Skip to main content
Log in

A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies

  • Review
  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

This review paper summarizes the scientific advancements in the field of concussion biomechanics in American football throughout the past five decades. The focus is on-field biomechanical data collection, and the translation of that data to injury metrics and helmet evaluation. On-field data has been collected with video analysis for laboratory reconstructions or wearable head impact sensors. Concussion biomechanics have been studied across all levels of play, from youth to professional, which has allowed for comparison of head impact exposure and injury tolerance between different age groups. In general, head impact exposure and injury tolerance increase with increasing age. Average values for concussive head impact kinematics are lower for youth players in both linear and rotational acceleration. Head impact data from concussive and non-concussive events have been used to develop injury metrics and risk functions for use in protective equipment evaluation. These risk functions have been used to evaluate helmet performance for each level of play, showing substantial differences in the ability of different helmet models to reduce concussion risk. New advances in head impact sensor technology allow for biomechanical measurements in helmeted and non-helmeted sports for a more complete understanding of concussion tolerance in different demographics. These sensors along with advances in finite element modeling will lead to a better understanding of the mechanisms of injury and human tolerance to head impact.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. Allison, M. A., Y. S. Kang, M. R. Maltese, J. H. Bolte, and K. B. Arbogast. Measurement of Hybrid III head impact kinematics using an accelerometer and gyroscope system in ice hockey helmets. Ann. Biomed. Eng. 43:1896–1906, 2015.

    Article  PubMed  Google Scholar 

  2. Anderson, V., C. Catroppa, S. Morse, F. Haritou, and J. Rosenfeld. Functional plasticity or vulnerability after early brain injury? Pediatrics 116:1374–1382, 2005.

    Article  PubMed  Google Scholar 

  3. Asken, B. M., Z. S. Brooke, T. C. Stevens, P. G. Silvestri, M. J. Graham, M. S. Jaffee, and J. R. Clugston. Drill-specific head impacts in collegiate football practice: implications for reducing “friendly fire” exposure. Ann. Biomed. Eng. 47:2094–2108, 2019.

    Article  PubMed  Google Scholar 

  4. Auerbach, P. S., and W. H. Waggoner. It’s time to change the rules. JAMA 316:1260–1261, 2016.

    Article  PubMed  Google Scholar 

  5. Bahrami, N., D. Sharma, S. Rosenthal, E. M. Davenport, J. E. Urban, B. Wagner, Y. Jung, C. G. Vaughan, G. A. Gioia, and J. D. Stitzel. Subconcussive head impact exposure and white matter tract changes over a single season of youth football. Radiology 281:919–926, 2016.

    Article  PubMed  Google Scholar 

  6. Bailes, J. E., A. L. Petraglia, B. I. Omalu, E. Nauman, and T. Talavage. Role of subconcussion in repetitive mild traumatic brain injury: a review. J. Neurosurg. 119:1235–1245, 2013.

    Article  PubMed  Google Scholar 

  7. Bailey A., J. Funk, D. Lessley, C. Sherwood, J. Crandall, W. Neale and N. Rose. Validation of a videogrammetry technique for analysing American football helmet kinematics. Sports Biomech. 1–23, 2018.

  8. Bari, S., D. O. Svaldi, I. Jang, T. E. Shenk, V. N. Poole, T. Lee, U. Dydak, J. V. Rispoli, E. A. Nauman, and T. M. Talavage. Dependence on subconcussive impacts of brain metabolism in collision sport athletes: an MR spectroscopic study. Brain Imaging Behav. 13:735–749, 2019.

    Article  PubMed  Google Scholar 

  9. Bartsch, A., S. Samorezov, E. Benzel, V. Miele, and D. Brett. Validation of an “intelligent mouthguard” single event head impact dosimeter. Stapp Car Crash J. 58:1, 2014.

    PubMed  Google Scholar 

  10. Baugh, C. M., P. T. Kiernan, E. Kroshus, D. H. Daneshvar, P. H. Montenigro, A. C. McKee, and R. A. Stern. Frequency of head-impact-related outcomes by position in NCAA division I collegiate football players. J. Neurotrauma 32:314–326, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Beckwith, J. G., R. M. Greenwald, and J. J. Chu. Measuring head kinematics in football: correlation between the head impact telemetry system and hybrid III headform. Ann. Biomed. Eng. 40:237–248, 2012.

    Article  PubMed  Google Scholar 

  12. Beckwith, J. G., R. M. Greenwald, J. J. Chu, J. J. Crisco, S. Rowson, S. M. Duma, S. P. Broglio, T. W. McAllister, K. M. Guskiewicz, J. P. Mihalik, S. Anderson, B. Schnebel, P. G. Brolinson, and M. W. Collins. Head impact exposure sustained by football players on days of diagnosed concussion. Med. Sci. Sports Exerc. 45:737–746, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Beckwith, J. G., R. M. Greenwald, J. J. Chu, J. J. Crisco, S. Rowson, S. M. Duma, S. P. Broglio, T. W. McAllister, K. M. Guskiewicz, J. P. Mihalik, S. Anderson, B. Schnebel, P. G. Brolinson, and M. W. Collins. Timing of concussion diagnosis is related to head impact exposure prior to injury. Med. Sci. Sports Exerc. 45:747–754, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Beckwith, J. G., W. Zhao, S. Ji, A. G. Ajamil, R. P. Bolander, J. J. Chu, T. W. McAllister, J. J. Crisco, S. M. Duma, and S. Rowson. Estimated brain tissue response following impacts associated with and without diagnosed concussion. Ann. Biomed. Eng. 46:819–830, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Begonia, M., and S. Rowson. Flag Football Headgear STAR Protocol, 2019.

