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Birth and evolution of the football helmet

ARTICLE in NEUROSURGERY OCTOBER 2004
Impact Factor: 3.03 DOI: 10.1227/01.NEU.0000134599.01917.AA Source: PubMed

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LITERATURE REVIEWS

BIRTH
Michael L. Levy, M.D.,
Ph.D.
Division of Neurosurgery,
University of California at
San Diego School of Medicine,
San Diego, California

Burak M. Ozgur, M.D.

Division of Neurosurgery,
University of California at
San Diego School of Medicine,
San Diego, California

Cherisse Berry, B.S.

Keck School of Medicine,
University of Southern California,
Los Angeles, California

Henry E. Aryan, M.D.

Division of Neurosurgery,
University of California at
San Diego School of Medicine,
San Diego, California

Michael L.J. Apuzzo, M.D.

Department of Neurological
Surgery, Keck School of Medicine,
University of Southern California,
Los Angeles, California
Reprint requests:
Michael L. Levy, M.D., Ph.D.,
Suite 502, 8010 Frost Street,
San Diego, CA 92123.
Email: mlevy@chsd.org
Received, October 6, 2003.
Accepted, February 23, 2004.

AND

EVOLUTION

OF THE

FOOTBALL HELMET

OBJECTIVE: To review the advent and evolution of the football helmet through
historical, physiological, and biomechanical analysis.
METHODS: We obtained data from a thorough review of the literature.
RESULTS: Significant correlation exists between head injuries and the advent of the
football helmet in 1896, through its evolution in the early to mid-1900s, and regulatory
standards for both helmet use and design and tackling rules and regulations. With the
implementation of National Operating Committee on Standards for Athletic Equipment
standards, fatalities decreased by 74% and serious head injuries decreased from 4.25
per 100,000 to 0.68 per 100,000. Not only is the material used important, but the
protective design also proves essential in head injury prevention. Competition among
leading helmet manufacturers has benefited the ultimate goal of injury prevention.
However, just as significant in decreasing the incidence and severity of head injury is
the implementation of newer rules and regulations in teaching, coaching, and governing tackling techniques.
CONCLUSION: Helmet use in conjunction with more stringent head injury guidelines
and rules has had a tremendous impact in decreasing head injury severity in football.
Modifications of current testing models may further improve helmet design and hence
further decrease the incidence and severity of head injury sustained while playing
football.
KEY WORDS: Biomechanics, Football, Head injury, Helmet, Sports injury prevention
Neurosurgery 55:656-662, 2004

DOI: 10.1227/01.NEU.0000134599.01917.AA

HISTORICAL BACKGROUND

oday, American society has declared Superbowl Sunday to be the biggest television event of the year. Fathers live vicariously through their sons by encouraging
them to play peewee football and then supporting their play through varsity football and
perhaps, for the very few, to the professional
leagues. Part of this culture must reflect the
tremendous decline in the incidence of serious
head injury and death. Perhaps, had not certain changes taken place, few parents would
be so eager to allow their child to play such a
potentially dangerous game.
Eighteen deaths and 159 serious injuries
were attributed to American football from
1869 to 1905. The first documented use of a
helmet during a football game occurred during an Army-Navy game in 1893. Initial helmets consisted merely of leather. Replicas of
the three main types of leather football helmets are shown in Figures 1, 2, and 3. Then,

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with time, metal alloys were added to provide

more support and protection. Helmet use did
not become mandatory for the National Collegiate Athletic Association until 1939 and the
National Football League until 1940. Even
with the first single-bar face mask (appearing
in 1951) and the first double-bar face masks/
cages (appearing in 1958), both tackling drill
fatalities and head injuries continued to increase, whereas spine injuries decreased between 1955 and 1964. The increases in
football-related injuries resulted in the prospective collection of injury data, which was
initiated in 1967. As a result of the continued
increase in head and spine injuries from 1965
to 1974, rule changes were implemented. The
National Operating Committee on Standards
for Athletic Equipment (NOCSAE), founded
in 1969, initiated research efforts for head protection and implemented the first safety standards for football helmets in 1973 (1, 4, 10).
The Standard Method of Impact Test and
Performance Requirements for Football Hel-

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EVOLUTION

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FOOTBALL HELMET

FIGURE 1. Photograph of beehive style leather football helmet.

mets published in 1973 required the use of a head model that

closely simulates the response of the human head to impact.
Standards are based on the helmet falling in a guided free fall.
In each case, the helmet is positioned on a head form. The
head form is human-like and complex in function and is
constructed to provide a measure of the ability of the helmet
to attenuate the kinetic energy released during the test. The
energy is based on the drop velocity and the mass of the head

FIGURE 2. Photograph of flat-top style leather football helmet.

