09/29/2025

Can Better Equipment Eliminate Concussions In Sports?

Football season is well underway, and fans know those athletes get hit hard. Could better helmets and guidelines around concussion prevention someday eliminate head injuries from the sport?

Host Flora Lichtman speaks with concussion doctor Michael Collins and helmet specialist Barry Miller about how our understanding of head injuries and equipment has evolved.


Behind The Scenes At The Helmet Lab

At Virginia Tech’s Helmet Lab, researchers swing a pendulum designed to match helmet-to-helmet impacts in football to test a helmet’s ability to protect athletes from head injury.

A big pendulum swings and hits a helmet on a dummy head. Concussion, sports injury testing
An example of how the Helmet Lab rates varsity football helmets. Credit: Virginia Tech

Sign Up For The Week In Science Newsletter

Keep up with the week’s essential science news headlines, plus stories that offer extra joy and awe.

Subscribe

Segment Guests

Barry Miller

Dr. Barry Miller is the director of outreach at the Virginia Tech Helmet Lab.

Michael Collins

Dr. Michael Collins is the clinical and executive director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center.

Segment Transcript

FLORA LICHTMAN: Hey, it’s Flora Lichtman, and you’re listening to Science Friday.

[THEME MUSIC]

Today on the show, concussions and how new science is shaking up treatment and prevention.

GUEST: I’m not telling patients now to turn down lights, turn down noises, get off their phones, off their computers, no.

FLORA LICHTMAN: Really? Because that is– I still have heard that– I feel like that is the prevailing–

GUEST: I know.

FLORA LICHTMAN: Wisdom.

GUEST: It drives me crazy.

FLORA LICHTMAN: Really– tell us more.

If you’ve ever watched a football game and I’m sure you have, I don’t have to tell you that those athletes get hit hard, and concussions have long been considered a kind of occupational hazard of the sport. But is this a risk we can engineer our way out of? With better helmets and guidelines around concussion prevention, could we expect no concussions for football players or other athletes?

Joining me now to talk about the science of helmets and head injuries are my guests, Dr. Michael Collins, clinical and executive director of the sports medicine concussion program at the University of Pittsburgh Medical Center, and Dr. Barry Miller, director of outreach at the Virginia Tech Helmet Lab. Welcome both of you to Science Friday.

BARRY MILLER: Thank you. Happy to be here.

MICHAEL COLLINS: Thank you.

FLORA LICHTMAN: Michael, let’s start with you. What physiologically is happening during a concussion? How well do we understand this injury?

MICHAEL COLLINS: We know it pretty well. The word concuss is– literally translates from Latin to English to mean to shake violently. And just for example’s sake, think about your brain as an egg yolk inside an egg shell and the egg yolk is going to move inside the shell even though the shell doesn’t crack.

FLORA LICHTMAN: This is your brain on concussions.

MICHAEL COLLINS: Yeah, that’s your brain on concussions. And what causes concussion actually happens at the cellular level where in our brain we obviously have billions of cells called neurons, and when the brain moves sufficiently enough in the skull, the membrane to the neuron will stretch. And this little chemical called potassium will leak out of the cell, and that increases the demand for glucose or energy in the brain.

And at the same time, this little chemical called calcium will leak into the cell, and it shouldn’t be there but it goes in. And when the calcium goes into the cell, we actually get constriction of our blood vessels, and we get less cerebral blood flow. And, of course, blood flow is what supplies energy.

And so there’s a mismatch between supply and demand of energy to the cell and the neuron. And that energy problem can affect different systems in the brain, and we’ve actually learned now there’s different types of concussions. And there’s different systems in the brain that can be affected.

And the cells fortunately do not die if you manage this injury properly and make sure there’s recovery before a second insult can occur. And we’ve made a lot of advances in terms of our treatments and understanding of this injury and actually getting patients fully healthy before getting back to play is an absolute key message that needs to be relayed to parents, coaches, et cetera out there.

FLORA LICHTMAN: That’s so fascinating. I didn’t realize that we understood what was happening on the cellular level with such granularity.

MICHAEL COLLINS: Yeah, it’s animal model work that has been done by very smart people over the years, and we have a pretty good understanding of the pathophysiology of the injury. We’re really learning about the symptoms that predict outcome risk factors, and most importantly we actually have treatments now that can actually help to treat this injury and get patients better faster and get them healthy and get them back to play safely. And that’s where the real progress in my opinion has been made over the last five or 10 years.

