Do mouthguards prevent concussions

Custom-made mouthguards reduce athletes’ risk of concussion, study shows

High school football players wearing store-bought, over-the-counter (OTC) mouthguards were more than twice as likely to suffer mild traumatic brain injures (MTBI)/concussions than those wearing custom-made, properly fitted mouthguards, reports a new study in the May/June 2014 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry (AGD).

“Researchers and, most importantly, parents, are looking for ways to better protect children against concussions,” said lead author Jackson Winters, DDS, a pediatric dentist who also served as a high school and collegiate football official for 28 years. “Consumers may believe that today’s advanced helmet design provides sufficient protection, but our research indicates that, when compared to over-the-counter versions, a custom-made, properly fitted mouthguard also is essential to player safety.”

The study followed 412 players from six high school football teams. Three teams (220 athletes) were randomly assigned to wear custom-made mouthguards, and three teams (192 athletes) wore standard OTC mouthguards of their own choosing. All players wore the same style of football helmet.

According to the study, 8.3 percent of athletes in the OTC mouthguard group suffered MTBI/concussion injuries. For those with custom-made mouthguards, however, the rate was only 3.6 percent.

Many variables contribute to MTBI/concussion injuries, and mouthguards — whose primary function is protecting the teeth — cannot completely prevent them from occurring. Previous studies have theorized that mouthguards can reduce concussion risk, however, because they help absorb shock, stabilize the head and neck, and limit movement caused by a direct hit to the jaw.

Mouthguard thickness also has been shown to be a factor that contributes to the level of protection. The average thickness of the custom-made mouthguards in this study was 3.50 millimeters, while the average thickness of the OTC mouthguards was only 1.65 millimeters.

“Although more research on this topic is needed, our study shows the value of a custom-made mouthguard,” Dr. Winters said. “The benefits of protecting your child far outweigh the costs associated with a dental or medical injury, which is likelier to occur with a store-bought model.”

Custom-made mouthguards also can last longer than store-bought models and may be less prone to damage by the athletes, said AGD Spokesperson Eugene Antenucci, DDS, FAGD. “Over-the-counter mouthguards are not fitted to the athlete’s mouth, making them less comfortable than custom guards made by a dentist,” said Dr. Antenucci. “When a mouthguard is not comfortable, the athlete is likely to chew it, reducing its thickness and resulting in less protection.”

Dr. Antenucci offers the following tips for caring for a custom-made mouthguard:

  1. After each use, brush your mouthguard with a toothbrush and cool (not hot) water.
  2. Keep your mouthguard in a well-ventilated, plastic storage box when not in use. Your dentist will provide you with a case for your mouthguard.
  3. Heat is bad for a mouthguard, so don’t leave it in direct sunlight or in a hot car. The heat can melt the mouthguard, altering the way it fits in your mouth and resulting in less protection.
  4. When you see your dentist twice a year for your regular cleanings, bring your mouthguard with you. Your dentist can give your mouthguard a thorough cleaning and check its structure and fit.
  5. Call your dentist if you have any concerns about your mouthguard.

To get custom-made mouthguard for your child, talk to your general dentist.

Sam Edwards / Getty Images/OJO Images RF

A global consensus report provides new guidance on diagnosing and treating concussions.

As concerns about concussions among football players continues to capture the attention of doctors as well as sports officials, an international team of researchers released an update to the Consensus Statement on Concussion in Sport.

It’s the fourth since the original report was developed in Vienna in 2001 to raise public awareness of the risks of concussions. Researchers and clinicians from around the globe presented the latest findings on brain injury and long term damage from concussions occurring during sports, over a two-day meeting held in Zurich, Switzerland last November. A panel of 32 experts then drafted the Consensus based on the research, published in the British Journal of Sports Medicine.

(MORE: Even Football Players Without Concussions Show Signs of Brain Injury)

Written as a guide for athletic trainers, doctors and health care providers, the statement clarifies the definition of a concussion to emphasize that loss of consciousness isn’t necessary to remove players from a game; symptoms can include headaches, memory loss and slow reaction times, immediately after the trauma to the head. Later symptoms could also include irritability and sleep disturbances.

New advice in the Consensus states that children should not return to the field to play on the same day they experience a potential concussion, an acknowledgment that it may take longer for kids to recuperate from blows to the head than adults because their neural connections are still developing.