NEUROSURGERY

FIGURE 3. Photograph of dog-ear style leather football helmet.

form. The goal of NOCSAE was to develop a standard that

would measure the ability of the football helmet to withstand
repeated blows of various magnitudes under a wide variety of
playing conditions without any sacrifice in protective quality.
Drawings illustrating the types of testing that helmet manufacturers are held accountable for are provided in the
NOCSAE guidelines and reproduced in Figure 4. A photograph of actual testing apparatus is displayed in Figure 5.
Helmets must be able to endure forces occurring over multiple
seasons without the need for reconditioning. Standards were
applied to players ranging in age from 14 years to professionals. The standards were also applied to numerous environmental conditions (freezing cold, driving rain, heavy snow, or
high heat and humidity) and playing surfaces (hard-packed
dirt, thick mud, deep grass, or artificial turf).
In 1975, Joseph S. Torg, then Director of Sports Medicine at
Temple University, initiated a central registry for the collection, documentation, and analysis of cases of severe neck
injuries occurring in football (3, 11). Torg determined that
tackling techniques also played a significant role in the types
and severity of football-related injuries. At the end of the 1975
season, both the National Collegiate Athletic Association and
the National Alliance Football Rules Committee enacted rules
designed to prevent the use of the head as the initial point of
contact during play. The rules implemented stated that no
player shall intentionally strike a runner with the crown or top
of the helmet. Spearing is the deliberate use of the helmet in an
attempt to punish an opponent, and no player shall deliberately use his helmet to butt or ram an opponent.
The National Alliance Football Rules Committee provision
prohibited any technique involving a blow with the face mask,

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FIGURE 5. Photograph of helmet testing apparatus.

safety standards in 1978 for college football and in 1980 for

high school football. Currently, it is mandatory for all high
school and college players to wear helmets meeting NOCSAE
standards (5).

HELMETS

FIGURE 4. Illustrations depicting testing guidelines by NOCSAE.

frontal area, or top of the helmet driven directly into an

opponent as the primary point of contact either in close line
play or in the open field. As a result of the prohibition of
headfirst contact, there was a resultant decrease in head and
neck injuries.
In 1977, the National Collegiate Athletic Association funded
the initial National Survey of Catastrophic Football Injuries,
which from 1982 to the present has been known as the National Center for Catastrophic Sports Injury Research under
the direction of Dr. Fred Mueller. NOCSAE established helmet

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The American football helmet was and is designed to protect the areas of the players head directly covered by the
helmet from direct linear impact only. The helmet was not and
cannot be designed to prevent injury to or protect the cervical
spine or spinal column on those areas of the neck not covered
by the helmet or to prevent injuries to the brain that result
from rotational acceleration. As a result of NOCSAE, critical
changes became apparent in the protective qualities of football
helmets beginning in the early 1970s. According to Schneider
(9), football helmets should be constructed specifically on the
basis of an anatomic knowledge of the cranium and brain with
an understanding of the mechanical principles involved in
head injuries. Schneider stated that the outer shell of the
helmet should be constructed to cover either the fragile areas
of the cranium, which might fracture, or to cover specific
portions of the intracranial contents, which are most frequently vulnerable to head injuries and may result in concussion. The firm posterior margin of the outer shell of the helmet
should be cut high to avoid potential cervical injuries. More
recently, helmet manufacturers have focused further on the
inner suspension system developed to distribute forces generated by impact uniformly over the head. This system consists of two crowns, one within the other. Each crown is a
hemisphere of hollow plastic material with arches extending
from the apex to the base or circumference of the crown (RC
Schneider [9]). Air or gas injected through valves into these
structures diffuses throughout all parts of each individual
crown (9). In the completed helmet, the two crowns are
injection-molded and electrically sealed together as a single
piece by use of a high-frequency sound wave. An inner crown
is inflated pneumatically to fit the individual player, but the
outer crown lining the outer shell of the helmet is inflated to
the same pressure for all wearers (9). The presence of the two

