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Making Sport Safer by Managing Head Impacts

The awareness of head impacts and concussion in sport is rising quickly as more research into the long term effects of these types of injuries is undertaken.

What are concussions, sub-concussive events and head impacts?

Firstly, it’s useful to understand the terminology that we’re using here. At one end of the spectrum we have actual concussions. These are traumatic brain injuries that affect your brain function. Your brain typically is protected by the cerebrospinal fluid inside your skull. A violent blow however can cause your brain to move back and forth bumping into the inner walls of your skull. This can happen in many different sporting incidences and ultimately can cause brain injury. Sub-concussive events though are those hits that are below that concussion threshold: the brain shakes, but not to the same degree that causes damage severe enough to be noticed through symptoms (1).

Even such sub-concussive events are certainly a cause for concern for some athletes, especially when a whole lifetime of competing could result in a large accumulation. It is heavily speculated that the accumulation of such events may result in long-term detrimental effects on brain function (2)

Ultimately, repeated blows to the head can lead to the brain condition chronic traumatic encephalopathy (CTE), which research suggests leads to cognitive decline (3,4). It is a heavily discussed topic in sports such as American Football, both codes of rugby and Australian Rules Football, and has heightened concern amongst the public, scientific, and medical communities equally. With increased awareness of the potential long term effects of head impacts, now is the time to act to make sport safer for those who take part.

Why and how to measure head impacts

Having established that there is a serious risk associated with large and small head impacts it is important for us to consider what we can do to safeguard athletes. Without removing head impacts from sport entirely, the best way to manage player welfare is to identify when and if a head impact has occurred, quantify the size of that impact, and manage the player’s recovery accordingly. This allows us to understand the level of risk to that individual, to record accumulating impacts and to decide what treatments or protocols they may need to adhere to following the incident. Some research has also suggested that athletes and support staff may not even recognise some incidences of head impacts in real time (5) so the ability to measure such events ensures that we don’t miss anything that may be vitally important.

The best way to measure head impacts is to consider the direction and force with which the head moves during specific events. This might be movement in a straight line or in a rotational fashion. Historically, in many sporting scenarios, this has been quite challenging due to the disruption of the sport caused by any kind of elaborate measurement apparatus. More recently a range of sports technologies have been created to measure impacts. Some of these technologies have relied on instrumented helmets or patches that are stuck to the players, at HitIQ our research suggests that the most accurate way of measuring head impacts is to attach the measurement device directly to the skull, and that is exactly what we have done with an instrumented mouthguard that fits over the upper teeth. The approach has been backed up by research suggesting that such gumshields can accurately detect such impacts (6) and that those detections are able to accurately measure the magnitude of those impacts (7). Some trials have also looked at the use of headgear to reduce the consequences of impacts. These have been shown to be useful in some cases during head-to-head contacts but this was not the case in soccer when considering head-to-ball impacts during headers (8). Despite headgear providing some protection it is recommended that the first step in minimising risk is to reduce incidence. It is also feared that headgear may encourage harder impact situations as athletes feel protected, a further reason why we chose a mouthguard that can be worn with a helmet if that is appropriate for the sport.

It should be made clear that HitIQ mouthguards measure head impacts, both in terms of volume and magnitude, but they are not a diagnostic tool. Head-impact sensors have limited applications to concussion diagnosis but may provide side-line staff with estimates of athlete exposure and real-time data to monitor players (9). Given that concussion risk is influenced by many factors in addition to impact biomechanics, viewing an athlete’s head-impact data may provide context for the clinician working on the side-lines, but impact sensors should not replace clinical judgment (9). We believe that the place of head impact data in sport is to provide objective data that becomes an important part of the decision making process in both the periodisation of head impact incidences and also providing supporting data for clinical diagnoses.

Impact periodsation by playing position shown in the Nexus portal.

How to periodise head impacts to protect player wellbeing

Once you are accurately measuring impacts, it is important to understand how to use the impact data and manage player load accordingly. The key to this is being able to quantify the risk that each impact represents, the risk of the cumulative effects of multiple impacts and how to manage that load through periodisation of impacts. For example, in soccer, young players are being advised not to head the ball at all (10). Some governing bodies including U.S. Soccer have followed this up with limiting the number of head contacts during training sessions based on age. In other sports where head impacts are common, the advice is to monitor athletes more closely to recognise head injury incidences that could be missed. HItIQ technology is designed to do exactly that. By using HitIQ Nexus A9 mouthguards with athletes you can effectively monitor their exposure to head impacts, the data provided will allow you to manage head impacts in training, and as a result reduce the incidence of concussion. This approach should actually increase player availability for competition by managing load to reduce the likelihood of concussive events resulting in players requiring enforced recovery periods.

Conclusion

As the awareness of the risks of repeated head impacts from sport grows, the pressure on national governing bodies, professional and amateur sports and their practitioners to ensure that participants are safe will only grow. At HitIQ our vision is for a safe environment for all to take part in sport. The nature of some sports means that in order to ensure players are kept safe, the volume and magnitude of any head impacts they are exposed to must be measured, and the exposure to head impacts carefully periodised. Through our Nexus A9 mouthguard and Nexus software platform, this is made possible, and straightforward. If you are not measuring head impacts with your players, and tailoring their training accordingly, we believe that you are not doing the best you can for your players’ wellbeing. If you’d like more information then get in contact with us, we can help.


References

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  2. Downs DS, Abwender D. Neuropsychological impairment in soccer athletes. J Sports Med Phys Fitness [Internet]. 2002 Mar;42(1):103–7. Available from: http://www.ncbi.nlm.nih.gov/pu...
  3. Hunter LE, Branch CA, Lipton ML. The neurobiological effects of repetitive head impacts in collision sports. Neurobiol Dis [Internet]. 2019;123:122–6. Available from: http://www.ncbi.nlm.nih.gov/pu...
  4. Owens TS, Calverley TA, Stacey BS, Iannatelli A, Venables L, Rose G, Fall L, Tsukamoto H, Berg RMG, Jones GL, Marley CJ, Bailey DM. Contact events in rugby union and the link to reduced cognition: evidence for impaired redox-regulation of cerebrovascular function. Exp Physiol. 2021 Sep;106(9):1971-1980. doi: 10.1113/EP089330.
  5. Zimmerman KA, Laverse E, Samra R, Yanez Lopez M, Jolly AE, Bourke NJ, et al. White matter abnormalities in active elite adult rugby players. Brain Commun. 2021;3(3).
  6. Goodin P, Gardner A, Iverson G. Development of a Machine Learning Based Classifier for Identification of Head and Body Impacts in Elite Level Australian Rules Football Players. Frontiers (Boulder). 2021;148:148–62.
  7. Stitt D, Draper N, Alexander K, Kabaliuk N. Laboratory Validation of Instrumented Mouthguard for Use in Sport. Sensors [Internet]. 2021 Sep 9;21(18):6028. Available from: https://www.mdpi.com/1424-8220...
  8. Caccese JB, Kaminski TW. Minimizing Head Acceleration in Soccer: A Review of the Literature. Sport Med. 2016;46(11):1591–604.
  9. O’Connor KL, Rowson S, Duma SM, Broglio SP. Head-impact-measurement devices: A systematic review. J Athl Train. 2017;52(3):206–27.
  10. Bunc G, Ravnik J, Velnar T. May Heading in Soccer Result in Traumatic Brain Injury? A Review of Literature. Med Arch. 2017;71(5):356–9.