  16. Bland, M. L., C. McNally, D. S. Zuby, B. C. Mueller, and S. Rowson. Development of the STAR evaluation system for assessing bicycle helmet protective performance. Ann. Biomed. Eng. 48:47–57, 2020.

    Article  PubMed  Google Scholar 

  17. Breedlove, E. L., M. Robinson, T. M. Talavage, K. E. Morigaki, U. Yoruk, K. O’Keefe, J. King, L. J. Leverenz, J. W. Gilger, and E. A. Nauman. Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. J. Biomech. 45:1265–1272, 2012.

    Article  PubMed  Google Scholar 

  18. Brennan, J. H., B. Mitra, A. Synnot, J. McKenzie, C. Willmott, A. S. McIntosh, J. J. Maller, and J. V. Rosenfeld. Accelerometers for the assessment of concussion in male athletes: a systematic review and meta-analysis. Sports Med. 47:469–478, 2017.

    Article  PubMed  Google Scholar 

  19. Broglio, S. P., J. T. Eckner, D. Martini, J. J. Sosnoff, J. S. Kutcher, and C. Randolph. Cumulative head impact burden in high school football. J. Neurotrauma 28:2069–2078, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Broglio, S. P., D. Martini, L. Kasper, J. T. Eckner, and J. S. Kutcher. Estimation of head impact exposure in high school football: implications for regulating contact practices. Am. J. Sports Med. 41:2877–2884, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Broglio, S. P., M. McCrea, T. McAllister, J. Harezlak, B. Katz, D. Hack, B. Hainline, and C. C. Investigators. A national study on the effects of concussion in collegiate athletes and US military service academy members: the NCAA–DoD concussion assessment, research and education (CARE) consortium structure and methods. Sports Med. 47:1437–1451, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Broglio, S. P., B. Schnebel, J. J. Sosnoff, S. Shin, X. Fend, X. He, and J. Zimmerman. Biomechanical properties of concussions in high school football. Med. Sci. Sports Exerc. 42:2064–2071, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Caccese, J. B., L. C. Lamond, T. A. Buckley, and T. W. Kaminski. Reducing purposeful headers from goal kicks and punts may reduce cumulative exposure to head acceleration. Res. Sports Med. 24:407–415, 2016.

    Article  PubMed  Google Scholar 

  24. Camarillo, D. B., P. B. Shull, J. Mattson, R. Shultz, and D. Garza. An instrumented mouthguard for measuring linear and angular head impact kinematics in American football. Ann. Biomed. Eng. 41:1939–1949, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Campolettano, E. T., R. A. Gellner, E. P. Smith, S. Bellamkonda, C. T. Tierney, J. J. Crisco, D. A. Jones, M. E. Kelley, J. E. Urban, and J. D. Stitzel. Development of a concussion risk function for a youth population using head linear and rotational acceleration. Ann. Biomed. Eng. 48:92–103, 2020.

    Article  PubMed  Google Scholar 

  26. Campolettano, E. T., R. A. Gellner, D. W. Sproule, M. T. Begonia and S. Rowson. Quantifying youth football helmet performance: assessing linear and rotational head acceleration. Ann. Biomed. Eng. 1–11, 2020.

  27. Campolettano, E. T., S. Rowson, S. M. Duma, B. Stemper, A. Shah, J. Harezlak, L. D. Riggen, J. Mihalik, A. Brooks, and K. Cameron. Factors affecting head impact exposure in college football practices: a multi-institutional study. Ann. Biomed. Eng. 47:2086–2093, 2019.

    Article  PubMed  Google Scholar 

  28. Caswell, S. V., A. E. Lincoln, J. L. Almquist, R. E. Dunn, and R. Y. Hinton. Video incident analysis of head injuries in high school girls’ lacrosse. Am. J. sports Med. 40:756–762, 2012.

    Article  PubMed  Google Scholar 

  29. Choe, M. C., T. Babikian, J. DiFiori, D. A. Hovda, and C. C. Giza. A pediatric perspective on concussion pathophysiology. Curr. Opin. Pediatr. 24:689–695, 2012.

    Article  PubMed  Google Scholar 

  30. Chrisman, S., K. Harmon, J. Schmidt, T. Kaminski, T. Buckley, A. Kontos, J. Clugston, M. McCrea, T. McAllister, and S. Broglio. Impact of factors that affect reading skill level on King-Devick baseline performance time. Ann. Biomed. Eng. 47:2122–2127, 2019.

    Article  CAS  PubMed  Google Scholar 

  31. Cobb, B. R., J. E. Urban, E. M. Davenport, S. Rowson, S. M. Duma, J. A. Maldjian, C. T. Whitlow, A. K. Powers, and J. D. Stitzel. Head impact exposure in youth football: elementary school ages 9-12 years and the effect of practice structure. Ann. Biomed. Eng. 41:2463–2473, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cobb, B. R., A. M. Zadnik and S. Rowson. Comparative analysis of helmeted impact response of Hybrid III and National Operating Committee on Standards for Athletic Equipment headforms. Proc. Inst. Mech. Eng. Part P 1754337115599133, 2015.

  33. Colello, R. J., I. A. Colello, D. Abdelhameid, K. G. Cresswell, R. Merchant, and E. Beckett. Making football safer: assessing the current national football league policy on the type of helmets allowed on the playing field. J. Neurotrauma 35:1213–1223, 2018.

    Article  PubMed  Google Scholar 

  34. Crisco, J. J., J. J. Chu, and R. M. Greenwald. An algorithm for estimating acceleration magnitude and impact location using multiple nonorthogonal single-axis accelerometers. J. Biomech. Eng. 126:849–854, 2004.