(MORE: Study Details How Brain Injury from Concussions Progresses)

“Concussions are an evolving injury,” explains author Dr. Willem Meeuwisse, leader of the University of Calgary’s Brain Injury Initiative.”When you look at it from the moment it occurs to hours and even days later, it tends to change. That’s why, ‘when in doubt, sit them out,’ works.”

Additionally, the authors say there is a lack of evidence that mouth-guards and helmets prevent concussions. These pieces of equipment can protect against injuries to the head and face, but likely do little to ward off the more serious internal damage from a concussion. In fact, they may give players have a false sense of security and encourage them to behave more recklessly and aggressively. In the statement, the authors write:

An important consideration in the use of protective equipment is the concept of risk compensation. This is where the use of protective equipment results in behavioral change such as the adoption of more dangerous playing techniques, which can result in a paradoxical increase in injury rates.

The researchers also added recommended against the blanket tendency for extended rest for people who have been concussed. “About 80% of people improve from rest after eight to ten days,” says Meeuwisse. “For those who are not better in ten days, they need a more thorough assessment and maybe therapy for neck problems or balance.”

(MORE: NFL Players May Be More Vulnerable to Alzheimer’s Disease)

For the first time, the Consensus also includes a guide for untrained individuals such as parents and coaches to recognize and help people who might be concussed as well as an assessment tool designed specifically for children that clinicians can use.

The report is backed by the International Ice Hockey Federation, the International Olympic Committee, FIFA (the international governing body for soccer), and the International Rugby Board, among a number of other international sports organizations.

High-Tech Mouth Guards Raise Awareness of Concussion Prevention

The Growing Market for Concussion Monitors

Prevent Biometrics isn’t the only company that thinks mouth guards are the answer to better diagnosing concussions on the sidelines.

As a college rugby player, Anthony Gonzales wanted to create a company by athletes, for athletes to make high-impact sports safer. As a graduate student at Arizona University, he founded Force Impact Technologies (FIT), a company that integrates technology into sporting equipment to increase detection of potential injuries. The company received several grants in 2013 to develop a mouthpiece that lights up to signal a concussion.

Similar to the Prevent Biometrics product, FIT’s FITGuard measures linear acceleration (how fast the skull is starting and stopping) and rotational acceleration (how fast the head is spinning). The device also has a magnetometer which can identify where the head is facing when it receives an impact. The FITGuard has an app component and asks users to provide their weight, age, and gender to produce a more individualized impact threshold and concussion risk, a feature that’s not available on the Prevent IM Mouthguard.

Users complete a baseline cognitive exam when they receive the FITGuard, which is then repeated after moments of high-impact during practice and game play. And the FITGuard is HIPAA compliant, meaning that the data can be brought to a doctor to determine a diagnosis.

Pending a Stanford-backed white paper and clinical trials slated for the coming months, Gonzales foresees that the mouth guard will be available in the fall of 2018.

RELATED: What Complications Can Arise From a Concussion?

RELATED: New Eye-Tracking Technology Detects Hidden Brain Injuries

But not everyone is convinced that concussion-detecting mouth guards are the answer to concussion diagnosis. Alan Shahtaji, DO, a sports medicine and family physician as well as the codirector of the Sports Concussion Clinic at UC San Diego Health, finds evidence of the benefits of concussion-monitoring mouth guards to be inconclusive.

“Unfortunately, there’s nothing that really can prevent concussions, Dr. Shahtaji says. “There are certain contact laws in youth sports, and in soccer you have to be a certain age in some states to head a ball — we know those methods are effective in preventing concussions. With the monitors, we don’t have good literature on that yet.”

Shahtaji says that parents who are considering dropping at least $199 on a mouth guard for their young athletes may want to think again.

“How do you measure the actual force that is transferred to the brain? It’s not just a linear force, so damage can be easily overestimated, or underestimated ,” he adds.

Joshua Blomgren, DO, a sports medicine physician at Rush University Medical Center and a co-team physician for the Chicago White Sox, believes that even if the mouth guard can accurately measure the linear and rotational force of impact, many athletes may still avoid seeking treatment.

“It’s very common that people won’t report their symptoms because they don’t want to go through the protocol for returning to play,” Dr. Blomgren says.