FLORA LICHTMAN: I want to come back to treatments in a minute, but before we do talked about risk factors. Are some people at higher risk for concussion injury than others?

MICHAEL COLLINS: Absolutely. And we’re talking about the human brain, and we’re talking about there’s very specific risk factors that we’ve been able to determine through our research that predicts not only who might get a concussion more easily but also who’s going to have a longer time recovering. And some of those risk factors, the most identifiable ones in our research, believe it or not, motion sickness. Being sensitive to motion as a youngster predicts the vestibular system in the brain will decompensate more easily from that energy problem, and that actually predicts a little more easily who gets concussed and who takes a little longer to recover.

But also history of migraine is a very significant risk factor. A history of anxiety is a significant– definitely a significant risk factor. And actually being female predicts someone who may be concussed more easily. Females are six times more likely to have motion sickness, to have migraine and a little more at risk for anxiety. And so we feel that females are a little more at risk to sustain an injury and have a little longer outcome because of those preexisting risk factors.

So in terms of– I know we’re talking about prevention here. I really feel that work needs to interface with some of the clinical work that’s being done because you’re not– you’re never going to have a threshold for concussion in my opinion because the human brain is so complicated and the human being is so complicated and there’s going to be different risk levels for different people when they play sports.

FLORA LICHTMAN: One person could get hit and not get a concussion, and another person could have the same hit and get a concussion?

MICHAEL COLLINS: We see it all day long in our clinics.

FLORA LICHTMAN: I want to stay with prevention for a second, and I want to go to you, Barry. You co-lead the Virginia Tech Helmet Lab, which by the way just sounds like a very cool job. But tell me how you test helmets.

BARRY MILLER: Yeah, so the Helmet Lab is actually a comprehensive injury biomechanics lab, so we do all kinds of research. Our background’s in automotive safety, but obviously we took that information and apply it to sports world. And when we talk about helmet testing– so we figure out how do you actually hit your head in these various sports or environments whether it’s football, falling off your horse, or just recently we did some stuff with construction helmets.

And we take those real-world fall accidents back into the lab and create a standardized test protocol to evaluate those helmets. And these test rigs include pendulum impactors, linear impactors, different types of devices, and so we just try to best mimic those real-world accidents. And then we test helmets against those real-world scenarios.

FLORA LICHTMAN: I’m picturing crash test dummies in cars– you know what I’m talking about? This is dating me but those ’80s commercials where you see cars zooming into a concrete wall with a mannequin in them, how far off am I?

BARRY MILLER: Well, we do have– another part of our research, we have a lab across campus that does that, but our impactors are a little bit different.

FLORA LICHTMAN: Describe it for me. Paint me a picture, Barry.

BARRY MILLER: So for bike helmets, for example, we use what we call a drop tower. And so we have basically a ring or a halo if you will that holds the head form and the helmet above an anvil at an angle, and then we drop that. And the halo holds the helmet in place as it impacts the anvil at the location we’re trying to hit.

FLORA LICHTMAN: Wow. What about football? What is– how do you test football helmets?

BARRY MILLER: Football we use something called a pendulum impactor. So we have a big pendulum arm with the– we can change out the face of that pendulum but use it for football. We use a mushroom shaped– it’s hard nylon that’s basically the same shape as a football helmet.

And then that arm comes down and hits a helmet, a head form, a surrogate neck, and a sliding mask that represents the torso of a football player. And then we can measure our impacts from those scenarios. And it’s called a target table, and so we can orient the head pretty much in any position we want. And for football we use for locations and three energy levels so 12 specific test conditions to evaluate hel– football helmets.

FLORA LICHTMAN: What makes one helmet better than another one? Has the technology improved, and what are you looking for?

BARRY MILLER: The helmets have drastically improved. When we first launched our helmet ratings in 2011, there was only what we consider one five-star helmet, and we just rescaled recently because all the helmets were five star, so five star being the best and zero stars being the worst.

That best helmet way back in 2011 would be the worst helmet today. So the advancements have been huge. The star scores, which represents concussion risk in some form or fashion, continue to drop. So the football helmets are really impressive.

[MUSIC PLAYING]

FLORA LICHTMAN: We have to take a break but don’t go anywhere because after the break, we will find out whether our guests think with the right headgear concussions in sports could become a thing of the past.