    Article  PubMed  Google Scholar 

  35. Crisco, J. J., R. Fiore, J. G. Beckwith, J. J. Chu, P. G. Brolinson, S. Duma, T. W. McAllister, A. C. Duhaime, and R. M. Greenwald. Frequency and location of head impact exposures in individual collegiate football players. J. Athl. Train. 45:549–559, 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Crisco, J. J., B. J. Wilcox, J. G. Beckwith, J. J. Chu, A. C. Duhaime, S. Rowson, S. M. Duma, A. C. Maerlender, T. W. McAllister, and R. M. Greenwald. Head impact exposure in collegiate football players. J. Biomech. 44:2673–2678, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Crisco, J. J., B. J. Wilcox, J. T. Machan, T. W. McAllister, A. C. Duhaime, S. M. Duma, S. Rowson, J. G. Beckwith, J. J. Chu, and R. M. Greenwald. Magnitude of head impact exposures in individual collegiate football players. J. Appl. Biomech. 28:174–183, 2012.

    Article  PubMed  Google Scholar 

  38. Daneshvar, D. H., C. M. Baugh, C. J. Nowinski, A. C. McKee, R. A. Stern, and R. C. Cantu. Helmets and mouth guards: the role of personal equipment in preventing sport-related concussions. Clin. Sports Med. 30:145–163, 2011.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Daniel, R. W., S. Rowson, and S. M. Duma. Head impact exposure in youth football. Ann. Biomed. Eng. 40:976–981, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Daniel, R. W., S. Rowson, and S. M. Duma. Head impact exposure in youth football: middle school ages 12–14 years. J. Biomech. Eng. 136:094501, 2014.

    Article  PubMed  Google Scholar 

  41. Davenport, E. M., C. T. Whitlow, J. E. Urban, M. A. Espeland, Y. Jung, D. A. Rosenbaum, G. A. Gioia, A. K. Powers, J. D. Stitzel, and J. A. Maldjian. Abnormal white matter integrity related to head impact exposure in a season of high school varsity football. J. Neurotrauma 31:1617–1624, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Duma, S. M., S. J. Manoogian, W. R. Bussone, P. G. Brolinson, M. W. Goforth, J. J. Donnenwerth, R. M. Greenwald, J. J. Chu, and J. J. Crisco. Analysis of real-time head accelerations in collegiate football players. Clin. J. Sport Med. 15:3–8, 2005.

    Article  PubMed  Google Scholar 

  43. Eckner, J. T., K. L. O’Connor, S. P. Broglio, and J. A. Ashton-Miller. Comparison of head impact exposure between male and female high school ice hockey athletes. Am. J. Sports Med. 46:2253–2262, 2018.

    Article  PubMed  Google Scholar 

  44. Funk, J., J. Crandall, M. Wonnacott, C. Withnall and D. Drive. NFL linear impactor helmet test protocol. Biocore, Charlottesville, VA, accessed Feb 1: 2019, 2017.

  45. Funk, J. R., S. M. Duma, S. J. Manoogian and S. Rowson. Development of concussion risk curves based on head impact data from collegiate football players. In: Injury Biomechanics Research, Proceedings of the Thirty-Fourth Internation Workshop, 2006.

  46. Funk, J. R., S. M. Duma, S. J. Manoogian, and S. Rowson. Biomechanical risk estimates for mild traumatic brain injury. Annu. Proc. Assoc. Adv. Autom. Med. 51:343–361, 2007.

    CAS  Google Scholar 

  47. Funk, J. R., S. Rowson, R. W. Daniel, and S. M. Duma. Validation of Concussion Risk Curves for Collegiate Football Players Derived from HITS Data. Ann. Biomed. Eng. 40:79–89, 2012.

    Article  PubMed  Google Scholar 

  48. Gabler, L. F., J. R. Crandall, and M. B. Panzer. Development of a metric for predicting brain strain responses using head kinematics. Ann. Biomed. Eng. 46:972–985, 2018.

    Article  PubMed  Google Scholar 

  49. Gabler, L. F., J. R. Crandall, and M. B. Panzer. Development of a second-order system for rapid estimation of maximum brain strain. Ann. Biomed. Eng. 47:1971–1981, 2019.

    Article  PubMed  Google Scholar 

  50. Giudice, J. S., G. Park, K. Kong, A. Bailey, R. Kent, and M. B. Panzer. Development of open-source dummy and impactor models for the assessment of American football helmet finite element models. Ann. Biomed. Eng. 47:464–474, 2019.

    Article  PubMed  Google Scholar 

  51. Greenwald, R. M., J. T. Gwin, J. J. Chu, and J. J. Crisco. Head impact severity measures for evaluating mild traumatic brain injury risk exposure. Neurosurgery 62:789–798, 2008; (discussion 798).

    Article  PubMed  Google Scholar 

  52. Guskiewicz, K. M., J. P. Mihalik, V. Shankar, S. W. Marshall, D. H. Crowell, S. M. Oliaro, M. F. Ciocca, and D. N. Hooker. Measurement of head impacts in collegiate football players: relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery 61:1244–1253, 2007.

    Article  PubMed  Google Scholar 

  53. Houston, M. N., M. C. Hoch, S. R. Malvasi, K. Y. Peck, S. J. Svoboda, and K. L. Cameron. Level of agreement between human-rated and instrumented balance error scoring system scores. Ann. Biomed. Eng. 47:2128–2135, 2019.

    Article  PubMed  Google Scholar 

  54. Jadischke, R., D. C. Viano, N. Dau, A. I. King, and J. McCarthy. On the accuracy of the Head Impact Telemetry (HIT) System used in football helmets. J. Biomech. 46:2310–2315, 2013.

    Article  PubMed  Google Scholar 

  55. Joodaki, H., A. Bailey, D. Lessley, J. Funk, C. Sherwood, and J. Crandall. Relative motion between the helmet and the head in football impact test. J. Biomech. Eng. 141:081006, 2019.