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EVOLUTION

separate, pneumatically sealed systems avoids the problems

of the headgear bouncing on the head. The helmet is maintained in position on the head with a four-point attached chin
strap.
Helmet material must allow for more deformation and
gradual deceleration of the head. The face guard should be
flattened, and the chin straps should release easily. The posterior rim of the shell should be advanced, and shoulder rolls
must be used for further craniocervical protection. Web suspensions absorb force at fixation points; however, isolated
fluid or air pockets should avoid supraorbital and occipital
nerves. Helmet shell material must allow for more protection
of fragile regions of the cranium and areas prone to concussive
injury. The initial force of impact must be decreased from the
athlete and the lower force distributed over larger area and a
longer period of time.
Although the characteristics of energy absorption and attenuation of blows to the helmet are of critical importance in
helmet design, many researchers think that there are many
other requirements and considerations that should not be
overlooked. Position maintenance so that no slippage occurs
during wear; good ventilation; good vision so that there is no
restriction of peripheral vision; light weight; a smooth, hard
exterior surface; good fit to the players head; continued functional use after repeated blows; comfort; economics; appearance; ability to withstand the effects of sun, temperature,
paints, or cleansers on the shell or components; and durability
are all essential characteristics to helmet design. Helmet designers have attempted to incorporate all of these characteristics in designing protective headgear while at the same time
maximizing the linear impact absorption and attenuation capabilities of the helmet.
Position maintenance and individual contour fitting are essential goals of any helmet. Helmet systems and design elements vary considerably in their ability to satisfactorily meet
the requirements of the large variability of cranial contour and
volume. In addition, significant testing has determined that no
statistical differences were observed for comparison among
helmeted and nonhelmeted trials for heart rate, core temperature, weight loss, or other physiological strain indices (6).

DESIGN
In testing helmets in 1977, Elwyn Gooding, then a research
associate at the University of Michigan, with Richard Schneider, simulated the forces present during the production of
both acute subdural hematomas and cervical spine injuries
with tetraplegia and compared the effectiveness of various
types of protective football headgear in attenuating these
forces. In this series of impact testing, Gooding used a bare
headform against a rigid anvil as a signal to record specific
types of impacts. These tests were repeated with different
types of helmets of varying construction and under various
conditions. Gooding found that in simulating impacts to both
the occipital region of the head, known to produce subdural
hematomas, and to the vertex of the head, known to produce

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OF THE

FOOTBALL HELMET

cervical fractures with tetraplegia, a severe brainstem contusion, or hemorrhage, all types of helmets attenuated the blow
considerably compared with blows sustained by the bare head
form against a plain anvil. After testing all types of web and
foam suspension systems and combined web and foam systems, Gooding found that the better helmet is one that has a
small initial rise and a distribution of force at a lower peak for
a longer time. Myers et al. (7) determined that helmet systems
using pneumatic or a combination of pneumatic and foam
padding systems were the most successful at absorbing energy compared with purely foam or suspension-type helmets.
Further comparison revealed that the double-crown pneumatic helmet provided the best protection. Bishop et al. (2)
also performed mechanical testing to demonstrate failure rates
in relation to the Gadd Severity Index for suspension-type
liners versus padded liners. They found that at a Gadd Severity Index score of 1500, failure rates were 19 and 2% for
suspension-type and padded-type liners, respectively. Furthermore, at a Gadd Severity Index score of 1200, failure rates
were 65 and 11% for suspension-type and padded-type liners,
respectively. Clearly, their study demonstrated the superiority
of padded-type liners over suspension-type liners under impact conditions.
Although value exists in determining compatibility with
known standards, performance in the established test methods and comparisons of various helmet designs must not be
used to predict the likelihood of the capability of any headgear
to limit certain injuries. There is no helmet that can prevent all
head injuries.

ASSESSMENT
NOCSAE has allowed for the standardization of tests by use
of performance testing of existing and novel helmets (8). In
addition to defining the standard drop test method and equipment used in evaluating the performance characteristics of
protective headgear, they also provide a laboratory procedural
guide for certifying newly manufactured football helmets and
describing the equipment calibration procedures. Standard
performance specifications for newly manufactured football
helmets have also been defined.
In testing helmets, at least two of each model and size must
be tested. Helmets are tested without face guards or face
guard-specific hardware. One problem with current testing is
that sizes smaller than 658 usually will not fit the smallest
NOCSAE head forms. In that event, testing of that size is
waived as long as the other sizes of that model have been
tested and meet all requirements. The implementation of numerous sized headforms would be more appropriate. In addition, to obtain a reasonable fit for testing purposes, helmets
larger than size 758 may require shim pads to be inserted
between the largest head forms and the interior of the helmet,
opposite from the impact site. Helmet manufacturers are required to stamp the NOCSAE emblem and warnings on helmets, as demonstrated in Figure 6.

