The Record (Bergen County, NJ)
08-29-2006
THE HEADGEAR DEBATE -- Experts question whether helmets are needed to meet
every threat
By HUGO MARTIN, LOS ANGELES TIMES
Date: 08-29-2006, Tuesday
Section: HEALTH
Edtion: All Editions
College track star Kevin Dare shook the track and field world four years ago
when he attempted to pole vault 15 feet, 7 inches during a Big Ten
Conference track meet in Minnesota.
The vault was no record attempt. It was not even Dare's personal best. The
jump was sadly unforgettable because Dare missed and was killed when he
landed headfirst in the steel takeoff box that vaulters use to catapult
themselves into the air.
After years of debate on ways to make the sport safer, a standards panel
approved in May the first specifications for a pole vaulting helmet,
spurring production of several models.
In the last few years, that same panel, the American Society for Testing and
Materials, has approved headgear standards for martial arts, short-track
speed skating, horseback riding, bull riding and soccer — a total of 13
helmets since 2000.
This is in addition to headgear already on the market for bicycling,
motorcycle riding, in-line skating, skiing, baseball and football.
Call it the "helmetization" of America. And blame it on an increasingly
safety-conscious world in which nearly every sport or recreational activity
that poses a head-injury threat — even a minor one — is sized up for a
helmet.
Head injury experts worry that new helmets have come on the market without
empirical data to show the need for or the effectiveness of the headgear.
"There is limited data for some of these kinds of sports," said Dr.
Frederick P. Rivara, a pediatrics professor at the University of Washington
School of Medicine who has studied helmet use among youngsters. "Before we
push these kinds of helmets we need to have an idea on the effectiveness."
Dr. Tony Strickland, director of the Sports Concussion Institute at the
Centinela Freeman Regional Medical Center in Los Angeles, shares the same
concerns, adding that poorly designed helmets could interfere with an
athlete's hearing and vision.
"Some might argue that some protection is better than none," he says.
"That's not always the case."
America's helmet movement began 20 years ago, when states and local
governments started adopting bicycle helmet laws targeting children. It was
prompted by a national campaign led by parents and doctors and fueled by a
New England Journal of Medicine study that said 85 percent of bicycle head
injuries could be prevented by wearing a helmet.
Although bicycle helmet use has varied by state, surveys show the helmets
are effective when worn.
The same might not be said of other helmets. In recent years, the
development of new headgear has been pushed less by the number of injuries
and more by emotion-filled campaigns led by advocacy groups, in most cases
headed by the parents of injured youngsters. Pole vaulting, for example, has
new helmet standards — but did not experience a preceding sharp spike in
head injuries.
"It starts with an individual with a story," said Susan Connor, president of
the Brain Injury Association, a Washington, D.C.-based group that represents
more than 5 million brain injury victims, families and professionals. "It's
not ideal, but that is the normal course of events."
The American Society for Testing and Materials — one of four panels that
approve helmet standards in the country — has been reviewing dozens of
requests for new helmet standards in the last few years.
Because athletic associations and government agencies usually don't require
helmets until a standard is set for thickness, shape, material and design, a
campaign to mandate helmets for a sport often starts by persuading a testing
agency to set a standard. Thus, the four panels are the target of heavy
lobbying by helmet manufacturers and the parents of injured athletes.
The agencies' willingness to consider new gear may also reflect the public's
growing acceptance of helmets. In 2002, Americans bought 2.4 million helmets
for all sports. By 2004, that number had jumped to 4.7 million, according to
Board-Trac, an Orange County, Calif.-based sports market research firm.
Randy Swart, vice chairman of ASTM's headgear subcommittee, said his group
typically wouldn't consider adopting a helmet standard until a group of
athletes, schools or parents made a push for such a standard. A jump in
reported head injuries alone won't prompt action from his group, he said.
Emotional interest
As an example, he pointed out that basketball has one of the highest rates
of head injuries of any sport, but that his subcommittee has not considered
standards for a basketball helmet because no one has lobbied for it.
"If the people in the sport are not interested, then there is no point to
make headgear," he said.
So new helmets are typically created through a movement by the people in a
particular sport — some of whom have not just an emotional interest, but a
financial one as well.
Perhaps, pediatrics professor Rivara says, new helmets should be developed
based on recommendations by the Centers for Disease Control and Prevention
or the U.S. Consumer Product Safety Commission.
After Dare's death in 2002, the National Collegiate Athletic Association
mandated larger landing pads but did not mandate helmets. The NCAA allows
vaulters to wear helmets on a voluntary basis.
