Objective The study identifies barriers to the supply of helmets/headgear/headguards (headgear) that are likely to be effective in preventing concussion.

Design Literature review and biomechanical testing.

Setting All sports.

Outcome measures Sport federation rules on headgear and headgear impact performance with regards to concussion.

Main results A review of laws and regulations showed that many sports have not developed relevant performance based technical specifications for headgear. World Rugby performance requirements comprise a drop height of 300 mm and pass level of greater than 200 g in impact energy attenuation tests. Testing of current World Rugby approved headgear showed peak linear headform accelerations (PLA) in the range 400 to 600 g in 200 mm and 300 mm drop tests. The performance of the exemplar models is arguably worse than in similar models tested circa 2000 and exceed informative concussion injury criteria, e.g. PLA<75 g. Combat sports generally do not mandate performance requirements. Similarly, there is a range of performance from good to poor in laboratory-tested combat sport headgear with respect to concussion prevention; e.g. for headgear tested at a 500 mm drop height, PLA ranged from 50 g to 466 g. PLA results were reflected in angular head acceleration performance in impact tests. Other sports will be considered, e.g. ice hockey and American football, where performance standards are mandated.

Conclusions The availability of headgear designed to prevent concussion is limited because relevant performance requirements are absent and/or aligned with other head injury prevention goals, e.g. preventing severe head injury.

Competing interests None.