Success Stories

Earlier in the process of developing ND006, NOCSAE awarded research grants to help expand the scientific background for a possible standard. One of these studies, “Brain Trauma Exposure for American Tackle Football Players 5 to 9 and 9 to 14 Years of Age,” is by a team of researchers who found that younger players can experience more serious impacts because they have weaker necks and proportionally larger heads, which makes it difficult for them to control their bodies during a fall to the ground and on the recoil after helmet-to-helmet impacts. This effect has been referred to as the Bobble-Head Effect.

This study involved three stages of analysis: video analysis, laboratory reconstructions, and finite element modeling of head impacts from youth football games.

Video
Sixty football games were videotaped and were divided into two categories for ages 5 to 9 and 9- to 14-year-olds. There were 30 teams in each age group.  Head impacts were documented for 7 players on the team. The players were one quarterback, one running back, one wide receiver, one offensive lineman, one defensive lineman, one linebacker, and one defensive back. For each verified head impact that was observed on the video, the researchers documented where the impact occurred on the head, and how it occurred, such as head-to-head or head-to-ground. The researchers then visually classified the velocity of the impact from very low to high.

Laboratory Reconstructions
Following the video analysis of the head impacts, the researchers simulated the impact scenario in the laboratory. For these simulations, they chose the head-to-head, head-to-ground, and head-to-shoulder impacts as these made up over 85% of the impacts seen on the videos. They used the small-sized NOCSAE headform for both age groups, fitted with a youth-sized football helmet. Head-to-ground impacts were simulated using the free fall drop test and head-to-head and head-to-shoulder simulations were completed using a pendulum test.

Finite Element Modeling (FEM)
The third component of the study involved using finite element modeling, which is a computer-derived model of the brain that allows the researcher to enter an impact magnitude (from the laboratory reconstructions) into the model to determine peak maximum principal strain. MPS is used to classify the severity of a head impact.

More About FEM
Finite Element Modeling is a computational technique used in brain injury research (and other types of investigations) to simulate and analyze the mechanical behavior of the brain and its tissues under various conditions, such as impact or acceleration. It breaks down complex structures, like the brain, into smaller, simpler elements (finite elements) that can be analyzed mathematically. It helps us understand how brain tissue behaves under stress, including deformation (changes in shape or structure caused by pressure) and strain (stretch). This allows researchers to model the physical responses of brain tissues to different forces and predict injury risk.

More About MPS
Maximum Principal Strain is a threshold calculation for measuring the highest level of deformation that a material, such as brain tissue, experiences under stress. It is an important concept in brain injury research because it helps predict how and when brain tissue will fail or sustain damage due to forces like acceleration (sudden movements) and impact.

What were the results of the study?

In the group of 5- to 9-year-olds, the researchers recorded 590 head impacts in 30 games. In the group of 9- to 14-year-olds, researchers verified 805 head impacts. This difference in the number of impacts between groups is not statistically significant. In both age groups, most impacts were a result of head-to-head contact, and the next highest number were head-to-ground impacts.

The majority of impacts in both age groups had MPS values classified as low. While impacts in this category may not be linked to diagnosed concussions, they are important to note because they are linked to injuries that lead to changes in brain structures and cognitive impairments that may not have symptoms.

More impacts in the moderate-range category occurred in the younger group than in the older group. Moderate-range MPS level impacts have been associated with concussions. This higher number of moderate-range impacts appears to be due to the relative inability of younger kids to control the the motion of their heads during an impact event. Further, because the added weight of a helmet adds to this problem, the researchers concluded that younger athletes may benefit from a smaller and lighter helmet.

In both age categories, most of the head impacts occurred to running backs, followed by defensive line players, and then linebackers. Impact events were similar for both age groups as well. Most impacts were a result of head-to-head followed in number by head-to-ground.