BARRY MILLER: Well, we always say the helmet is the last line of defense. Best option’s don’t hit your head.

[AUDIO LOGO]

FLORA LICHTMAN: Michael, will we ever get to a place where helmets can fully prevent concussions?

MICHAEL COLLINS: I’m not so sure we can get to a place where helmets fully prevent concussions, but I applaud the work that’s being done at Virginia Tech and other locations. And we really embrace that research, and we’re learning a lot.

And if you marry engineering improvements to clinical improvements, I would say we’re– we’ve never been safer as a population to play football. And I really think this is the best time we’ve ever had to– if you sustain a concussion, the advances are real over the past decade or two decades, and there’s so many people doing research on this now, which is exciting. So– but to get to a point where you can prevent this injury from happening entirely, I don’t see that occurring.

And we also have to keep in mind and most of these injuries occur in non-helmeted activities, too. So slip and falls are probably the most common reason why people have concussions and car accidents, et cetera. And there’s a lot of people having concussions out there. Again, I really think it’s exciting work that’s being done, but to prevent the brain from moving inside the skull is a hard ask.

FLORA LICHTMAN: Barry, what do you think? Where are you on this question?

BARRY MILLER: Well, we always say the helmet is the last line of defense. So if you can minimize any head impacts, that’s what you want to do. And granted, the helmets have drastically improved, but it’s a risk of concussion. And some people get injured at really low energy levels.

So, yeah I agree with Dr. Collins completely that eliminate, probably not. Drastically reduce, we’re improving. And so– but, yeah, the best– best option’s don’t hit your head.

FLORA LICHTMAN: Barry, if I had a kid who played football or even I’m just looking for a bike helmet for myself or someone I love, what should I look for? How would I evaluate whether that helmet is a five star or not?

BARRY MILLER: That’s a great question. All helmets have to be certified. I don’t know if your listeners would this, but the certifications are pass/fail whether it’s a football helmet, bike helmet, snow sport helmet. Different organizations certify these to a standard.

The threshold to pass those standards is the point of catastrophic head injury. So we’re talking skull fracture or death. And so we supplement those mandatory required certifications with sport specific helmets. And so there’s no way for you to tell which helmet’s safer than another until you use our web page because two helmets on the shelf at Walmart, bike helmets, you don’t which one’s safer. They both pass the basic certification, but that’s all you know.

And it’s just like anything else. There’s product differentiation. Some cars are safer than the others. Some helmets are safer than others.

FLORA LICHTMAN: And y’all are completely independent? You’re not funded by the hel– some helmet maker?

BARRY MILLER: That is correct. We’re a public institution, an independent testing facility. That’s correct.

FLORA LICHTMAN: Michael, in the case of football, I hear that what y’all are saying, which is it’s never been safer, but I also wonder if the game has changed at least in the case of football. Are people getting hit harder than they ever were?

MICHAEL COLLINS: Yes, force equals mass times acceleration. So we’ve never seen faster, heavier athletes. And the training that goes on for performance is improved as well. So the speeds are greater. The size of the individuals are greater in football and other sports.

And so as those forces go up, theoretically we’ll see more concussions, which we do, but I do think that the work that’s being done with helmet technology is we’re meeting those challenges with some of this research that’s being done not only in helmet technology but also in terms of clinical understanding of the injury. I really do feel like it has never been safer to play the sport than now just because of these advances across all these different domains.

Clinical helmet technology research and these injuries do happen in five-star helmets, and they do happen in recreational sports and all over. But it’s an exciting time because the interest in this injury– the spotlight is iridescent on concussion, And I really feel that the academic community and clinical communities have– are rising to the challenge and great work is being done. And I don’t want to sound pollyannaish. This is an injury that can occur, but I’m very encouraged by what we’re learning in terms of how we evaluate, manage, treat this injury as well as the helmet technology advances that we’re seeing.

FLORA LICHTMAN: Michael, let’s talk treatment. What has changed about treatment of concussions in the last 10, 20 years.

MICHAEL COLLINS: At a very basic level, what we’ve learned is that rest is not the way to treat this injury. We’ve actually come up with targeted active rehab. I’m not telling patients now to turn down lights, turn down noises, get off their phones, off their computers, no.

FLORA LICHTMAN: Really? Because that is– I still have heard that– I feel like that is the prevailing–

MICHAEL COLLINS: I know.

FLORA LICHTMAN: Wisdom.