    Article  Google Scholar 

  56. Karton, C., T. B. Hoshizaki, and M. D. Gilchrist. A novel repetitive head impact exposure measurement tool differentiates player position in National Football League. Sci. Rep. 10:1–14, 2020.

    Article  CAS  Google Scholar 

  57. Kelley, M. E., J. E. Urban, L. E. Miller, D. A. Jones, M. A. Espeland, E. M. Davenport, C. T. Whitlow, J. A. Maldjian, and J. D. Stitzel. Head impact exposure in youth football: comparing age-and weight-based levels of play. J. Neurotrauma 34:1939–1947, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Kent, R., J. Forman, A. M. Bailey, J. Funk, C. Sherwood, J. Crandall, K. B. Arbogast, and B. S. Myers. The biomechanics of concussive helmet-to-ground impacts in the National Football League. J. Biomech. 99:109551, 2020.

    Article  PubMed  Google Scholar 

  59. Kerr, Z. Y., J. K. Register-Mihalik, E. Kroshus, C. M. Baugh, and S. W. Marshall. Motivations associated with nondisclosure of self-reported concussions in former collegiate athletes. The American journal of sports medicine 44:220–225, 2016.

    Article  PubMed  Google Scholar 

  60. Kerr, Z. Y., S. Yeargin, T. C. V. McLeod, V. C. Nittoli, J. Mensch, T. Dodge, R. Hayden, and T. P. Dompier. Comprehensive coach education and practice contact restriction guidelines result in lower injury rates in youth American football. Orthop. J. Sports Med. 3:2325967115594578, 2015.

    PubMed  PubMed Central  Google Scholar 

  61. Kerr, Z. Y., S. W. Yeargin, T. C. Valovich McLeod, J. Mensch, R. Hayden, and T. P. Dompier. Comprehensive coach education reduces head impact exposure in American youth football. Orthop. J. Sports Med. 3:2325967115610545, 2015.

    PubMed  PubMed Central  Google Scholar 

  62. Kleiven, S. Predictors for traumatic brain injuries evaluated through accident reconstructions. Stapp Car Crash J. 51:81–114, 2007.

    PubMed  Google Scholar 

  63. Kroshus, E., B. Garnett, M. Hawrilenko, C. M. Baugh, and J. P. Calzo. Concussion under-reporting and pressure from coaches, teammates, fans, and parents. Soc. Sci. Med. 134:66–75, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Kuo, C., L. Wu, J. Loza, D. Senif, S. C. Anderson, and D. B. Camarillo. Comparison of video-based and sensor-based head impact exposure. PLoS ONE 13:e0199238, 2018.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. Laituri, T. R., R. E. El-Jawahri, S. Henry and K. Sullivan. Field-based assessments of various AIS2+ head risk curves for frontal impact. SAE Technical Paper, 2015.

  66. Lamond, L. C. Differences in Head Acceleration Across Impact Type, Player Position, and Playing Scenario in Collegiate Women’s Soccer Athletes. Delaware: University of Delaware, 2016.

    Google Scholar 

  67. Langburt, W., B. Cohen, N. Akhthar, K. O’Neill, and J. C. Lee. Incidence of concussion in high school football players of Ohio and Pennsylvania. J. Child Neurol. 16:83–85, 2001.

    Article  CAS  PubMed  Google Scholar 

  68. Lee, T. A., R. J. Lycke, P. J. Lee, C. M. Cudal, K. J. Torolski, S. E. Bucherl, N. Leiva-Molano, P. S. Auerbach, T. M. Talavage and E. A. Nauman. Distribution of head acceleration events varies by position and play type in North American football. Clin. J. Sport Med., 2020.

  69. Lessley, D. J., R. W. Kent, J. R. Funk, C. P. Sherwood, J. M. Cormier, J. R. Crandall, K. B. Arbogast, and B. S. Myers. Video analysis of reported concussion events in the National Football League during the 2015–2016 and 2016–2017 seasons. Am. J. Sports Med. 46:3502–3510, 2018.

    Article  PubMed  Google Scholar 

  70. Lynall, R. C., M. D. Clark, E. E. Grand, J. C. Stucker, A. C. Littleton, A. J. Aguilar, M. A. Petschauer, E. F. Teel, and J. P. Mihalik. Head impact biomechanics in women’s college soccer. Med. Sci. Sports Exerc. 48:1772–1778, 2016.

    Article  PubMed  Google Scholar 

  71. MacManus, D. B., B. Pierrat, J. G. Murphy, and M. D. Gilchrist. Region and species dependent mechanical properties of adolescent and young adult brain tissue. Sci. Rep. 7:1–12, 2017.

    Article  CAS  Google Scholar 

  72. Manoogian, S., D. McNeely, S. Duma, G. Brolinson, and R. Greenwald. Head acceleration is less than 10 percent of helmet acceleration in football impacts. Biomed. Sci. Instrum. 42:383–388, 2006.

    PubMed  Google Scholar 

  73. McAllister, T. W., L. A. Flashman, A. Maerlender, R. M. Greenwald, J. G. Beckwith, T. D. Tosteson, J. J. Crisco, P. G. Brolinson, S. M. Duma, A. C. Duhaime, M. R. Grove, and J. H. Turco. Cognitive effects of one season of head impacts in a cohort of collegiate contact sport athletes. Neurology 78:1777–1784, 2012.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. McCrea, M., T. Hammeke, G. Olsen, P. Leo, and K. Guskiewicz. Unreported concussion in high school football players: implications for prevention. Clin. J. Sport Med. 14:13–17, 2004.

