Headgear and Concussion:
What the Evidence Actually Shows

“The AFL has backed new headgear despite no scientific evidence to yet prove that helmets can reduce concussions. Leading sports neuroscientists are concerned the helmet is being sold to the public. The move comes as former players take on the code in a class action lawsuit and the news that many current elite footballers will no longer be insured for head trauma from May 1”

>>> Neuroscientist slams AFL’s ‘potentially dangerous’ headgear move (2026).

>>> AFL-backed helmet company GameGear erases concussion protection claims.

Why The Concussion Debate Matters

The concussion debate in Australian contact sport has reached a critical point in 2026. The AFL has formally endorsed new headgear technology despite an absence of field evidence that it prevents concussion. Leading sports neuroscientists have publicly raised concerns that the product is being sold to the public in a misleading context (ABC News, 9 April 2026).

Former players are simultaneously pursuing a class action against the code, with the legal action focused not just on what happened to players, but on whether the league and clubs acted soon enough and strongly enough in response to the risks of repeated head trauma. Compounding the issue, Zurich Australia has announced concussion and head trauma exclusions for elite AFL and AFLW players holding total and permanent disablement insurance, effective May 1 — meaning no TPD benefit will be payable for football-related brain injury including concussion and chronic traumatic encephalopathy.

Against this backdrop, it is essential that athletes, parents, coaches, and clinicians understand what the peer-reviewed evidence actually shows. The conclusion is clear: headgear does not prevent sport-related concussion (SRC).

The Biomechanical Problem: Why Headgear Cannot Prevent Concussion

Story AFLPA Kav Di Piertro

To understand why the evidence is so consistently negative, it is important to understand the mechanism of injury. A concussion is not caused by breaking the skin or fracturing the skull — it is caused by the brain moving within the skull.

Hard helmets protect reasonably well against translational forces, significantly reducing the risk of skull fractures and intracranial bleeding. However, they are far less effective against rotational movements, and it is these rotational forces that researchers believe are responsible for the majority of concussions.

Soft-shell headgear — the padded “scrum caps” worn in rugby, or the foam headbands used in soccer — operates within even tighter design limits. World Rugby explicitly states that headgear is not intended nor expected to protect against concussion or mild traumatic brain injury, and is designed only to protect against cuts, abrasions, and superficial injuries.

There is also a paradox in the physics of larger headgear.

A helmet or headgear with increased mass may actually increase the rotational acceleration generated from an impact because there is an increased radius over which the forces act. In other words, a heavier helmet may worsen the very forces responsible for concussion.

As International Concussion Society President Dr. John Leddy explains: “The brain accelerates, decelerates and rotates. So, the brain tissue moves even though a player is wearing a helmet. The helmet can’t decelerate the brain when somebody falls or gets hit.”

What is headgear good for?

While headgear does not prevent concussion, it does have a well-established and legitimate role in contact sport. The evidence consistently supports its use for:

Superficial head injuries — headgear reliably reduces lacerations, abrasions, and cuts to the scalp and ears. This is its original and primary design purpose, and it performs this function well.

Ear protection — scrum caps in particular are effective at preventing auricular haematoma (commonly known as “cauliflower ear”), a common and disfiguring injury in rugby forwards.

Skull fracture and severe focal brain injury — hard-shell helmets in sports such as cycling, cricket, and skiing significantly reduce the risk of skull fractures and intracranial bleeding from direct, high-force impacts, even if they do not prevent concussion.

Headgear should be worn for these reasons. The problem is not the equipment itself — it is the marketing of headgear as concussion prevention, which the evidence does not support.

The Evidence Against Headgear as Concussion Prevention

Systematic Review and Meta-Analysis

• The most comprehensive current evidence comes from Al Attar et al. (2024), published in *Sports Health*. This systematic review and meta-analysis of randomised controlled trials (RCTs) — including 6,311 players and 173,383 exposure hours — demonstrates that headgear does not prevent sport-related concussion among soccer and rugby players, and therefore does not currently support its use to prevent SRC in those sports.

Rugby Union: Elite and Community Cohort Studies

• The rugby-specific literature is particularly relevant to the Australian context. Multiple studies in both professional and community players show no reduction in concussion incidence with headgear use, with some reporting higher rates of head injury in headgear users. The 2021 case-control study by Stokes et al. in *International Journal of Sports Medicine* analysed 417 concussion cases in professional men’s rugby union and found that padded headgear did not reduce their incidence in match play. A 2026 observational cohort study published in European Journal of Sport Science confirmed no protective effect in professional men’s rugby players wearing regulation soft-padded headgear (Brown et.al., 2026).

Systematic Review in Youth Collision Sports

• Makovec Knight et al. (2021) conducted a systematic review of soft-shell headgear in youth team collision sports and found no protective effect on concussion rates in match play. This is particularly important given that youth athletes are often the demographic most aggressively marketed to.

The Lab-to-Field Translation Failure

• Perhaps the most important clinical point for parents and coaches to understand is the gap between laboratory impact testing and real-world outcomes. As Henley et al. (2023) in *Sport Sciences for Health* noted: “Despite recent lab studies showing promising impact attenuation of NPro and Gamebreaker units, the most recent field study did not find evidence of headgear reducing concussion risk, suggesting the trend over time has not changed. Although headgear is positively correlated with prevention of scalp and laceration injuries, concussion risk appears to be mostly unchanged.”
• This matters because manufacturers and sporting bodies regularly cite laboratory testing as evidence of concussion protection. Laboratory tests predominantly measure linear force attenuation — the very mechanism headgear can partially address. They do not replicate the multidirectional, rotational, player-to-player contact that causes most concussions in real sport. Several studies have provided biomechanical evidence of the reduction of impact forces to the brain due to headgear. However, in the majority of sports, these results have not translated into observed differences in the rate or severity of concussion.

JT crowned best headgear hero of the modern era
(NRL.com 9 Sep 2020)

The Risk Compensation Problem: A Potentially Dangerous False Sense of Security

The concern raised by neuroscientists about the AFL’s headgear endorsement is not merely that the equipment is ineffective — it is that promoting it as protective may cause harm.

Nearly 40% of collegiate rugby players surveyed believed headgear helped to prevent concussions, and 42% stated that if they were using headgear they would be more aggressive with their play in terms of running or tackling. Regression analysis confirmed that those who believed headgear prevented concussions were more likely to engage in aggressive play.

Most players (82%), coaches (66%), and referees (64%) incorrectly believe protective equipment prevents concussion in rugby. More concerningly, around a third of both club and school rugby players incorrectly believe that wearing a scrum cap or headguard can prevent chronic traumatic encephalopathy.

This disconnect between belief and evidence + aggressive commercialisation of unproven products — is precisely what leading neuroscientists are warning against.

What Emerging Research Supports Concussion Prevention

Acknowledging the limits of headgear is not a counsel of despair. Several evidence-based strategies show genuine promise.

Rule and policy changes consistently show the strongest effect. Contact restrictions, tackle height law modifications, and limitations on contact during training have all demonstrated reductions in head impact frequency in well-designed studies.

Cervical strengthening is the most promising individual intervention – particularly useful in sports where you can anticipate the contact. A study of 6,704 high school athletes found that after adjusting for gender and sport, overall neck strength remained a significant predictor of concussion risk — for every one-pound increase in neck strength, the odds of concussion decreased by 5%. A 2024 systematic review found that isometric neck strength, but not neck size, is a predictor for sport-related concussion prevention, and that formal neck strengthening programs are feasible and lead to decreased risk.

Education, protocols, and culture have among the most substantial evidence. Mandatory removal from play following suspected concussion, structured clearance protocols and active coach and parent education have together been associated with a 63% reduction in recurrent concussion rates in some cohorts.

Clinical Summary

Headgear has a legitimate and well-evidenced role in contact sport: it reduces lacerations, abrasions, and ear injuries. It does not prevent concussion. Presenting it otherwise — as the AFL has done in endorsing GameGear prior to completed field trials — creates a false sense of safety, may promote more aggressive play, and directs attention away from interventions that the evidence actually supports.

The insurance industry’s retreat from covering head trauma in professional sport is itself a signal the broader medical and actuarial community has been paying close attention to. The clinical community should do the same.