Pole vaulting ranks far below most other sports in total head injuries. In
2001, the American Journal of Sports Medicine published a study that found
31 catastrophic head injuries associated with pole vaulting in the high
school, college and amateur ranks between 1982 and 1998. Those accidents
resulted in 16 deaths, according to the study.
The study did not compare pole vaulting with other sports, but a Consumer
Product Safety Commission study found that head injury incidents for
pole-vaulters were relatively rare compared with other sports such as
basketball (23,908), baseball (20,583) and football (20,128) in 1995 alone.
One of the authors of the 2001 pole vaulting study, 1972 Olympic pole
vaulting bronze medalist Jan Johnson, has been highly critical of the
helmets. Johnson, who heads the pole vault safety committee for U.S. Track
and Field, the governing body for high school track and field, said there
has been only one catastrophic head injury since larger landing pads were
adopted in 2002. "I think the problem was solved that way," he said.
Warning on risk
Although the study did not investigate the pros and cons of a pole vault
helmet, Johnson says he worries that they may cause spinal injuries by
hyper-flexing a vaulter's neck on impact with the padding. "I am not a real
strong advocate for helmets in pole vaulting," he said.
Even the ASTM, while considering a pole vaulting helmet, warned that such
headgear would not eliminate the risk of head injuries altogether.
But Dare's father continues to press the NCAA and the National Federation of
State High School Associations to require helmets for all pole vaulters.
Edward Dare said there was no evidence that the helmets cause neck injuries.
As for Johnson's suggestion that the larger padding has solved the problem,
Dare said: "Tell that to the next parents whose son or daughter vaults and
hits their head on the asphalt and dies."
(SIDEBAR, page F01)
Head injuries by sport, 2004
Cycling topped the list of sports and recreational activities with the most
head injuries in 2004, the latest year for which data are available. The
rankings, based on the estimated number of people treated in U.S. hospital
emergency rooms, are:
* Cycling: 69,476
* Powered recreational vehicles (ATVs, dune buggies, off-road
motorcycles): 27,213
* Football: 25,515
* Basketball: 24,320
* Baseball and softball: 22,671
* Water sports (diving, surfing, swimming, water skiing): 18,860
* Winter sports (skiing, sledding, snowboarding): 18,566
* Skateboarding, scooters: 15,125
* Soccer: 14,465
* Horseback riding: 10,669
* Health club (exercise,
weightlifting): 9,901
* Golf: 8,049
* Trampoline: 5,392
* Hockey: 4,741
* Ball sports (unspecified): 4,221
* Skating (in-line, roller, roller
hockey): 4,041
* Ice skating: 2,852
* Fishing: 2,689
* Wrestling: 2,268
* Volleyball: 2,021
Source: U.S. Consumer Product Safety Commission
(SIDEBAR, page F02)
Guidelines on buying and fitting headgear
Finding the right helmet for a particular sport is just the first step in
protecting your head from injury. The helmet must also fit properly. Wearing
an ill-fitting helmet is almost as dangerous as wearing none at all, because
a loose-fitting helmet can fly off in an accident.
The following tips apply to most sporting and outdoor recreation helmets,
according to safety groups, including the Bicycle Helmet Safety Institute in
Arlington, Va. Craniums come in various shapes, so prepare to spend time
finding a helmet to fit your particular head.
* The helmet should comfortably touch your head on all sides. It should fit
so snuggly that it stays in place even when you shake your head violently.
Some have pads inside that can be moved to fill any gaps between your head
and the helmet.
* The helmet should sit level on your head, with the front just above the
eyebrows. If you wear glasses, the helmet should sit just above the frames.
When you look upward, the helmet's front rim should be barely visible to
your eye.
* Tighten the chin strap so that when you open your mouth wide, you feel the
helmet pull down a little. The "Y" on the side of the straps that run down
the side of your head should fit just below your ears.
* Test the fit of your helmet by pushing up and back on the front rim. If
your helmet moves more than an inch, you need to tighten the Y-section of
the chin strap that runs in front of your ears. Push forward and up on the
back rim. If your helmet moves more than one inch, tighten the Y-section in
back of your ears.
* On one-size-fits-all helmets, tighten the fitting ring until the helmet
stays in place even during a violent shake.
* When buying a helmet, look for labels that indicate that it meets the
standards set by at least one of these American testing agencies: The U.S.
Consumer Product Safety Commission, the American Society for Testing and
Materials; the American National Standards Institute or the Snell Memorial
Foundation.