Helmets in collision sports

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Date last updated

Helmets absorb, dissipate, and reduce impact forces to an athlete’s head and brain during collisions between players or a fall to the ground. Helmet design and specifications vary by sport and athlete’s position; helmets typically include a comfort liner, an impact energy attenuating liner, a restraint system, and a shell. Some sporting organizations provide standards regarding helmet design, construction, level of protection, stability, and vision along with impact test criteria and requirements1

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Reduced sports-related concussion

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced head injury

What does the research say about effectiveness?

There is some evidence that wearing helmets in collision sports reduces concussion23, 4, 5. However, effects vary by sport. Additional evidence is needed to confirm effects.

Helmet use has been shown to reduce concussion and severe head injuries for recreational skiers and snowboarders3, 4, 6. Wearing helmets may reduce high school football players’ likelihood of concussion when helmets fit appropriately5, 7. The design and model of football helmets appears to affect concussion risk among high school and college football players in some cases3, 5, 8.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

High school and college football players are required to wear helmets that meet the National Operating Committee on Standards for Athletic Equipment standards9. USA Hockey mandates use of helmets approved by the Hockey Equipment Certification Council (UECC) with an expiration date of UECC certification on a sticker on the helmet10. International Ski Federation (FIS) and U.S. Ski and Snowboard Association require all players in alpine competitions and official training to wear a helmet that meets the FIS standards11

Implementation Resources

NOCSAE - National Operating Committee on Standards for Athletic Equipment (NOCSAE).


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1 McIntosh 2011a - McIntosh AS, Andersen TE, Bahr R, et al. Sports helmets now and in the future. British Journal of Sports Medicine. 2011;45(16):1258-1265.

2 Collins 2016b - Collins CL, Mckenzie LB, Ferketich AK, Andridge R, Xiang H, Comstock RD. Concussion characteristics in high school football by helmet age/recondition status, manufacturer, and model: 2008-2009 through 2012-2013 academic years in the United States. The American Journal of Sports Medicine. 2016;44(6):1382-1390.

3 Bonfield 2015 - Bonfield CM, Shin SS, Kanter AS. Helmets, head injury and concussion in sport. The Physician and Sportsmedicine. 2015;43(3):236-246.

4 Daneshvar 2011 - Daneshvar DH, Baugh CM, Nowinski CJ, et al. Helmets and mouth guards: The role of personal equipment in preventing sport-related concussions. Clinics in Sports Medicine. 2011;30(1):145-163.

5 Emery 2017 - Emery CA, Black AM, Kolstad A, et al. What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. British Journal of Sports Medicine. 2017;51(12):978-984.

6 Russell 2010 - Russell K, Christie J, Hagel BE. The effect of helmets on the risk of head and neck injuries among skiers and snowboarders: A meta-analysis. Canadian Medical Association Journal. 2010;182(4):333-340.

7 Schneider 2017 - Schneider DK, Grandhi RK, Bansal P, et al. Current state of concussion prevention strategies: A systematic review and meta-analysis of prospective, controlled studies. British Journal of Sports Medicine. 2017;51(20):1473-1482.

8 McGuine 2014 - McGuine TA, Hetzel S, McCrea M, Brooks MA. Protective equipment and player characteristics associated with the incidence of sport-related concussion in high school football players: A multifactorial prospective study. The American Journal of Sports Medicine. 2014;42(10):2470-2478.

9 Levy 2004 - Levy ML, Ozgur BM, Berry C, Aryan HE, Apuzzo MLJ. Birth and evolution of the football helmet. Neurosurgery. 2004;55(3):656-662.

10 USA Hockey-Equipment - USA Hockey. Rulebook: Rule 304. Protective equipment.

11 USSA-Helmet - U.S. Ski and Snowboard Association (USSA). USSA and FIS helmet regulations. October 2015.