New gizmos and gadgets aside, the American Academy of Orthopaedic Surgeons (AAOS) urges physicians, coaches, and parents to take the following steps to help athletes prevent and monitor impact:

  • Discourage athletes from hiding symptoms of concussions including:
    • Headache
    • Dizziness
    • Concentration loss
    • Poor sleep
  • Remember that athletes who experience severe symptoms or have a history of concussions may have a prolonged recovery.
  • Note that female athletes may be more likely to have a concussion.

If you suspect a concussion, visit a doctor as soon as possible so they can assist you in creating an individualized recovery plan.

Mouth guards can’t prevent traumatic brain injuries, but they can signal the need for treatment and recovery, stopping further damage before it can become fatal.

RELATED: FDA Approves Blood Test to Help Detect Concussions

Mouth Guards Prevent Dental Injuries But Require Frequent Replacement

Mouth guards prevent dental injuries, but can increase the number and intensity of mouth cuts and abrasions and chance of infection, so they should be sanitized daily and replaced every two weeks, or when they develop sharp or jagged edges, whichever occurs first.

What youth sports have the most mouth injuries?

If you answered football or hockey, you would be wrong! Because the use of mouth guards in youth and high school football, lacrosse, and ice hockey has been mandatory since the early 1970’s, these sports have experienced a dramatic decline in the number of dental and jaw injuries.

Instead, studies show that the majority of mouth injuries occur in such popular youth sports as baseball, basketball, soccer, field hockey, softball and gymnastics, which lag far behind in injury protection.

Recent studies also report that oral and facial injuries to female athletes exceed those in males. According to a study published in the Journal of Pediatric Dentistry, roughly three times as many mouth injuries occur on the basketball court as on the football field. Most of these injuries could have been easily prevented had the athlete been wearing a mouth guard.

Injuries to the mouth and jaw – broken, cracked and lost teeth, jaw and joint fractures – are painful and hard to treat:

  • Severe jaw and joint injuries may require surgery and general anesthesia, which requires hospitalization and wiring the jaw shut for 30 days to let the injury heal.
  • A lost tooth must be re-implanted or false teeth made and fitted. Although easier to treat than a broken or fractured jaw, lost teeth are just as painful.
  • Players wearing braces can sustain serious mouth lacerations if the braces are hit with a ball or by another player. These types of injuries may call for extensive repair and lengthen orthodontic treatment time.

Mouth guard types

A mouth guard is a piece of soft plastic shaped to fit inside the mouth, protecting the lips, cheeks, tongue and teeth and the jaw when they are hit by large object – like a ball, or someone’s elbow or head.

There are 3 main types of mouth guards:

  • Stock. The least expensive, stock type mouth guards cost about $2 and come in three sizes: small, medium and large. You get what you pay for in terms of fit. Some users complain that they are too wide in the back, making it harder to talk.
  • Boil and Bite. A semi-custom fit can be made using a “boil and bite” model mouth guard. Hot water is used to soften the plastic and your child then bites into the guard, molding it to his or her teeth. This type of mouth guard sells for between $5 and $15 and offers very good protection.
  • Custom. A dentist or orthodontist makes the best fitting mouth guards in a dental office. Not surprisingly, this kind of mouth guard is the most expensive of the three, costing between $35 and $65. Custom mouth guards are the best option if your child plays a number of sports each year or plays sports with continuous activity, like basketball or soccer, and is advised for a child with braces so that the mouth guard won’t interfere with treatment (for more on mouth guards for children with braces, click here). Once a child reaches age 13 or 14, a custom fitted mouth guard should generally continue to fit for as long as needed. mouth guard

No one type of mouth guard is recognized as providing more protection. “The key point is to play it safe,” says Dr. Hugh R. Phillis, a trustee of the American Association of Orthodontists and orthodontist in Nashua, New Hampshire told MomsTeam. “Any mouth guard is better than none,” he says.

Do not protect against concussion

Mouth guards, regardless of type, help prevent injury to the mouth, teeth, lips, cheeks and tongue. Mouth guards worn by players with braces may even prevent injury to another player caused by contact with the braces. They also cushion blows that might cause jaw fractures. But there is no evidence that they protect against, or reduce the risk of, concussion.

In a January 2011 article in the journal Clinics in Sports Medicine researchers at Boston University and the Sports Legacy Institute, including MomsTeam’s first concussion expert, Dr. Bob Cantu, Chris Nowinski, and Dr. Ann McKee conducted a comprehensive review of the medical literature to date, and concluded that no studies existed to support a claim that mouth guards prevented concussions or reduced their severity.

