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Ill-fitted helmets leave school athletes at risk for concussion.

For high school football players, the best defense against concussions is a good offense--and that means a well-fitted football helmet, according to Dr. Eugene Hong.

Unfortunately, many high school athletes don't receive a proper helmet fitting, which can leave them at increased risk for concussion during play, he said in an interview.

"We take it for granted that these players are being fitted properly, "said Dr. Hong of Drexel University, Philadelphia. "But sports physicians know that isn't always the case."

Certified athletic trainers specially educated in gear fitting are most qualified to perform that task, Dr. Hong said. But his survey of 289 high schools in Pennsylvania and New Jersey revealed that although 90% of schools do have a certified athletic trainer available, only 44% actually use the trainer to fit helmets.

Coaches or other individuals (including parents) do the rest of the fitting, and make mistakes up to 25% of the time.

The overall concussion rate in Dr. Hong's survey was 3.5%, and wasn't significantly different between players fit by trainers and those fit by coaches or others. However, Dr. Hong said, athletic trainers were fitting helmets a little better than coaches were, with significant differences in 3 of 10 recommended fitting techniques.

The most commonly missed techniques among coaches were not having the facemask 2 inches from the nose (25.5%), not positioning the helmet 1 inch above the eyebrows (17.5%), and not having the chin straps equidistant from each other (17.5%).

Physicians don't need to know how to fit a football helmet, but they should remind both parents and student athletes of the importance of properly fit gear, Dr. Hong said.

The preparticipation physical is a great time to mention this. "It's also a good time to document whether the athlete has had previous concussions, since a history of concussion is one of the biggest risk factors for a subsequent concussion."

Proper follow-up with conservative return-to-play decisions are vitally important for athletes recovering from a concussion, he added.

Receiving a second blow to the head before a previous concussion has completely resolved can lead to second-impact syndrome, a usually fatal brain swelling.

Dr. Hong presented his data at the American College of Sports Medicine's annual meeting; the study will be published in the journal Medicine and Science in Sports and Exercise.

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Title Annotation:Clinical Rounds
Author:Sullivan, Michele G.
Publication:Pediatric News
Date:Oct 1, 2006
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