Concussion Wearables

Parents ask me about protective equipment all the time.

Should my son wear a Guardian Cap for football? What about a Q-Collar? Should my daughter wear a helmet for lacrosse? Does my soccer player need one of those padded headbands?

I understand the question. As a parent, if there is something you can put on your child that might make them safer, why wouldn't you?

The problem is that the answer is rarely as simple as we want it to be.

Protective equipment may reduce some injuries - and well-researched equipment may even modestly reduce concussion risk - but no piece of equipment makes the brain concussion-proof. The danger comes when a small or uncertain reduction in risk creates a large increase in confidence.

Over the years, we have seen different technologies introduced with the promise of protecting athletes. Some reduce impact forces in a laboratory. Some have evidence suggesting fewer injuries. Others have limited or conflicting data when we ask the question that parents really care about: Does this prevent concussion?

Guardian Caps are a good example. There are biomechanical reasons to believe that additional padding may attenuate certain impacts. But the largest high school study to date did not find a significant reduction in concussion among athletes wearing them during practice.

That doesn't mean Guardian Caps are useless.

It means we need to be careful about the difference between reducing force and preventing concussion.

And maybe even more importantly, we need to think about what happens to an athlete's behavior when we tell them that something they are wearing is protecting their brain.

Concussion remains a clinical diagnosis. We don't have the equivalent of a troponin (a marker of injury to the heart) for the brain - a biomarker that allows doctors to diagnose concussion definitively after a hit would definitively tell an athlete and parent whether a concussion occurred. It would also help us understand more accurately when it is safe to participate without masking an underlying injury. It is clear to doctors now that repetitive trauma to the brain, whether concussion is diagnosed or not, leads to poor outcomes.

Most of the time, I need to rely on the athlete to tell me what they are experiencing. That is not ideal. Athletes are motivated to work through pain and often play through injuries.

• Headache.
• Dizziness.
• Fogginess.
• Visual problems.
• Just not feeling right.

That makes concussion like other injuries in that athletes are incentivized to continue even when they are in pain. What makes brain injury different from many of the other injuries we manage in sports medicine is that red flags for ongoing injury and accumulated damage are invisible and devoid of any test that can identify risk for permanent injury and CTE.

And it collides with one of the things I love about sports.

Athletes learn to be resilient. They learn that discomfort isn't always something to fear. They learn to push themselves when they're tired, sore, frustrated, or unsure they can keep going.

There is nothing inherently wrong with playing through pain. Sometimes that ability to persevere is exactly what sport is supposed to teach us.

But there is a problem when that culture gets applied indiscriminately to the brain.

I've heard versions of it for years:

Don't say the C-word.

Because once an athlete says headache, dizziness, fogginess, or concussion, they know what may happen next.

So, they stay quiet.

And often the athletes who worry me most aren't the ones telling me every symptom. They're the ones telling me nothing. We have good evidence that delayed reporting matters. Athletes who continue playing after concussion symptoms begin tend to have greater symptom burdens and longer recoveries than athletes who report promptly and are removed.

So, imagine adding another thought to the calculation already occurring inside that athlete's head:

• I'm wearing something that's supposed to protect me.
• Maybe this headache isn't a concussion.
• Maybe I'm fine.

That is where protective equipment can create a problem that has nothing to do with the engineering of the equipment itself.

Protection isn't the problem. The perception of protection can be.

And my own thinking about protective equipment has changed over time.

I have become more comfortable with head protection in sports like women's lacrosse and with protective headgear in soccer.

Not because I believe we have solved concussion.

We haven't.

But athletes need protection from other things, too. A concussion is a stretching injury of the brain from rapid changes in direction or torsional forces. The skull protects the brain from direct impact. Sticks and balls can cause damage that a helmet does protect the wearer from. A lacrosse or field hockey stick can cause significant injury. So can a solid ball, a projectile, traveling at high speed. Head protection can potentially reduce lacerations, fractures, contusions, and other direct injuries. Those benefits matter.

I am not anti-helmet.

I'm not anti-Guardian Cap.

I'm not anti-technology.