Commenting on a 2005 study of National Hockey League players, which found that the concussion rate was 1.42 times greater in players who did not wear mouth guards compared with those who did, the authors concluded that the difference was not statistically significant. The same study, as later noted in a 2009 literature review in the British Journal of Sports Medicine, which counted among its authors two of the co-authors of the 2005 study, did note that symptom severity on a concussion evaluation post-concussion symptom scale was found to be significantly worse in athletes who were not wearing mouth guards than in those who were, but not that mouth guards reduced concussion risk.

Thus Dr. Cantu and his Boston University colleagues stated that “there is little evidence that mouth guards provide protection against concussion,” and, in the process, criticizing a 2009 study of college athletes reported in Dental Traumotology as being marked by “several design flaws.” The study thus concludes with the following statement:

Although mouth guards have been shown to be effective in preventing dental and orofacial injury, there is currently no evidence that standard or fitted mouth guards decrease the rate or severity of concussions in athletes. The bulk of the evidence indicating a potential protective effect of mouth guards on concussion incidence has been based on a limited case series studies and retrospective, non-randomized, cross-sectional surveys. There is also evidence that mouth guard use does not result in any difference in neurocognitive test performance after concussion.

***

The preponderance of evidence seems to indicate that helmets and mouth guards provide a significant benefit in protecting against many catastrophic head, neck and orofacial injuries. However, there is not yet significant evidence to advocate their effectiveness in preventing concussion. … Although newer equipment remains a promising potential tool in minimizing concussion severity and incidence, other methods such as rule changes, improved concussion education, and proper coaching and training may prove more effective in the immediate future.

Three studies released within weeks of each other in March 2013 all reached the same conclusion as the 2011 study: there is no valid evidence that mouth guards reduce the risk of concussion.

Interestingly, an even more recent research paper found that high school football players in Wisconsin who wore a generic mouth guard provided by the school actually had a lower rate of sport-related concussion than players with more expensive mouth guards.

Require frequent replacement and sanitization

A study in Sports Health: A Multidisciplinary Approach7 found that mouth guards may increase the number and intensity of mouth cuts and abrasions, exposing an athlete to an increased chance of infection due to the bacteria, yeast, and fungi that mouth guards routinely collect.

Researchers stress that even with the increase in oral lesions,mouth guards are still an important piece of safety equipment for contact sports. “By no means should the value of a mouth guard be discounted,” Glass emphasizes. “The protection they do offer teeth during contact sports is important. However, the length of time that a mouth guard is used and how often it is cleaned needs to be revised.”

As a result, experts now recommend four safety steps:

  1. Replace regularly or when mouth guard becomes sharp or jagged. A mouth guard should be replaced as soon as it becomes distorted or develops sharp jagged edges or after 14 days of regular use, whichever comes first;
  2. Replace if oral irritation or ulcer. Because the molds from mouth guards may cause exercise-induced asthma and allergies, mouth guards should be replaced whenever an athlete develops any type of oral lesion (mouth sore) or respiratory distress;
  3. Sanitize daily. Because mouth guards have a natural ability to become a breeding ground for bacteria, fungi, and mold, they should be sanitized on a daily basis using a commercially available antimicrobial denture-cleansing solution; and
  4. Have regular oral exams. Athletes’ mouths should be examined on an ongoing basis while they are using mouth guards.

“This study stresses the importance of informing athletes of the danger of not properly taking care of a mouth guard. A mouth guard will do your mouth good only if you keep it in good shape,” adds Glass.

In what sports should mouth guards be worn?

The American Academy of Pediatric Dentistry recommends a sports mouth guard for all youth competition, regardless of age. The American Dental Association recommends mouth guards for the following sports:

Acrobatics

Football

Martial Arts

Skiing

Volleyball

Basketball

Gymnastics

Racquetball

Skydiving

Water Polo

Boxing

Handball

Rugby

Soccer

Weight Lifting

Discus Throwing

Ice Hockey

Shot Putting

Squash

Wrestling

Field Hockey

Lacrosse

Skateboarding

Surfing

Some athletic associations are getting the message. For instance, the Massachusetts Interscholastic Athletic Association, the governing body in the state for high school athletics, made mouth guards mandatory for junior varsity and varsity soccer players for the first time. Mouth guards may soon become mandatory in other sports as well.

1. Daneshvar DH, Baugh CM, Nowinski CJ, McKee AC, Stern RA, Cantu RC. Helmets and Mouth Guards: The Role of Personal Equipment in Preventing Sport-Related Concussions. Clin Sports Med 2011; 30: 145-163.