    Article  PubMed  Google Scholar 

  75. McCuen, E., D. Svaldi, K. Breedlove, N. Kraz, B. Cummiskey, E. L. Breedlove, J. Traver, K. F. Desmond, R. E. Hannemann, and E. Zanath. Collegiate women’s soccer players suffer greater cumulative head impacts than their high school counterparts. J. Biomech. 48:3720–3723, 2015.

    Article  PubMed  Google Scholar 

  76. McKendry, G., H. Brown and J.-S. Blouin. Validation of i1 Biometrics Vector MouthGuard: Measuring Head Impact Frequency in Sport (S48. 008). AAN Enterprises, 2017.

  77. Mertz, H. J., P. Prasad and A. L. Irwin. Injury risk curves for children and adults in frontal and rear collisions. In: SAE Technical Paper Series, 1997, pp. 13–30.

  78. Mertz, H. J., P. Prasad and G. Nusholtz. Head injury risk assessment for forehead impacts. In: International Congress and Exposition. Detroit, MI: SAE Paper No. 960099, 1996.

  79. Mihalik, J. P., D. R. Bell, S. W. Marshall, and K. M. Guskiewicz. Measurement of head impacts in collegiate football players: an investigation of positional and event-type differences. Neurosurgery 61:1229–1235, 2007; (discussion 1235).

    Article  PubMed  Google Scholar 

  80. Mihalik, J. P., E. B. Wasserman, E. F. Teel, and S. W. Marshall. Head impact biomechanics differ between girls and boys youth ice hockey players. Ann. Biomed. Eng. 48:104–111, 2020.

    Article  PubMed  Google Scholar 

  81. Miller, L. E., J. E. Urban, M. E. Kelley, A. K. Powers, C. T. Whitlow, J. A. Maldjian, S. Rowson, and J. D. Stitzel. Evaluation of brain response during head impact in youth athletes using an anatomically accurate finite element model. J. Neurotrauma 36:1561–1570, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Montenigro, P. H., M. L. Alosco, B. M. Martin, D. H. Daneshvar, J. Mez, C. E. Chaisson, C. J. Nowinski, R. Au, A. C. McKee, and R. C. Cantu. Cumulative head impact exposure predicts later-life depression, apathy, executive dysfunction, and cognitive impairment in former high school and college football players. J. Neurotrauma 34:328–340, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Moon, D. W., C. W. Beedle, and C. R. Kovacic. Peak head acceleration of athletes during competition–football. Med. Sci. Sports 3:44–50, 1971.

    CAS  PubMed  Google Scholar 

  84. Morrison, W. E. Calibration and Utilization of an Instrumented Football Helmet for the Monitoring of Impact Accelerations. University Park: Penn State University, 1983.

    Google Scholar 

  85. National Highway Traffic Safety Administration. Federal Motor Vehicle Safety Standards—Occupant Crash Protection. 49 CFR §571.208, 2019.

  86. National Operating Committee on Standards for Athletic Equipment. Standard Performance Specification for Newly Manufactured Football Helmets. NOCSAE DOC (ND)002-17m19a, 2019.

  87. National Operating Committee on Standards for Athletic Equipment. Standard Pneumatic Ram Test Method and Equipment used in Evaluating the Performance Characteristics of Protective Headgear and Face Guards. NOCSAE DOC (ND)081-18am20, 2020.

  88. Naunheim, R. S., J. Standeven, C. Richter, and L. M. Lewis. Comparison of impact data in hockey, football, and soccer. J. Trauma 48:938–941, 2000.

    Article  CAS  PubMed  Google Scholar 

  89. Newman J. A. A generalized acceleration model for brain injury threshold (GAMBIT). In: Proceedings of International IRCOBI Conference, 19861986.

  90. Newman, J. A., C. Barr, M. C. Beusenberg, E. Fournier, N. Shewchenko, E. Welbourne and C. Withnall. A new biomechanical assessment of mild traumatic brain injury. Part 2: results and conclusions. In: Proceedings of the International Research Conference on the Biomechanics of Impacts (IRCOBI). Mountpellier, France: IRCOBI, 2000, pp. 223–230.

  91. Newman, J. A., M. C. Beusenberg, E. Fournier, N. Shewchenko, C. Withnall, A. I. King, K. Yang, L. Zhang, J. McElhaney, L. Thibault and G. McGinnes. A new biomechanical assessment of mild traimatic brain injury. Part 1: methodology. In: Proceedings of the International Research Conference on the Biomechanics of Impacts (IRCOBI). Barcelona, Spain: IRCOBI, 1999, pp. 17–36.

  92. Newman, J. A., N. Shewchenko, and E. Welbourne. A proposed new biomechanical head injury assessment function—the maximum power index. Stapp Car Crash J. 44:215–247, 2000.

    CAS  PubMed  Google Scholar 

  93. Ommaya, A. K., W. Goldsmith, and L. Thibault. Biomechanics and neuropathology of adult and paediatric head injury. Br. J. Neurosurg. 16:220–242, 2002.

    Article  CAS  PubMed  Google Scholar 

  94. Ommaya, A. K., P. Yarnell, A. E. Hirsch and E. H. Harris. Scaling of experimental data on cerebral concussion in sub-human primates to concussion threshold for man. In: Proceedings of the 11th Stapp Car Crash Conference SAE 670906, 1967.

  95. Panzer, M. B., R. Cameron, R. S. Salzar, J. Pellettiere, and B. Myers. Evaluation of ear-mounted sensors for determining impact head acceleration. Shock 1:54, 2009.

    Google Scholar 

  96. Pellman, E. J., M. R. Lovell, D. C. Viano, and I. R. Casson. Concussion in professional football: recovery of NFL and high school athletes assessed by computerized neuropsychological testing—part 12. Neurosurgery 58:263–274, 2006.