If we can make sports safer, we should.

But reducing one risk is not the same thing as eliminating concussion and repetitive head impact vulnerability.

Wear the helmet. Wear the headband. Use the additional padding if you and your medical team believe there is a reasonable benefit. Just don't let any of those things change the threshold for an athlete saying: Something doesn't feel right.

This is also one reason I started writing these thoughts down. These conversations are surprisingly difficult to have in the clinic. A parent asks a seemingly straightforward question: Should my child wear this? They deserve more than yes or no.

The answer might be: Yes, I think there may be reasons to wear it. No, I don't want you to believe it makes your child immune to concussion. And most importantly, I don't want your child believing that either.

That thought takes time to explain. A clinic visit doesn't always give us that time. There is an athlete to examine, a diagnosis to make, treatment to discuss, questions to answer, and another patient waiting.

Writing gives me something different. It gives me enough room to show the thought thread behind the advice. Maybe that's part of what I want this newsletter to become. The clinic gives me limited time to give an answer.

Here, Beyond the Clinic, I can explain how I arrived at it.

The evidence is mixed and sport/device-specific: no protective equipment eliminates concussion risk or replaces symptom recognition and reporting.

Short bibliography for the piece

1. Hammer E, Mosiman SJ, Joachim MR, et al. (2025). The association between Guardian Cap use during practices and sport-related concussion risk in high school American football players. British Journal of Sports Medicine, 59:257-262. Cited 7 times.

Why it matters: 2,610 high-school football players across 41 schools. Guardian Cap use was not associated with lower concussion risk during practice (adjusted RR 1.01, 95% CI 0.57–1.79). This is particularly useful for your discussion distinguishing laboratory impact attenuation from demonstrated concussion prevention. [1]

2. Shill I, Shepherd HA, Eliason P, et al. (2025). Prevention strategies and modifiable risk factors for concussion: a systematic review and meta-analysis for the FAIR consensus. British Journal of Sports Medicine, 59. Cited 18 times.

Why it matters: This provides the nuance you wanted regarding your changing opinion. Headgear was associated with about a 30% lower concussion rate in adolescent female lacrosse and soccer (IRR 0.70, 95% CI 0.50–0.99), but the authors rated the evidence very-low certainty. [2]

3. Al Attar WSA, Mahmoud H, Alfadel A, Faude O. (2023). Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours. Sports Health, 16:473-480. Cited 9 times.

Why it matters: Across randomized trials in soccer and rugby, headgear produced no significant reduction in concussion (RR 1.03, 95% CI 0.82–1.30). This supports your distinction between wearing protective equipment and being protected from concussion. [3]

4. Tjønndal A. (2021). Athletes' and Coaches' Attitudes Toward Protective Headgear as Concussion and Head Injury Prevention: A Scoping Review. Frontiers in Sports and Active Living, 3. Cited 13 times.

Why it matters: This one gets closest to your false-security thesis. Across 18 studies, athletes commonly believed headgear protected against concussion/head injury, while the literature showed discrepancies between those beliefs, actual protective effects, and behavior. [4]

5. Barnhart M, Bay R, Valovich McLeod TC. (2021). The Influence of Timing of Reporting and Clinic Presentation on Concussion Recovery Outcomes: A Systematic Review and Meta-Analysis. Sports Medicine, 51:1491-1508. Cited 53 times.

Why it matters: Probably your most important citation. Across 12 studies, athletes who immediately reported concussion recovered about 5.4 days sooner than delayed reporters. Delayed reporting/continued participation was associated with longer recovery and greater symptom severity. [5]

6. Schmidt JD, Broglio SP, Knight K, et al. (2022). Optimizing Concussion Care Seeking: A Longitudinal Analysis of Recovery. American Journal of Sports Medicine, 51:214-224. Cited 17 times.

Why it matters: In 2,758 CARE Consortium athletes/cadets, delayed reporters had greater acute symptom burden, took 2 days longer to become asymptomatic and 3 days longer to return to activity. Every additional 30 minutes of participation after injury was associated with an 8.1% increase in time to asymptomatic status. [6]