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Musculoskeletal and Sports Medicine

Soft Shell Helmet Add-On Efficacy in Concussion Prevention and Player Safety in American Football: A Systematic Review

Friday, October 24, 2025
8:00 AM - 9:15 AM MT
Location: Kiosk 8
Disclosure(s):
Hayden A. Reed: No financial relationships to disclose
Tamara Valovich McLeod, PhD, Other: No financial relationships to disclose
Background and/or Objectives: To systematically review literature evaluating the effectiveness of helmet add-on devices, such as Guardian Caps or ProTech shells, in reducing concussion rates and head impact metrics in American football.

Design: Systematic Review

Setting : Online search of Academic Search Complete, Education Source Complete, PubMed, SPORTDiscus, CINAHL, ERIC, and Scopus in addition to grey literature sources was conducted using a search string.

Participants : Studies published since 2010 involving a helmet add-on device to prevent concussion in American football were included. 1032 studies were imported into Covidence. After title and abstract screening and full-text review, 9 studies were selected for further review and data extraction.

Interventions: Not applicable

Main Outcome Measures: Data extracted from each study included study design, number and level of play of participants, number of impacts, type of add-on and helmet, and head impact metrics such as peak linear acceleration, Gadd severity index, and head acceleration response metric. A quality assessment was used to appraise each study.

Results: Of the 9 studies, 3 had clinical data of approximately 2600 high school and 100 collegiate football athletes, 5 were laboratory studies, and 1 had both. None of the 4 studies with clinical data showed a statistically significant reduction in concussion incidence or head impact metrics for add-ons when compared to helmets alone. Of the 6 laboratory studies, all but 1 showed a reduction in head impact metrics. The sixth study did not find a statistically significant reduction in concussion incidence or head impact metrics.

Conclusions: The limited real-world clinical evidence and conflicting lab results on the efficacy of helmet add-ons in concussion prevention suggest that they have limited clinical benefit. This study contributes to a growing body of knowledge regarding protective sports equipment and will inform future policy decisions on player safety to further reduce the incidence of concussions.