Laboratory reconstructions of the impacts showed that measurements of peak linear and rotational accelerations were both lower than the range used in testing helmets to the current football helmet standard. Because of this, researchers suggested lowering the pass/fail testing criteria for youth helmets to more accurately capture the magnitudes of impacts experienced by younger players on the field.

Ultimately the findings reported in this study supported the development of a youth-specific helmet standard. NOCSAE standard ND006 is currently in Proposed New status but may advance to final status early in 2025 and would go into effect 12 months later.

Where can I learn more about this study?

Read the full study on NOCSAE’s website: “Brain Trauma Exposure for American Tackle Football Players 5 to 9 and 9 to 14 Years of Age.”

Standard to Protect Against Commotio Cordis

Commotio cordis (CC) is a heart rhythm disruption caused by a blow to the chest. Although rare, it is one of the leading causes of sudden cardiac death in athletes. The injury happens most often in sports with projectiles such as baseball, softball, lacrosse, and hockey. NOCSAE invested $1.1 million to fund groundbreaking research that identified the physical cause of the injury and how to protect against it. Many athletes who died in the past were wearing a noncertified form of chest protection that wasn’t designed to protect against commotio cordis. NOCSAE finalized its standard for protectors in 2017, and USA Lacrosse, the NCAA, and NFHS now require chest protectors that are compliant to the NOCSAE standard.

In the late 1990s after an article in the New England Journal of Medicine raised awareness of the phenomenon, there was an uptick in reported CC events. Dr. Barry Maron, one of the article’s authors, would later take on an important role in NOCSAE’s efforts against CC. NOCSAE-funded research to investigate the commotio cordis injury began in 1995.

Before NOCSAE began investigating CC, no one could explain why only some hits over the heart were fatal or why so many of the victims were adolescents. Adding to the mystery was that a characteristic of the injury is an absence of any damage to the heart.

At around the same time, NOCSAE-funded research efforts were making headway.  Dr. Mark Link, who is an expert in electrophysiology and specializes in abnormal heartbeat patterns, was one of the investigators to receive funding from NOCSAE. He was chosen to spearhead our research efforts because he had been making impressive progress on the problem in his lab at Tufts University.

Dr. Link made a key discovery that answered the most puzzling question about CC. Why were some hits to the chest lethal even though most were not? He found that only hits striking at a critical moment in the cardiac electrical cycle cause CC arrythmia. Force transferred from a striking ball, through the chest wall to the heart, interrupts the heart’s cadence, sending it into a disorganized rhythm that stops blood circulation. Because of Link’s discovery, the world now knew how an ordinary-seeming ball strike can cause death.

Crucial Next Step

NOCSAE’s role in athlete safety is to write performance standards for athletic equipment. Sports equipment manufacturers design their products to perform to these standards. NOCSAE’s CC challenge was to develop a method for testing protective equipment against the conditions that cause this injury. There was still a lot of work to do.

Dr. Nathan Dau’s work in the Sports and Ballistics Lab at Wayne State University for NOCSAE yielded an important leap toward developing such a standard. He created a biomechanical chest surrogate to model, and measure, the human response to ball impacts.

In a series of further studies for NOCSAE, Dr. Link found that only perpendicular hits over the center of the heart cause CC. This was an important finding because it indicates exactly what area of the chest must be covered by a protector. He also identified the injury prevention threshold, which is a measure of how much impact force is necessary before commotio cordis is triggered. This is a key metric to test equipment performance. It is one of the measures manufacturer’s need to develop prototypes.

Setting the Standard

Ultimately, NOCSAE’s standards to protect against comotio cordis were approved by the NOCSAE Standards Committee:

• ND200: “Standard Test Method and Performance Specification Used in Evaluating the Performance Characteristics of Protectors for Commotio Cordis”
• ND201: “Laboratory Procedural Guide For Certifying Newly Manufactured Chest Protectors For Commotio Cordis”

NOCSAE also funded the establishment of a national registry to track CC cases, which was organized by Dr. Maron. As a result, it is now known that 15 – 25 athletes are affected annually.