from 10 to 21 days after concussion, which was two to three times as long as the 5-7 day period for on-going symptoms reported in college athletes.

The researchers involved in the study suggested that the risk of damage from concussion in younger athletes may be higher because their brains are undeveloped. There is also some evidence that the higher estrogen levels in girls, which may exacerbate brain injury. However, girls may also be more likely than boys to admit to injury and seek treatment. This is not to suggest that the girls did not show symptoms, but that the rate for boys may be lower because fewer of them reported to emergency centers for treatment. The actual risk rates for boys may be more similar to that for girls than the study suggests.

The findings also suggested that teenagers and younger children required a different response. The researchers said that the head and brain of a small child are proportionally larger in relation to the size of their body. This may mean that young people's heads are less steady on their shoulders. This may mean that collisions and accidental hits with an elbow or a boot during a soccer game may move the head more easily, and move their brains inside their skulls more easily causing concussions occur.

There are three issues that need to be looked at: