Think helmets protect developing brains from concussion? Experts say think again
Younger brains are more prone to concussions and need more time to recover. (Getty Images: Cameron Spencer)
When Berengere's 11-year-old son Henri was hit on the forehead by a basketball during a school match, he felt unwell and experienced pins and needles in his arms and legs.
Prompted by the school's first aid officer, Henri's family took him straight to the emergency department where his mother says he was diagnosed with "light whiplash" and told to go home.
Ten days later, while playing a junior league basketball match, Berengere could see Henri was not himself.
"He was suddenly immobile while on the court. Since he is a very competitive boy, I knew that something was wrong," she said.
Eleven-year-old Henri was diagnosed with a concussion after he was hit with a basketball at school. (Supplied)
A second trip to the emergency room saw Henri diagnosed with a concussion. In the four months that followed, he developed symptoms including loss of concentration, sensitivity to light and noise, insomnia, loss of mobility, and partial loss of vision.
"We had to remove him from school," the Melbourne mother said.
Henri's family didn't realise it would take a full year of doctor's appointments and hospital visits before Henri would be cleared and could return to class.
How concussion impacts young brains
Concussion, post-concussion syndrome and Chronic Truamatic Encephalopathy (CTE) have long been associated with mostly male professional athletes.
But according to Headsafe's brain injury specialist Adrian Cohen, younger brains are much more susceptible to concussion or a significant brain injury.
Brain injury specialist Adrian Cohen warns of increased vulnerability when playing social sports. (Supplied)
"These brains are still developing and often maturing up to the time you're 20 or 21," he said.
Figures from the Australian Institute of Health and Welfare (AIHW) show that in 2021-22, while the number of adults hospitalised with a sport-related concussion was 14 per cent, for children it was as high as 37 per cent.
It also revealed that sports, particularly Australian rules football, were the primary cause of concussion-related hospital admissions for children aged 10 to 15.
As children and adolescents have thinner skulls and less developed neck muscles, they are more susceptible to brain injuries from concussions and at risk of long-term issues such as learning difficulties and cognitive impairment.
Signs and symptoms of concussion
Contrary to popular belief, loss of consciousness occurs in less than 10 per cent of all concussions.
A concussion is a wave of energy, caused by a hit to the head (or body), that then spreads through the brain tissue.
"Firstly, there's a protective decrease in the blood supply to the brain," Dr Cohen said.
"The second thing that happens is right down at the level of the nerve cells themselves — there's actually damage to the cells' metabolism."
Post-concussion syndrome is diagnosed when symptoms last longer than three weeks.
For 29-year-old Emily, she knew something was wrong when she began spending large parts of her day lying in bed with the curtains drawn.
"My mother, who is a retired nurse, was like, 'What's wrong with you? Why aren't you getting out of bed?'", she said.
As it turns out, Emily was suffering from post-concussion syndrome after an incident while playing for a local soccer club when she was 25 years old.
Emily was diagnosed with post-concussion syndrome after an incident playing soccer. (Supplied)
"I dove forward to save a goal … and her shin collected me clean in the forehead," she said.
"And then my memory gets a bit murky."
Emily said, at the time, the governing body's concussion policies seemed "geared to professional teams with team doctors and physios" rather than players like her.
Dr Cohen says this is an additional vulnerability when playing in social or community sports.
"Having multiple doctors and physios at the game is not what happens on a Saturday afternoon at school sport or with community sport," he said.
After taking herself to hospital, Emily was diagnosed with concussion and told to rest for a few days. But chronic migraines made it difficult to function and she spent most of her days in bed.
"I was meant to be a full-time shift worker and I could barely stand up," she said.
Emily took eight months off work. During this time, she struggled with memory and concentration, making it difficult for her to use her phone, watch TV, or read.
Four years later, Emily is still dealing with a multitude of issues, including light and sound sensitivity, migraines and problems with her memory.
Emily loved playing sport from a young age. (Supplied)
Concussion dangers in social sport
27-year-old Liam Randles-Martin was playing for the Renegade Pub Football League in Melbourne when he suffered his first concussion during a friendly game of AFL 7s in the off-season.
"He went low, I went high and I got the point of his shoulder in my jaw," he said.
"I felt like I was looking down a tunnel and I got strangely emotional."
Liam took a couple of days off work but struggled to go for a walk, tired easily and "found the sunshine a struggle".
A GP eventually confirmed his concussion and recommended he take two months off playing contact sports.
Liam (third from right, bottom row) suffered a concussion while playing football for his local pub footy league. (Supplied)
Returning a young player with a concussion to training or the game before their brain has recovered can have further consequences, such as Second impact syndrome.
"As the name suggests [Second impact syndrome] is a second blow to the brain before it is fully recovered from the first," Dr Cohen said.
"Severe brain damage and death can be the result — some of these young players do not go home to their parents."
Do helmets prevent concussions?
The short answer, according to brain injury specialists, is no.
This is because helmets don't lessen the energy transferred to the brain. Instead, they help prevent "cauliflower ears" and superficial lacerations.
Dr Priglinger-Coorey (second from right) treats young concussion patients at Royal North Shore Hospital's concussion clinic. (Supplied)
"Nothing can fully prevent a concussion as the brain will still be shaken inside the skull regardless of protective gear," Miriam Priglinger-Coorey said.
Dr Priglinger-Coorey is a neurologist with Royal North Shore Hospital's concussion clinic and treats patients as young as eight with head injuries that range from being hit by a cricket ball to getting an opponent's elbow to the head.
"However, mouthguards and helmets can absorb some impact and should be worn to protect the teeth, jaw, tongue, and skull from injury and bleeding," she said.
Dr Cohen agrees and notes that hard helmets and soft headgear can also change playing behaviour.
"Players can think they are somewhat invincible and then use the helmet either offensively or defensively as part of their tackling, further increasing the risk of head injury to themselves and other players," he said.
Current state of concussion protocols
Australian Institute of Sport's concussion guidelines released earlier this year recommend athletes under the age of 19 return to competitive contact sports after a minimum of 21 days and call for the appointment of a concussion officer in clubs and schools.
Most Australian states have mandated concussion protocols for their schools, with the exception of Tasmania.
A spokesperson for Tasmania's Department of Education told the ABC "there is currently no specific concussion policy …" but there are "duty of care procedures" if a student needs medical assistance.
In junior sporting codes, the AFL is the only code to mandate the appointment of concussion officers and enforces a minimum of 21 days of no-play following a concussion. Meanwhile, the earliest a player may return in Rugby League and Rugby Union is 19 days.
Basketball Australia and Football Australia's return-to-play protocols state children must not return before 14 days from the complete resolution of all concussion symptoms.
Brain injury specialists say helmets only protect from 'cauliflower ears' and superficial lacerations. (Getty Images: master1305)
But some brain injury specialists believe strong protocols are not enough to protect young athletes.
Dr Priglinger-Coorey says children should be taught proper tackling techniques that consider differences in body mass and size, which vary significantly within age groups.
"Recent research suggests that heading the ball should be introduced only after the age of 14," she said.
"Promoting awareness of concussion symptoms and encouraging neck strengthening exercises can also be beneficial.
Children should return to learning activities before returning to sport, and only resume playing once they are completely symptom-free."
The six-part drama series Plum follows Australian football legend Peter ‘The Plum’ Lum as he deals with the long-term impact of hundreds of head injuries and concussions suffered on the field.
Stream all episodes of Plum free on ABC iview or watch Sundays 8.30pm on ABC TV.