2. Benson BW, Meeuwisse WH. Ice Hockey injuries. Med Sport Sci 2005;49:86-119.

4. Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology2013;DOI:10.1212/WNL.0b013e31828d57dd (published online before print March 18, 2013)(“There is no compelling evidence that mouth guards protect athletes from concussion.”)

5. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258 (There is no “good clinical evidence mouth guards will prevent concussions, although they have a “definite role in preventing dental and orofacial injury,”)

6. Benson B, McIntosh A, Maddocks D, Herring S, Raftery M, Dvorak J. What are the most effective risk-reduction strategies in sport concussion. Br J Sports Med 2013;47:321-326 (characterizing studies that appeared to show mouth guards reduced concussion risk, including the 2009 study criticized in the 2011 study, as having “several limitations which threaten the validity of their results.”)

8. McGuine T, Brooks A, Hetzel S, Rasmussen J, McCrea M. “The Association of the Type of Football Helmet and Mouth Guard With the Incidence of Sport-Related Concussion in High School Football Players.” Presentation Paper AOSSM, July 13, 2013.

Revised and updated August 22, 2016

Jul 16, 2015New Studies Reveal How Mouthguards Can Reduce Concussions

A new study reveals the role of a mouth guard in reducing concussions while another shows how the device can increase upper and lower isokinetic muscle function.

By Michael C. Hutchison, DDS

The use of an athletic mouth guard to protect the dentition from injury and tooth fracture has been a norm in contact sports since the early 1960’s. The growing amount of concussions in modern day sports has led to the claims that mouth appliances can be utilized as a protection against concussions. This continues to be a question now being asked by the sporting world, especially for high-impact sports such as hockey and football. Numerous minor hockey leagues and youth football leagues have introduced mouth guard rules as a possible prevention of concussion, rather than dental concerns.

Mainstream concussion studies have been directed to acceleration impact studies on surrogate subjects such as crash dummies or cadaver subjects. Very little research can be found on live human subjects as a cause and effect study. The present observations from the data of an ongoing 9-year study of athletes using the PowerPlus Mouthguard in live sports competition has shown to reduce the concussion incidents to 0.2 % of athletes when fitted correctly. There are at least three possible theories on the potential benefits of mouth guard fitted to the physiologic rest position of the mandible and the reduction of the incidence or severity of concussions. Some of the theories being postulated are the direct dissipation and/or absorption of force when taking a blow to the jaw, the increased separation of the head of the condyle of the mandible and glenoid fossa of the skull leading to reduced g-force impact to the brain and the increased head stabilization by balancing, activating and strengthening neck muscles. It should be noted that much more study needs to be done on live subjects in their athletic environment, but this study shows a definite promise in reducing the incidence of concussions in contact sports.

Introduction

The US Center for Disease Control reports that children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI. They report that almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years. In every age group, TBI rates are higher for males than for females. Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $76.5 billion in the United States in 2000. They estimate that upwards of 20% of athletes per years suffer from concussions, which are reported and not reported. Helmet manufacturers have continued to make improvements in their helmets but the rate of concussion incidence has remained the same for the last several years. Many studies have been conducted and have reported the strength benefits of placing the lower jaw in the physiologic rest position (PRP) but none have been conducted, to the knowledge of this author, of any affect the PRP has on the rate of concussions. The data used in this study will demonstrate the use of the human physiologic rest position of the mandible and associated musculature in reducing the incidence of concussions in football, hockey and basketball players tested from youth sports, high school, college and professional levels of contact sports competition. The PowerPlus Mouthguard ™ was used in this ongoing study of 847 athletes over the past 9 years. The hypothesis is that the 20% of concussions reported come from an unstable lower jaw and that placing the mandible in the PRP stabilizes the jaw against the potential concussion causing impact.

Method

Appliance fitting: Over a period of 9 years the PowerPlus Mouthguard appliance design has changed but the PRP has remained constant. The athletes were fitted with a lower PowerPlus Mouthguard ™ (Traverse City) according to the instructions provided. The PowerPlus Mouthguard is a patent-pending mandibular repositioning appliance that is designed to place the lower jaw in the PRP of each subject. Each subject’s vertical dimension of occlusion was measured and the mouth guard thickness adjusted to the optimal vertical dimension of occlusion of 19mm and the PRP.