MICHAEL COLLINS: It drives me crazy because–

FLORA LICHTMAN: Really? Tell us more.

MICHAEL COLLINS: It’s rehabilitation and not rest. What happens with this injury is this energy crisis can decompensate these different systems– vestibular, oculomotor, how our eyes work together. Our vestibular system’s a pathway in the brain that allows us to stabilize our vision. We move our head.

We see patients have migraine. What we know is that the best way to treat these issues is by retraining and desensitizing. We actually use exercise now to treat concussion. Exercise helps to treat migraine. Exercise rehabituates the vestibular system.

We have very specific movements that we can create to help retrain the vestibular system. We have exercises and physical therapy that we do to retrain the oculomotor system. Anxiety is highly prevalent in this injury, so what we do is we do a lot of exercise, which increases the parasympathetic nervous system, which helps to calm down the anxiety.

If you see me in Pittsburgh at UPMC, you’re going to be working out, and we’re going to be working out in very specific ways and be giving you very specific exercises to rehab and retrain these systems. And honestly one of the biggest problems we have now in terms of treating concussion are patients that have rested too much acutely and sub-acutely, and that leads to problems if it’s not managed properly. And there’s a lot of biology behind that. And so that’s probably surprising for the listenership to hear that, but, yes–

FLORA LICHTMAN: That’s a huge paradigm shift.

MICHAEL COLLINS: Huge paradigm shift. I’ve never been more confident than I am right now in telling you that it’s needed, a needed paradigm shift. And we’re doing a lot of work on that, and a lot of research has come out showing the benefits of exercise, targeted exercise. I make– want to make sure people understand that there’s–

FLORA LICHTMAN: Under doctor supervision.

MICHAEL COLLINS: Under specialist supervision, not just doctor supervision but knowing how to work these patients out and who do we push harder than others. But there’s a lot that goes into that from an evaluation standpoint. But, yes, rest is not effective at treating concussion.

FLORA LICHTMAN: What about CTE, the neurodegenerative disease that can follow repeated head trauma. Does– do we have treatment that can prevent that outcome.

MICHAEL COLLINS: In a very general sense, we have a lot to learn about CTE, and I actually was just reviewing a paper 10 minutes before I got on this call, which shows that– this paper showed that the prevalence of that is very, very low in what we just saw in the research. There’s a wide gamut of research out there on CTE.

What I want to say at the basic level is the best way to prevent problems with concussion is to manage it and treat it effectively when you have one. We do not want kids out there playing through concussions. We don’t want kids going back to play before their concussions are recovered.

We do not know who is at risk for CTE. We do not the factors that play into patients that end up having those difficulties and issues. A lot more work is needed. I know everyone wants answers on that, but we have decades of research in front of us before we better understand that construct. It’s a nebulous construct that we need a lot more science on.

FLORA LICHTMAN: This was so fascinating. Thank you both for joining me today.

BARRY MILLER: You’re welcome.

MICHAEL COLLINS: Thank you.

[MUSIC PLAYING]

FLORA LICHTMAN: And before we go, a heads up. If you’re looking for an out of this world adventure, Science Friday’s Down to Earth program returns this year on October 3rd for World Space Week. We will have fun, daily activities that show you how space science makes our world better. Please join us. No spacesuit required. Register today for Down to Earth at sciencefriday.com/DownToEarth.

Thanks for listening. Don’t forget to rate and review us wherever you listen. It really does help us get the word out and get the show in front of new listeners. Today’s episode was produced by Kathleen Davis. I’m Flora Lichtman. Thanks for listening.

Copyright © 2025 Science Friday Initiative. All rights reserved. Science Friday transcripts are produced on a tight deadline by 3Play Media. Fidelity to the original aired/published audio or video file might vary, and text might be updated or amended in the future. For the authoritative record of Science Friday’s programming, please visit the original aired/published recording. For terms of use and more information, visit our policies pages at http://www.sciencefriday.com/about/policies/

Meet the Producers and Host

About Kathleen Davis

Kathleen Davis is a producer and fill-in host at Science Friday, which means she spends her weeks researching, writing, editing, and sometimes talking into a microphone. She’s always eager to talk about freshwater lakes and Coney Island diners.

About Flora Lichtman

Flora Lichtman is a host of Science Friday. In a previous life, she lived on a research ship where apertivi were served on the top deck, hoisted there via pulley by the ship’s chef.

Explore More