Science Friday - Can Better Equipment Eliminate Concussions In Sports?

Episode Date: September 29, 2025

Football season is well underway, and fans know those athletes get hit hard. Could better helmets and guidelines around concussion prevention someday eliminate head injuries from the sport? Host Flora Lichtman speaks with concussion doctor Michael Collins and helmet specialist Barry Miller about how our understanding of head injuries and equipment has evolved. Guests:  Dr. Michael Collins is the clinical and executive director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center.Dr. Barry Miller is the director of outreach at the Virginia Tech Helmet Lab.Transcripts for each episode are available within 1-3 days at sciencefriday.com.   Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Hey, it's Flora Lickman, and you're listening to Science Friday. Today in the show, Concussions, and how new science is shaking up treatment and prevention. I'm not telling patients now to turn down lights, turn down noises, get off their phones, off their computers. Really? Because that is, I still have heard, you know, that, I feel like that is the prevailing. I know. Wisdom. It drives me crazy. Really? Okay, tell us more. You know, if you've ever watched a football game, and I'm sure you have, I don't.

don't have to tell you that those athletes get hit hard. And concussions have long been considered a kind of occupational hazard of the sport. But is this a risk we can engineer our way out of? With better helmets and guidelines around concussion prevention, could we expect no concussions for football players or other athletes? Joining me now to talk about the science of helmets and head injuries are my guests. Dr. Michael Collins, clinical and executive director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, and Dr. Barry Miller, Director of Outreach at the Virginia Tech Helmet Lab. Welcome both of you to Science Friday. Thank you. Michael, let's start with you. Michael, let's start with you. What physiologically

is happening during a concussion? Like, how well do we understand this injury? We know it pretty well. You know, the word concusses literally translates from Latin to English to mean to shake violently. And just for example's sake, think about your brain as an egg yolk inside an egg shell, and the egg yolk is going to move inside the shell, even though shell doesn't crack. This is your brain on concussions. That's your brain on concussions. And what causes concussion actually happens at the cellular level, where in our brain we obviously have billions of cells called neurons. And when the brain moves sufficiently enough in the skull, the membrane to the neuron will stretch. And this little chemical called potassium will leak out of the cell.

and that increases the demand for glucose or energy in the brain. And at the same time, this little chemical called calcium will leak into the cell, and it shouldn't be there, but it goes in. And when the calcium goes into the cell, we actually get constriction of our blood vessels, and we get less cerebral blood flow. And of course, blood flow is what supplies energy. And so there's a mismatch between supply and demand of energy to the cell and the neuron, and that energy problem can affect different systems in the brain.

and we've actually learned now there's different types of concussions and there's different systems in the brain that can be affected. And the cells fortunately do not die if you manage this injury properly and make sure there's recovery before a second insult can occur. And we've made a lot of advances in terms of our treatments and understanding of this injury and actually getting patients fully healthy before getting back to play is an absolute key message that needs to be relayed to parents, coaches,

that are out there. That's so fascinating. I didn't realize that we understood what was happening on the cellular level with such granularity. Yeah, it's animal model work that has been done by very smart people over the years, and we have a pretty good understanding of the path of physiology of the injury. We're really learning about the symptoms that predict outcome, risk factors, and most importantly, we actually have treatments now that can actually help to treat this injury and get patients better or faster and get them healthy and get them back to play safely. And that's where the real progress, in my opinion, has been made over the last five or 10 years. I want to come back to treatments in a minute.

But before we do, you talked about risk factors. Are some people at higher risk for concussion injury than others? Absolutely. And we're talking about the human brain. We're talking about there's very specific risk factors that we've been able to determine through our research that predicts not only who might get a concussion more easily, but also who's going to have a longer time recovering. And some of those risk factors, the most identifiable ones in our research, believe it or not, motion sickness, being sensitive to motion

as a youngster predicts the vestibular system in the brain will decompensate more easily from that energy problem. And that actually predicts a little more easily who gets concussed who takes a little longer recover, but also history of migraine is a very significant risk factor. History of anxiety is definitely a significant risk factor. And actually being female predicts someone who may be concussed more easily. Females are six times more likely to have motion sickness, to have migraine, and a little more at risk for anxiety. And so we feel that females are a little more at risk to sustain an injury and have a little

longer outcome because of those pre-existing risk factors. So in terms of, you know, I know we're talking about prevention here, I really feel that work needs to interface with some of the clinical work that's being done because you're not, you're never going to have a threshold for concussion, in my opinion, because the human brain is so complicated and the human being is so complicated and it's going to be different risk levels for different people when they play sports. One person could get hit and not get a concussion and another person could have the same hit and get a concussion. We see it all day long in our clinics. I want to stay with prevention for a second and I want to go to you, Barry.