Data Collection

Individual subjects and teams were fitted with the PowerPlus Mouthguard and instructed to use it in practice and game competition throughout their respective seasons of competition. Individual athletes were tract on their progress individually throughout the season and personally interviewed for the results. Teams were asked to fill out a report form showing how many concussions were diagnosed by a health care professional, and forms were submitted at the end of the season. Data was processed and tallied over the 9-year period for all 868 athletes. There were no verbal instructions as to how the PowerPlus Mouthguard should be used, except for the players to use it as they would a traditional mouth guard.

Data Analysis

Percent of concussions were calculated for the data proved remarkable. The subjects who wore the PowerPlus Mouthguard showed a 0.34% concussion rate compared to the CDC’s report of 20% per year with any or no mouth guard.

Discussion

These results over 9 years indicate that positioning the jaw in the PRP can reduce the incidence of concussion in contact sports. It is important to note that the results are dependent on the correct vertical dimension placement of the jaw in its unique PRP for the result to be reproduced.

Continued studies must be conducted to examine the long term effects of PRP and concussions.

Conclusion

These data indicate that positioning an athletes jaw in its physiological rest position can dramatically reduce the incidence of concussions in contact sports. The results indicate that not all mouth guards are equal, and greater safety can be achieved by applying normal human physiology to position the mandible for improved safety in athletic competition.

1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

2. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.

3. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006.

4. Coronado, McGuire, Faul, Sugerman, Pearson. The Epidemiology and Prevention of TBI (in press) 2012.

5. Carlson, J (2003). Orthocranial occlusion and the Acculiner system. Blue Pine Unlimited, USA.

6. Center For Disease Control and Prevention (CDC) ( 2003), National Center For Injury Prevention and Control. Report to congress on mild traumatic brain injury in the United States: Steps to prevent a serious public health problem. Atlanta (GA) : Center for Disease Control And Prevention.

9. Halstead, P., (2009). The role of intraoral protective appliances in the reduction of mild traumatic brain injury. Compendium of Continuing Dental Education, 30 (2) :18-21

11. Klossner, D., 2008. National Collegiate Athletic Association. Guidelne $ c , Mouth Guards. Indianapolis, IN: ncaa.org.

13. Mason, M.P., (2008). Head cases. Stories of brain injury and its aftermath. New York, NY: Ferrar, Straus and Giroux

14. Peterson, C., (2010) The TMJ healing plan. Alameda, CA: Hunter House, Inc. Publishers

15. Reibel, K. (2010). Sport Concussion: Cutting through the confusion. Coach and Athletic Director Magazine. Brookfield, WI: Lessiter Publications

Smart Mouthguards Can Detect Concussions And Reduce Injuries In Rugby

Australia’s Samu Kerevi penalised for leading with the arm against Wales’ Rhys Patchell during the … Rugby World Cup 2019 Group D game between Australia and Wales at Tokyo Stadium on September 29, 2019 in Chofu, Tokyo, Japan. (Photo by Ashley Western/MB Media/Getty Images)

Getty Images

Many of the headlines surrounding the first two weeks of the 2019 Rugby World Cup in Japan have concerned refereeing decisions and citations–specifically those related to tackling.

Rugby union was one of the last major sports to outlaw professionalism in the 1990s, a change that has resulted in significant advances in training, fitness and quality of play. But as players become fitter and stronger, the impact of collisions on players’ bodies has become greater.

As the first generation of players whose entire career has taken place during professionalism have retired, there has been growing concern about the long-term effects on player health. Head injuries, including concussions, are chief among these.

The sport is undoubtedly far safer than it was even ten years ago, thanks to rule changes and growing awareness of concussions. Head Injury Assessments (HIA) have helped, while the controversial tackling rules at the World Cup are a further attempt to improve safety.

But according to one study, the average professional rugby union player is more likely than not to sustain a concussion after 25 matches. It’s clear that more needs to be done, and technology could help.

Smart mouthguard

Sports & Wellbeing Analytics (SWA) has developed a smart mouthguard that can measure the impact of collisions on players during matches and training, and feed this data back to coaching and medical staff.

The PROTECHT mouthguard is identical to a regular mouthguard, except for the accelerometers, gyroscopes and wireless equipment embedded in the unit.

“ works in any contact sport where you need a mouthguard,” says Chris Turner, SWA CEO. “It just happens to be the piece of kit that every player is required to wear, but it also closely brings the sensors to the skull. A headband or shirt is moving independently .”