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In evaluating helmet response, the GADD Severity

Index score of any impact
shall not exceed 1200. In addition, helmet fit must be
maintained without intervention throughout the entire series of impacts. Any
structural changes or other
changes that take place dur- FIGURE 6. Photograph of NOCSAE
ing impact testing that result helmet safety and warning labels.
in loosening the fit to the
head form shall be cause for failure. Helmet repositioning during
testing is anticipated. However, additional, unrestorable loosening of the fit is not allowed.
Three companies currently provide football headgear at the
National Football League level. All have hard plastic shells,
foams of various densities to attenuate linear impacts, and a fit
system that inflates. All three helmet models use the same jaw
pads, chin straps, and face guards. Along with these elements,
any system must allow satisfactory flexibility to fit and maintain stability on the individual. One design has an inflatable
air liner that is a continuous tube-like design. When inflated,
these tubes expand to aid in the fit. The air system is nested
into a foam system that is composed of two different densities
and is molded to shape. The two layers are ethyl vinyl acetate
and polyvinyl chloride nitrile rubber (vinyl nitrile). The front
and rear pads of similar design and the air inflation system are
used for fitting.
The second helmet uses similar foam, but instead of the
foam being molded, die-cut pieces are placed in a molded case
that holds the resulting blocks of foam layers in place. Air is
introduced into the same molded case, causing the case to
expand and fit the head. In this design, the front pad is a
molded urethane that fits into a sleeve. The third helmet uses
a different approach. The shell is ventilated and lighter than
the previous two. The air liner is similar to helmet 2 in construction but is different in shape and does not serve as a
holder for the primary foam components. A unique inner liner
of expanded polypropylene increases the inner shell. A foam
molded ethyl vinyl acetate component with vinyl nitrile inserts similar to helmet 1 serves as a cover to the expanded
polypropylene and a holder of the air fit system. A vinyl nitrile
front pad is provided but is not changed for fitting.
Recently, a new lightweight helmet system has been designed, the Pro-Edition helmet from Bike Athletic (Fig. 7). The
manufacturer boasts that the helmet has an anthropometric
outer shell that better conforms to the head contours, improving the fit and comfort and creating a means of deflection. The
venting system allows air to circulate and dissipate quickly. A
unique, stiff skeletal substructure effectively supports the shell
construction and assists in attenuating impacts.
The other major manufacturer of football helmets in this
country is Riddell. Their most recent productions include the
VSR-4 and the Revolution, which contain a combination of
adjustable inflatable liners and foam padding. The latter con-

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FIGURE 7. Photograph of Bike Athletic Pro-Edition helmet.

tains their Z-pad design for an inflatable liner on the sides of

the helmet to further protect against lateral blows to the head
and face. Figures 8 and 9 display the Riddell VSR-4 and Revolution, respectively.
It should be stressed that these tests offer at best limited
assessment of the protective capabilities of a helmet. Thus far,
no evaluation of rotational forces or repetitive endurance has
been performed. Despite the stringent efforts set forth over the
past 30 years to improve safety and more than 51 injury
prevention rules implemented, football-related fatalities and
injuries such as concussion continue to occur.

CONCLUSION
The establishment and implementation of rules and guidelines governing tackling techniques has certainly played a
pivotal role in football safety. Also proved important are the

FIGURE 8. Illustration of Riddell VSR-4 helmet.

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8. National Operating Committee on Standards for Athletic Equipment: Standard Drop Test Method and Equipment Used in Evaluating the Performance
Characteristics of Protective Headgear (NOCSAE Doc (ND) 001-04m04).
Shawnee Mission, 2004.
9. Schneider RC: Football head and neck injury. Surg Neurol 27:507508, 1987.
10. Thompson N, Halpern B, Curl W, Andrews J, Hunter S, Boring J: High
school football injuries: Evaluation. Am J Sports Med 15:117124, 1987.
11. Torg JS, Quedenfeld T, Burstein A, Spealman A, Nichols CI: The National
Football Head and Neck Injury Registry: Report on cervical quadriplegia,
19711975. Am J Sports Med 7:127132, 1979.