You co-lead the Virginia Tech Helmet Lab, which by the way just sounds like a very cool job. But tell me how you test helmets. Yeah, so the Helmet Lab is actually a comprehensive injury biomechanics lab. So we do all kinds of research. Our backgrounds in automotive safety, but obviously we took that information and applied it to sports world. And when we talk about helmet testing, so we figure out how do you actually hit your head in these various sports or environments, whether it's football, falling off your horse, or just recently we did some stuff with construction helmets. And we take those real world fall accidents back into the lab and create a standardized test protocol to evaluate those helmets.

And, you know, these test rigs include pendulum impactors, linear impactors, different types of devices. And so we just try to best mimic those real world accidents. And then we test helmets against those real world scenarios. I'm picturing crash test dummies in car. You know, what I'm talking about, like, this is dating me, but those 80s commercials where you see cars zooming into a concrete wall with like a mannequin in them. How far off am I? Well, we do have another part of our research. lab across campus that does that. But our impactors are a little bit different. Describe it from

paint me a picture, Barry. Okay. So for bike helmets, for example, we use what we call a drop tower. And so we have a basically a ring or a halo, if you will, that holds the head form and the helmet above an anvil at an angle. And then we drop that and the halo holds the helmet in place as it impacts the anvil at the location we're trying to hit. Wow. What about football? How do you test football helmets? Football, we use something called a pendulum impactor. So we have a big pendulum arm with the, we can change out the face of that pendulum, but you know, usually for football, we use a mushroom shaped, it's hard nylon that's basically the same shape as a football helmet. And then that arm comes down and hits a helmet, a head form, a surrogate neck, and a sliding

mass that represents the torso of a football player. And then we can measure our impacts from those scenarios. It's called a target table. And so we can orient the head pretty much in any position we want. And for football, we use four locations and three energy levels. So 12 specific test conditions to evaluate football helmets. What makes one helmet better than another one? Like, has the technology improved? And what are you looking for? The helmets have drastically improved. When we first launched our helmet ratings in 2011, there was only what we considered a one five-star helmet. And we just rescaled recently because all the helmets were five-star. So five-star being the best, zero-star is being the worst.

That best helmet way back in 2011 would be the worst helmet today. So the advancements have been huge. The star scores, which represents concussion risks in some sort of fashion, continue to drop. So the football helmets are really impressive. Okay, we have to take a break, but don't go anywhere because after the break, we will find out whether our guests think, with the right head gear, concussions in sports could become a thing of the past. Well, we always say the helmet is the last line of defense.

Best options don't hit your head. Michael, will we ever get to a place where helmets can fully prevent concussions? I'm not so sure we can get to a place where helmets fully prevent concussions, but I applaud the work that's being done at Virginia Tech and other locations, and we really embrace that research, and we're learning a lot. And if you marry engineering improvements to clinical improvements, I would say we've never been safer as a population to play football. And I really think this is the best time we've ever had to, if you sustain a concussion, the advances are real in over the past decade, two decades. And there's so many people who are researched on this now, which is exciting.

But to get to a point where you can prevent this injury from happening entirely, I don't see. see that occurring. And we also have to keep in mind, and most of these injuries occur in non-helmeted activities too, right? I mean, so slip and falls are probably the most common reason why people have concussions and car accidents, et cetera. And there's a lot of people having concussions out there. You know, again, I really think it's exciting work that's being done, but to prevent the brain from moving inside the skull is a hard ask. Barry, what do you think? Where are you on this question. Well, we always say the helmet is the last line of defense. So if you can minimize any head impacts, that's what you want to do. And granted, the helmets have drastically improved, but, you know,

it's a risk of concussion. And some people get injured at really low energy levels. So, yeah, I agree with Dr. Collins completely. Eliminate, probably not drastically reduce. We're improving. And so, but yeah, the best options don't hit your head. Barry, if I had a kid who played football, you know, or even I'm just like looking for a bike helmet for myself or someone I love, what should I look for? How would I evaluate whether that helmet is a five star or not? That's a great question. All helmets have to be certified. I don't know if your listeners would know this. But the certifications are past, fail, whether it's a football helmet, bike helmet, snow sport helmet. Different organizations certify these to a standard. threshold to pass those standards is the point of catastrophic head injury. So we're talking skull fracture or death, right? And so we supplement those mandatory required certifications with sport-specific helmeries. And so there's no way for you to tell which helmets safer than another until you

use our webpage, right? Because two helmets on the shelf at Walmart, bike helmets, you don't know which one's safer. They both pass the basic certification, but that's all you know. And it's just like anything else. There's product differentiation. You know, some cars are safer than the other. Some helmets are safer than others. And y'all are completely independent, right? You're not funded by some helmet maker. That is correct. We're a public institution, independent testing facility. That's correct. Michael, in the case of football, I mean, I hear what y'all are saying, which is, you know, it's never been safer. But I also wonder if the game has changed, at least in the case of football. I mean, are people getting hit harder than they ever were?