The system is currently being used by two Welsh professional teams, the Cardiff Blues and the Ospreys. The latter is the former club of SWA director and Wales international Roger Blyth.

“Rugby is collision-based but have been impossible to measure,” explains Simon Church, head of physical performance at Ospreys. “We can measure GPS data but analysts have measured collisions based on carries and tackles.”

This method is incapable of measuring the impact of collisions on the body.

“ gives us a better idea of the demands of the game,” adds Allen Clarke, Ospreys head coach. “As a purest of rugby you like to think of rugby as a collision game so getting accurate reliable data on those collisions. We’re now using real-time data on the field rather than being retrospective.”

Top-down revolution

SWA has worked with Keytree to integrate PROTECHT with SAP’s analytics technology. This means collision data can then be overlaid with other metrics, such as GPS and fitness data, to assess injuries and change training schedules.

“Where it becomes more interesting for the teams, is that the information can be viewed by a team per drill, per half, and that level of data via the right access control is visible without any action,” adds Turner. “A national union can look at all clubs associated with that union or look at different drills.”

SWA has worked with World Rugby and the Welsh Rugby Union (WRU) to gain approval for PROTECHT. Not because they’re concerned the mouthguard is any less safe than a standard mouthguard, but to ensure the data being collected is reliable and accurate and that player safety can be guaranteed.

Turner says extensive testing has been carried out and that by targeting professional rugby first, the effectiveness of PROTECHT can be proved to the amateur game. In general, governing bodies have been very receptive to the idea.

“Elite is where we started because we feel it’s important to get the credibility,” he adds. “Are you giving players and parents a false sense of security? But the vision is to bring it into the consumer world.”

“We’ve spent a lot of time getting it accurate and reliable.”

Keytree believes the technology could eventually be used in other sectors, including medicine and logistics. “We started out with two things in mind. The first was to solve this particular problem and the second was to gain knowledge for other areas,” says Dan McNamara, Keytree CEO. “Other health and wellbeing areas that are based on data and algorithms.”

The Player’s view

Ospreys are full of praise for the system, saying it is already having an impact on training sessions and how they manage workloads in between games. This, Clarke believes, will lead to a reduced risk of injury and could even extend players’ careers.

“As a coach, you want the higher availability of players,” says Clarke. “We have better data that informs us coaches and this gives us what we think is best practice.

“We can’t plan for the number of collisions in a game but we can be smart during a week and make sure players are in the best possible position for the game. You’ve only got one body. With smarter training programs and more information and players are going to have longer careers.”

Ospreys fly-half James Hook agrees: “It will increase the longevity of careers, definitely. Since I first started , the amount of contact in training sessions has dropped dramatically.

“I think everyone’s concerned about . I’m a father and this is not just for the professional game, this for the amateur game. This is a great sport and you want to be safe.”

There are 3.8 million sports-related head injuries each year, and 47 percent of athletes do not report symptoms of their head injuries, whether out of lack of understanding or a need to feel tough.

As we’ve learned over the past few years, from the death of NFL athletes like Frank Gifford or the movie Concussion, based on the research of Dr. Bennet Omalu, blows to the head can cause permanent damage to the brain. ForceImpact Tech is looking to prevent this type of damage with their first product, the FITGuard.

FITGuard is a mouthguard that detects the severity of an impact to the head, and then uses LEDs embedded in the mouthguard to indicate how intense that impact was.

The lights turn green to show a low-impact blow, whereas blue means there is a moderate risk of injury. Red LED lights signify that the impact was severe enough to immediately remove the player from the field, and does so in a way that coaches, teammates and referees can see without any indication from the player.

As is standard with most modern gadgets, the FITGuard pairs with a mobile app that can be monitored by a coach or parent, providing real-time insight into an athlete’s injury. This also allows medical professionals to look at the athlete’s history of head injuries and impacts.

Because FITGuard’s app uses information around the user’s weight, gender, and age, it’s able to be user-specific when it measures the impact of a blow.

Individuals will be able to purchase the device for $129, but the company is looking to ramp up distribution by selling directly to leagues, teams and universities at a price point under $100. Moreover, they want to partner with insurance companies to ensure that those insurance providers will offer a discount to users of the device.

ForceImpact Tech plans to ship before the fall season of football this year, and you can learn more about the product here.

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