Article Text

The biomechanics of concussion in unhelmeted football players in Australia: a case–control study
  1. Andrew S McIntosh1,2,
  2. Declan A Patton3,
  3. Bertrand Fréchède4,5,6,
  4. Paul-André Pierré7,
  5. Edouard Ferry8,
  6. Tobias Barthels9
  1. 1Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
  2. 2Monash Injury Research Institute, Monash University, Melbourne Australia
  3. 3Faculty of Science, University of New South Wales, Sydney, Australia
  4. 4Université de Lyon, F-69622, Lyon, France
  5. 5Université Claude Bernard Lyon 1, Villeurbanne
  6. 6IFSTTAR, UMR_T9406, LBMC, F-69675, Bron
  7. 7Techspace Aero, Safran Group Milmort, Belgium
  8. 8Centre d'Expertise en Dynamique Rapide, Explosions et Multiphysique (CEDREM), Ecoparc d'Affaires de Sologne, Domaine de Villemorant, Neung-sur-Beuvron, France
  9. 9Stryker GmbH & Co, Duisburg, Germany, Belgium
  1. Correspondence to Dr Andrew S McIntosh; as.mcintosh{at}


Objective Concussion is a prevalent brain injury in sport and the wider community. Despite this, little research has been conducted investigating the dynamics of impacts to the unprotected human head and injury causation in vivo, in particular the roles of linear and angular head acceleration.

Setting Professional contact football in Australia.

Participants Adult male professional Australian rules football players participating in 30 games randomly selected from 103 games. Cases selected based on an observable head impact, no observable symptoms (eg, loss-of-consciousness and convulsions), no on-field medical management and no injury recorded at the time.

Primary and secondary outcome measures A data set for no-injury head impact cases comprising head impact locations and head impact dynamic parameters estimated through rigid body simulations using the MAthematical DYnamic MOdels (MADYMO) human facet model. This data set was compared to previously reported concussion case data.

Results Qualitative analysis showed that the head was more vulnerable to lateral impacts. Logistic regression analyses of head acceleration and velocity components revealed that angular acceleration of the head in the coronal plane had the strongest association with concussion; tentative tolerance levels of 1747 rad/s2 and 2296 rad/s2 were reported for a 50% and 75% likelihood of concussion, respectively. The mean maximum resultant angular accelerations for the concussion and no-injury cases were 7951 rad/s2 (SD 3562 rad/s2) and 4300 rad/s2 (SD 3657 rad/s2), respectively. Linear acceleration is currently used in the assessment of helmets and padded headgear. The 50% and 75% likelihood of concussion values for resultant linear head acceleration in this study were 65.1 and 88.5 g, respectively.

Conclusions As hypothesised by Holbourn over 70 years ago, angular acceleration plays an important role in the pathomechanics of concussion, which has major ramifications in terms of helmet design and other efforts to prevent and manage concussion.

  • Sports Medicine
  • Public Health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.