    Article  PubMed  Google Scholar 

  97. Pellman, E. J., M. R. Lovell, D. C. Viano, I. R. Casson, and A. M. Tucker. Concussion in professional football: neuropsychological testing—part 6. Neurosurgery 55:1290–1305, 2004.

    Article  PubMed  Google Scholar 

  98. Pellman, E. J., J. W. Powell, D. C. Viano, I. R. Casson, A. M. Tucker, H. Feuer, M. Lovell, J. F. Waeckerle, and D. W. Robertson. Concussion in professional football: epidemiological features of game injuries and review of the literature–part 3. Neurosurgery 54:81–94, 2004; (discussion 94-86).

    Article  PubMed  Google Scholar 

  99. Pellman, E. J., D. C. Viano, I. R. Casson, C. Arfken, and H. Feuer. Concussion in professional football: players returning to the same game—part 7. Neurosurgery 56:79–92, 2005.

    Article  PubMed  Google Scholar 

  100. Pellman, E. J., D. C. Viano, I. R. Casson, C. Arfken, and J. Powell. Concussion in professional football: Injuries involving 7 or more days out—part 5. Neurosurgery 55:1100–1119, 2004.

    Article  PubMed  Google Scholar 

  101. Pellman, E. J., D. C. Viano, I. R. Casson, A. M. Tucker, J. F. Waeckerle, J. W. Powell, and H. Feuer. Concussion in professional football: repeat injuries–part 4. Neurosurgery 55:860–873, 2004; (discussion 873-866).

    Article  PubMed  Google Scholar 

  102. Pellman, E. J., D. C. Viano, A. M. Tucker, and I. R. Casson. Concussion in professional football: location and direction of helmet impacts—part 2. Neurosurgery 53:1328–1340, 2003; (discussion 1340-1321).

    Article  PubMed  Google Scholar 

  103. Pellman, E. J., D. C. Viano, A. M. Tucker, I. R. Casson, and J. F. Waeckerle. Concussion in professional football: reconstruction of game impacts and injuries. Neurosurgery 53:799–812, 2003; (discussion 812-794).

    Article  PubMed  Google Scholar 

  104. Pellman, E. J., D. C. Viano, C. Withnall, N. Shewchenko, C. A. Bir, and P. D. Halstead. Concussion in professional football: helmet testing to assess impact performance–part 11. Neurosurgery 58:78–96, 2006; (discussion 78-96).

    Article  PubMed  Google Scholar 

  105. Prange, M. T., and S. S. Margulies. Regional, directional, and age-dependent properties of the brain undergoing large deformation. J. Biomech. Eng. 124:244–252, 2002.

    Article  PubMed  Google Scholar 

  106. Press, J. N., and S. Rowson. Quantifying head impact exposure in collegiate women’s soccer. Clin. J. Sport Med. 27:104–110, 2017.

    Article  PubMed  Google Scholar 

  107. Reid, S. E., H. M. Epstein, T. J. O’Dea, M. W. Louis, and S. E. Reid, Jr. Head protection in football. J. Sports Med. 2:86–92, 1974.

    Article  CAS  PubMed  Google Scholar 

  108. Reid, S. E., J. A. Tarkington, H. M. Epstein, and T. J. O’Dea. Brain tolerance to impact in football. Surg. Gynecol. Obstet. 133:929–936, 1971.

    CAS  PubMed  Google Scholar 

  109. Reynolds, B. B., J. Patrie, E. J. Henry, H. P. Goodkin, D. K. Broshek, M. Wintermark, and T. J. Druzgal. Comparative analysis of head impact in contact and collision sports. J. Neurotrauma 34:38–49, 2017.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Rich, A. M., T. M. Filben, L. E. Miller, B. T. Tomblin, A. R. Van Gorkom, M. A. Hurst, R. T. Barnard, D. S. Kohn, J. E. Urban, and J. D. Stitzel. Development, validation and pilot field deployment of a custom mouthpiece for head impact measurement. Ann. Biomed. Eng. 47:2109–2121, 2019.

    Article  PubMed  Google Scholar 

  111. Rowson, S., M. L. Bland, E. T. Campolettano, J. N. Press, B. Rowson, J. A. Smith, D. W. Sproule, A. M. Tyson, and S. M. Duma. Biomechanical perspectives on concussion in sport. Sports Med. Arthrosc. Rev. 24:100–107, 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  112. Rowson, S., G. Brolinson, M. Goforth, D. Dietter, and S. M. Duma. Linear and angular head acceleration measurements in collegiate football. J. Biomech. Eng. 131:061016, 2009.

    Article  PubMed  Google Scholar 

  113. Rowson, S., E. T. Campolettano, S. M. Duma, B. Stemper, A. Shah, J. Harezlak, L. Riggen, J. P. Mihalik, K. M. Guskiewicz, and C. Giza. Accounting for variance in concussion tolerance between individuals: comparing head accelerations between concussed and physically matched control subjects. Ann. Biomed. Eng. 47:2048–2056, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Rowson, S., J. J. Chu, J. G. Beckwith, R. M. Greenwald, J. D. Stitzel, H. Kimpara and S. M. Duma. Six degree of freedom head acceleration measurements in football players. In: Injury Biomechanics Research, Proceedings of the Thirty-Fifth International Workshop, 2007.

  115. Rowson, S., and S. M. Duma. Development of the STAR evaluation system for football helmets: integrating player head impact exposure and risk of concussion. Ann. Biomed. Eng. 39:2130–2140, 2011.

    Article  PubMed  Google Scholar 

  116. Rowson, S., and S. M. Duma. Brain injury prediction: assessing the combined probability of concussion using linear and rotational head acceleration. Ann. Biomed. Eng. 41:873–882, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Rowson, S., S. M. Duma, J. G. Beckwith, J. J. Chu, R. M. Greenwald, J. J. Crisco, P. G. Brolinson, A. C. Duhaime, T. W. McAllister, and A. C. Maerlender. Rotational head kinematics in football impacts: an injury risk function for concussion. Ann. Biomed. Eng. 40:1–13, 2012.

