September 17, 2024
When Miami Dolphins quarterback Tua Tagovailoa suffered his latest concussion during last Thursday night’s game against the Buffalo Bills, it spurred a world of “what-ifs.”
What if he had not taken off from the pocket? What if he’d slid instead of going into Bills defensive back Damar Hamlin? What if it was his first concussion?
But there’s a new question some are asking: What if Tagovailoa had been wearing a Guardian cap?
What are Guardian caps now being used in the NFL?
Guardian caps, now allowed in NFL regular-season games, are covers that include a soft layer of foam placed over a regular football helmet.
NFL players wore the caps developed by Guardian Sports during training camp this year. Two weeks into the regular season, six players have worn them in a game: Browns linebacker Jeremiah Owusu-Koramoah, Titans tight end Josh Whyle, Steelers guard James Daniels, Patriots safety Jabrill Peppers and tight end Kylen Granson and safety Rodney Thomas II of the Colts.
Preliminary studies have shown that wearing the caps during practice reduced concussions as much as 50 percent.
“We’ve got two years of data now showing significant concussion reductions in those players that wear Guardian Caps in the NFL,” said Allen Sills, Chief Medical Officer of the NFL, according to a testimony on Guardian Sports’ website.
That said, Guardian Sports also has a disclaimer that warns against their product being lauded as a catch-all for concussion prevention.
“No helmet, practice apparatus or helmet pad can prevent or eliminate the risk of concussions or other serious head injuries while playing sports. Researchers have not reached an agreement on how the results of impact absorption tests relate to concussions.”
Would wearing one have prevented Tagovailoa’s concussion?
Maybe, and maybe not, says Edward Benzel, who served as Emeritus Chair of Neurosurgery at the Cleveland Clinic.
“It can slide a little bit and it can deflect a blow that may have been of greater magnitude than if it was a direct hit as opposed to something that glanced off,” Benzel said. He went on to explain that there exists a world, even if unlikely, in which that scenario “could be worse . . . because the glancing blow could add a rotational component.”
Much of the research done on the Guardian caps is preliminary. While the NFL and Guardian Sports have argued that the results show the caps are leading to fewer concussions, other independent studies question the validity of that assertion.
“More data is still needed to determine if it prevents concussions,” said Joseph Maroon, neurosurgeon for the Pittsburgh Steelers for 39 years, as well as a board-certified clinical professor of neurological surgery at the Pittsburgh Medical Center.
“Studies show it reduces the impact forces by 10% if one person collides and 20% if both are wearing,” he said before addressing Dr. Sills’ testimony on the guardian caps.
“The results at the NFL level are gratifying, but additional studies would be helpful at the high school and college level,” Dr. Maroon said.
Ultimately, Benzel was hesitant to suggest it would have made an impact had Tagovailoa been wearing one, suggesting that the Dolphins quarterback’s history of head trauma and apparent susceptibility to concussions likely would have outweighed any small reduction in the magnitude of the contact.
Instrumented mouth guards and role in concussion education
One of the ways that medical experts can learn more about the effects of Guardian caps and other instruments of head trauma management is an instrumented mouth guard – a mouth guard embedded with a sensor.
Developed in part by Benzel, these mouth guards help to collect data on the changes in motion that a body undergoes with respect to variables such as time, velocity and acceleration. These mouth guards are able to collect that data on athletes during contact because they’re connected to the upper row of teeth connected directly to the skull.
The NFL employs an “eye in the sky” – an athletic trainer positioned in the press box who helps identify the need for a player to enter concussion protocol – but even then, these trainers often only identify the most egregious reactions to hits.
“Accumulation of trauma, particularly in a short time-frame like a football game, can most certainly add up and make the last hit, which may not have been as significant as others, profound in its result,” Benzel said.
Using these mouth guards already had notable effects in both education and prevention when it comes to head trauma in sports.
“They have observed significant benefits in identifying the people who were at risk for injury, and then they were held out and found to have had injuries that wouldn’t have been identified before,” Benzel said. “That’s huge, because the ‘eye in the sky’ can pick the gross ones out, but not the subtleties.”
According to a report in the National Library of Medicine, a preliminary study of the Guardian caps’ effectiveness in college football players using the instrumented mouth guards suggested the caps would not help prevent concussions.
The abstract of the study concludes: “These data suggested no difference in head kinematics data when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players.”
What do the Dolphins have to say about Guardian caps?
The Palm Beach Post’s Hal Habib spoke with multiple Dolphins players at the beginning of August when many NFL players were donning the Guardian caps in preseason play after wearing them for much of training camp.
At the time, many weren’t sold on wearing them when it came time to play in the regular season.
Has that changed because of the injury to Tagovailoa?
That remains to be seen. When asked Monday whether he would urge Tua to wear one if and when he returns to the field, Dolphins coach Mike McDaniel said he’s open-minded to “absolutely everything” to help players.
“I think just in general, the second people are telling me directly how much this, that or the other would specifically benefit a particular individual; when that particular conversation comes up, I’ll absolutely do whatever I can to follow up with things specific to individuals that could help them moving forward,” McDaniel said. “I think those types of things are far away from me from my standpoint, but that hasn’t necessarily come up.”