I mean, yes, force equals mass times acceleration. So we've never seen faster, heavier athletes. And the training that goes on for performance is improved as well. So the speeds are greater. The size of the individuals are greater in football and other sports. And so, you know, as those forces go up, you know, theoretically we'll see more concussions, which we do. But I, I, I, I, do think that the work that's being done with helmet technology is we're meeting those challenges with some of this research as being done not only in helmet technology but also in terms of our clinical understanding of the injury. I really do feel like it's it has never been safer to play the sport than now just because of these advances across all these different domains. Clinical

helmet technology research and these injuries do happen. five-star helmets and they do happen in recreation sports and all over. But it's an exciting time because the interest in this injury, the spotlight's iridescent on concussion. And I really feel that the academic community and clinical communities are rising to the challenge and great work is being done. I don't want to sound polyanish. I mean, this is an injury that can occur.

But I'm very encouraged by what we're. learning in terms of, you know, how we evaluate, manage, treat this injury as well as the helmet technology advances that we're seeing. Michael, let's talk treatment. What has changed about treatment of concussions in the last 10, 20 years? At a very basic level, what we've learned is that rest is not the way to treat this injury. We've actually come up with targeted active rehab. I'm not telling patients now to turn down lights, turn down noises, get off their phones, off their computers.

Really? Because that is, I still have heard, you know, that I feel like that is the prevailing. I know. It drives me crazy because. Really? Okay. Tell us more. It's reabituation and not rest. What happens with this injury is this energy crisis can decompensate these different systems, vestibular, oculom motor, you know, how our eyes work together. our vestibular system is a pathway in the brain that allows us to stabilize our vision, we move

our head. We see patients have migraine. What we know is that the best way to treat these issues is by retraining and desensitizing. We actually use exercise now to treat concussion. Exercise helps to treat migraine. Exercise reabituates the vestibular system. We have very specific movements that we can create to help retrain the vestibular system. We have exercises in physical therapy that we do to retrain the ocula motor system. Anxiety is highly prevalent in this injury. So what we do is we do a lot of exercise, which increases a parasympathetic nervous system, which helps to calm down the anxiety. If you see me in Pittsburgh at UPMC, you're going to be working out and we're going to be working on in very specific ways and be giving you very specific exercises to rehab and

retrain these systems. And honestly, one of the biggest problems we have now in terms of treating concussion are patients that have rested too much acutely and subacutely. And that leads to problems if it's not managed properly. And there's a lot of biology behind that. And so that's probably surprising for the listenership to hear that. But yes, that's a huge paradigm shift. Huge paradigm shifts. I've never been more confident than I am right now in telling you that it's needed, a needed paradigm shift. And we're doing a lot of work on that. And a lot of research has come out showing the benefits of exercise, targeted exercise. I want to make sure people understand that there's under doctor supervision. Under specialist supervision, not just doctor's supervision, but knowing how to work these patients out. And who do we push harder? than others. But there's a lot that goes into that from an evaluation standpoint. But yes, rest is not effective at treating concussion. What about CTE, the neurodegenerated disease that can follow repeated head trauma? Do we have treatment that can prevent that outcome?

In a very general sense, we have a lot to learn about CTE. And I actually was just reviewing a paper 10 minutes before I got on this call, which shows that this paper showed that the prevalence of that is very, very low in what we just saw in the research. There's a wide gamut of research out there on CT. What I want to say at the basic level is the best way to prevent problems with

concussion is to manage it and treat it effectively when you have one. We do not want kids out there playing through concussions. We don't want kids going back to play before the concussions are recovered. we do not know who is at risk for CTE. We do not know the factors that play into patients that end up having those difficulties and issues. A lot more work is needed.

I know everyone wants answers on that, but we have decades of research in front of us before we better understand that construct. It's a nebulous construct that we need a lot more science on. This was so fascinating. Thank you both for joining me today. You're welcome. Thank you.

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Today's episode was produced by Kathleen Davis. I'm Flora Lichtman. Thanks for listening.