    Article  PubMed  Google Scholar 

  118. Rowson, S., S. M. Duma, R. M. Greenwald, J. G. Beckwith, J. J. Chu, K. M. Guskiewicz, J. P. Mihalik, J. J. Crisco, B. J. Wilcox, T. W. McAllister, A. C. Maerlender, S. P. Broglio, B. Schnebel, S. Anderson, and P. G. Brolinson. Can helmet design reduce the risk of concussion in football? J. Neurosurg. 120:919–922, 2014.

    Article  PubMed  Google Scholar 

  119. Rowson, S., S. M. Duma, B. D. Stemper, A. Shah, J. P. Mihalik, J. Harezlak, L. D. Riggen, C. C. Giza, J. P. DiFiori, and A. Brooks. Correlation of concussion symptom profile with head impact biomechanics: a case for individual-specific injury tolerance. J. Neurotrauma 35:681–690, 2018.

    Article  PubMed  Google Scholar 

  120. Rowson, B., S. Rowson, and S. M. Duma. Hockey STAR: a methodology for assessing the biomechanical performance of hockey helmets. Ann. Biomed. Eng. 43:2429–2443, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Rowson, B., J. D. Stitzel, and S. M. Duma. Special issue on the NCAA-DoD CARE Consortium Research. Ann. Biomed. Eng. 47:2045–2047, 2019.

    Article  PubMed  Google Scholar 

  122. Sanchez, E. J., L. F. Gabler, A. B. Good, J. R. Funk, J. R. Crandall, and M. B. Panzer. A reanalysis of football impact reconstructions for head kinematics and finite element modeling. Clin. Biomech. 64:82–89, 2019.

    Article  Google Scholar 

  123. Schnebel, B., S. Anderson, and R. Gatlin. In vivo study of head impacts in football: a comparison of National Collegiate Athletic Association Division I versus high school impacts. Neurosurgery 60:490–495, 2007; (discussion 495-496).

    Article  PubMed  Google Scholar 

  124. Schussler, E., R. J. Jagacinski, S. E. White, A. M. Chaudhari, J. A. Buford, and J. A. Onate. The effect of tackling training on head accelerations in youth American football. Int. J. Sports Phys. Ther. 13:229, 2018.

    Article  PubMed  PubMed Central  Google Scholar 

  125. Siegmund, G. P., K. M. Guskiewicz, S. W. Marshall, A. L. DeMarco, and S. J. Bonin. Laboratory validation of two wearable sensor systems for measuring head impact severity in football players. Ann. Biomed. Eng. 44:1257–1274, 2016.

    Article  PubMed  Google Scholar 

  126. Stapp, J. P., Closing Remarks, Ann Arbor, MI, 1978.

  127. Stemper, B. D., A. S. Shah, J. Harezlak, S. Rowson, S. Duma, J. P. Mihalik, L. D. Riggen, A. Brooks, K. L. Cameron, and C. C. Giza. Repetitive head impact exposure in college football following an NCAA rule change to eliminate two-a-day preseason practices: a study from the NCAA-DoD CARE Consortium. Ann. Biomed. Eng. 47:2073–2085, 2019.

    Article  PubMed  PubMed Central  Google Scholar 

  128. Stemper, B. D., A. S. Shah, J. Harezlak, S. Rowson, J. P. Mihalik, S. M. Duma, L. D. Riggen, A. Brooks, K. L. Cameron, and D. Campbell. Comparison of head impact exposure between concussed football athletes and matched controls: evidence for a possible second mechanism of sport-related concussion. Ann. Biomed. Eng. 47:2057–2072, 2019.

    Article  PubMed  Google Scholar 

  129. Stojsih, S., M. Boitano, M. Wilhelm, and C. Bir. A prospective study of punch biomechanics and cognitive function for amateur boxers. Br. J. Sports Med. 44:725–730, 2010.

    Article  CAS  PubMed  Google Scholar 

  130. Svaldi, D. O., E. C. McCuen, C. Joshi, M. E. Robinson, Y. Nho, R. Hannemann, E. A. Nauman, L. J. Leverenz, and T. M. Talavage. Cerebrovascular reactivity changes in asymptomatic female athletes attributable to high school soccer participation. Brain Imaging Behav. 11:98–112, 2017.

    Article  PubMed  Google Scholar 

  131. Swartz, E. E., S. P. Broglio, S. B. Cook, R. C. Cantu, M. S. Ferrara, K. M. Guskiewicz, and J. L. Myers. Early results of a helmetless-tackling intervention to decrease head impacts in football players. J. Athl. Train. 50:1219–1222, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Takhounts, E. G., M. J. Craig, K. Moorhouse, J. McFadden, and V. Hasija. Development of brain injury criteria (Br IC). Stapp Car Crash J. 57:243, 2013.

    PubMed  Google Scholar 

  133. Talavage, T. M., E. A. Nauman, E. L. Breedlove, U. Yoruk, A. E. Dye, K. E. Morigaki, H. Feuer, and L. J. Leverenz. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. J. Neurotrauma 31:327–338, 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Thibault, K. L., and S. S. Margulies. Age-dependent material properties of the porcine cerebrum: effect on pediatric inertial head injury criteria. J. Biomech. 31:1119–1126, 1998.

    Article  CAS  PubMed  Google Scholar 

  135. Tierney, R. T., M. Higgins, S. V. Caswell, J. Brady, K. McHardy, J. B. Driban, and K. Darvish. Sex differences in head acceleration during heading while wearing soccer headgear. J. Athl. Train. 43:578–584, 2008.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Tyson, A. M., S. M. Duma, and S. Rowson. Laboratory evaluation of low-cost wearable sensors for measuring head impacts in sports. J. Appl. Biomech. 34:320–326, 2018.