COMMENTS

FIGURE 9. Illustration of Riddell Revolution helmet.

advent and evolution of the football helmet. Surely, much of

the decline in head injury may be attributed to safer helmet
design as a result of NOCSAE standards. However, some
critique the NOCSAE setup because, although the arrangement does a good job at assessing impacts under linear acceleration, in reality, very few impacts occur under straightforward linear impaction upon a static flat surface. Instead, a
more complicated interaction occurs between two players,
each with his own angular acceleration. These collisions are
now being studied in more depth with complex video editing
techniques, at various speeds, and from varying angles.
Competition between leading manufacturers has helped stir
creative development of safer yet lighter-weight helmets.
More advanced analytical and modeling techniques will continue to further mold the evolution. Certainly, even the most
current testing standards will have to evolve as well to satisfy
critics that a linear drop model is simply insufficient to adequately assess safety in helmet design.

REFERENCES
1. Bennett T (ed): The NFLs Official Encyclopedic History of Professional Football.
New York, Macmillan, 1977, ed 2.
2. Bishop PJ, Norman RW, Kozey JW: An evaluation of football helmets under
impact conditions. Am J Sports Med 12:233236, 1984.
3. Clarke K: An epidemiological view of the problem, in Torg JS (ed): Athletic
Injuries to the Head, Neck, and Face. Philadelphia, Lea & Febiger, 1982.
4. Clarke K, Powell J: Football helmets and neurotrauma: An epidemiological
overview of three seasons. Med Sci Sports 11:138145, 1979.
5. Hodgson V: National Operating Committee on Standards for Athletic
Equipment football helmet certification program. Med Sci Sports 7:225232,
1975.
6. Llanos J, Pascoe D: The physiological strain and heat storage related to
football helmets. Med Sci Sports Exerc 33:S223S227, 2001.
7. Myers T, Yoganadan N, Sances A Jr, Pintar F, Reinartz J, Battocletti J: Energy
absorption characteristics of football helmets under low and high rates of
loading. Biomed Mater Eng 3:1524, 1993.

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he authors have reviewed the evolution of the football

helmet and head protection in football from 1896 to the
present. They have illustrated the article with the National
Operating Committee on Standards for Athletic Equipment
helmet testing system and illustrated the initial leather helmets with no internal suspension systems and the development to the present polycarbonate external shell with the
various foam and air suspension systems that have evolved
over the years. The article is of significant historical interest
and, with the recent introduction of the Revolution Helmet by
Riddell and the Pro-Edition Helmet from Bike Athletic, brings
us to the current state of different helmet designs in use.
The authors are correct in their statement that competition
among leading helmet manufacturers has benefited the ultimate goal of injury prevention. Not stated, however, is that,
because of the medicolegal environment and the liability associated with head and neck injuries in sports, many manufacturers have been forced out of business, thus limiting the
providers to currently only three. I certainly agree with the
authors that the standards of the National Operating Committee on Standards for Athletic Equipment do an adequate job in
assessing impacts under linear acceleration, but the various
articles published by Pellman et al. in this journal (but not
referenced in this article) do indeed support more advanced
analytical and modeling techniques for assessing headprotective devices in the future.
Joseph C. Maroon
Pittsburgh, Pennsylvania

evy et al. describe the stages of head protection in the game

of American football. From the 19th-century leather helmets to todays advanced design, it is curious and amazing to
imagine how the sports leaders sequentially added a firmer
outer surface, an evolving face mask, chin strap, suspension
system, air bladder, and other modern features, while simultaneously the impacts were becoming more violent.
In a sport in which the head protection must withstand
repeated impacts and yet continue to perform, there are several nuances for optimal function. The football helmet must
reduce the probability of impact-induced traumatic brain injury and at the same time be affordable, comfortable, and
esthetically acceptable. In addition to the multitude of engineering and materials issues with which the sports helmet
industry has had to contend, they now are under assault from

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the product liability standpoint. There have been many milestones in the development to our current technology, but
improvements in materials, design, and impact performance
assessments have all contributed to create todays helmets. It
is hoped that new synthetic components, mathematical and
computer modeling, and research into the biomechanics of

football-related concussion will continue to improve upon

head protection in contact sports in the future. This is a fine
review of the development of the modern football helmet.
Julian E. Bailes
Morgantown, West Virginia

Anatomic plate from Raymundi Vieussens Nevrographia Universalis. (See page 648 for the frontispiece to
the book.)

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