    Article  PubMed  Google Scholar 

  137. Tyson, A. M., J. Press and S. Rowson. Soccer Headgear STAR Protocol, 2018.

  138. Tyson, A. M. and S. Rowson. Varsity Football Helmet STAR Protocol, 2018.

  139. Urban, J. E., E. M. Davenport, A. J. Golman, J. A. Maldjian, C. T. Whitlow, A. K. Powers, and J. D. Stitzel. Head impact exposure in youth football: high school ages 14 to 18 years and cumulative impact analysis. Ann. Biomed. Eng. 41:2474–2487, 2013.

    Article  PubMed  PubMed Central  Google Scholar 

  140. Viano, D. C., I. R. Casson, and E. J. Pellman. Concussion in professional football: biomechanics of the struck player—part 14. Neurosurgery 61:313–327, 2007; (discussion 327-318).

    Article  PubMed  Google Scholar 

  141. Viano, D. C., I. R. Casson, E. J. Pellman, C. A. Bir, L. Zhang, D. C. Sherman, and M. A. Boitano. Concussion in professional football: comparison with boxing head impacts—part 10. Neurosurgery 57:1154–1172, 2005.

    Article  PubMed  Google Scholar 

  142. Viano, D. C., I. R. Casson, E. J. Pellman, L. Zhang, A. I. King, and K. H. Yang. Concussion in professional football: brain responses by finite element analysis: part 9. Neurosurgery 57:891–916, 2005.

    Article  PubMed  Google Scholar 

  143. Viano, D. C., and D. Halstead. Change in size and impact performance of football helmets from the 1970s to 2010. Ann. Biomed. Eng. 40:175–184, 2012.

    Article  PubMed  Google Scholar 

  144. Viano, D. C., and E. J. Pellman. Concussion in professional football: biomechanics of the striking player—part 8. Neurosurgery 56:266–280, 2005; (discussion 266-280).

    Article  PubMed  Google Scholar 

  145. Viano, D. C., E. J. Pellman, C. Withnall, and N. Shewchenko. Concussion in professional football: performance of newer helmets in reconstructed game impacts-Part 13. Neurosurgery 59:591, 2006.

    Article  PubMed  Google Scholar 

  146. Viano, D. C., C. Withnall, and D. Halstead. Impact performance of modern football helmets. Ann. Biomed. Eng. 40:160–174, 2012.

    Article  PubMed  Google Scholar 

  147. Weber, M., R. Lynall, N. Hoffman, E. Miller, T. Kaminski, T. Buckley, H. Benjamin, C. Miles, C. Whitlow, and L. Lintner. Health-related quality of life following concussion in collegiate student-athletes with and without concussion history. Ann. Biomed. Eng. 47:2136–2146, 2019.

    Article  CAS  PubMed  Google Scholar 

  148. Wilcox, B. J., J. G. Beckwith, R. M. Greenwald, J. J. Chu, T. W. McAllister, L. A. Flashman, A. C. Maerlender, A.-C. Duhaime, and J. J. Crisco. Head impact exposure in male and female collegiate ice hockey players. J. Biomech. 47:109–114, 2014.

    Article  PubMed  Google Scholar 

  149. Wilcox, B. J., J. G. Beckwith, R. M. Greenwald, N. P. Raukar, J. J. Chu, T. W. McAllister, L. A. Flashman, A. C. Maerlender, A.-C. Duhaime, and J. J. Crisco. Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. J. Biomech. 48:2201–2204, 2015.

    Article  PubMed  PubMed Central  Google Scholar 

  150. Williamson, I. J., and D. Goodman. Converging evidence for the under-reporting of concussions in youth ice hockey. Br. J. Sports Med. 40:128–132, 2006; (discussion 128-132).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  151. Wu, L. C., V. Nangia, K. Bui, B. Hammoor, M. Kurt, F. Hernandez, C. Kuo, and D. B. Camarillo. In vivo evaluation of wearable head impact sensors. Ann. Biomed. Eng. 44:1234–1245, 2016.

    Article  PubMed  Google Scholar 

  152. Yeargin, S. W., P. Kingsley, J. M. Mensch, J. P. Mihalik, and E. V. Monsma. Anthropometrics and maturity status: a preliminary study of youth football head impact biomechanics. Int. J. Psychophysiol. 132:87–92, 2018.

    Article  PubMed  Google Scholar 

  153. Young, T. J., R. W. Daniel, S. Rowson, and S. M. Duma. Head impact exposure in youth football: elementary school ages 7-8 years and the effect of returning players. Clin. J. Sport Med. 24:416–421, 2014.

    Article  PubMed  Google Scholar 

  154. Young, T., S. Rowson, and S. M. Duma. High magnitude head impacts experienced during youth football practices. Biomed. Sci. Instrum. 50:100–105, 2013.

    Google Scholar 

  155. Zhang, L., K. H. Yang, and A. I. King. A proposed injury threshold for mild traumatic brain injury. J. Biomech. Eng. 126:226–236, 2004.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Much of the youth football data collection was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number R01NS094410. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The college data collection was supported by the NCAA—DOD Grand Alliance, and the NFL data collection was supported by the NFL.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bethany Rowson.

Additional information

Associate Editor Jane Grande-Allen oversaw the review of this article.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rowson, B., Duma, S.M. A Review of On-Field Investigations into the Biomechanics of Concussion in Football and Translation to Head Injury Mitigation Strategies. Ann Biomed Eng 48, 2734–2750 (2020). https://doi.org/10.1007/s10439-020-02684-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-020-02684-w

Keywords

Navigation