title: Birth and evolution of the football helmet.
abstract: OBJECTIVE
  To review the advent and evolution of the football helmet through historical, physiological, and biomechanical analysis.
  
  
  METHODS
  We obtained data from a thorough review of the literature.
  
  
  RESULTS
  Significant correlation exists between head injuries and the advent of the football helmet in 1896, through its evolution in the early to mid-1900s, and regulatory standards for both helmet use and design and tackling rules and regulations. With the implementation of National Operating Committee on Standards for Athletic Equipment standards, fatalities decreased by 74% and serious head injuries decreased from 4.25 per 100,000 to 0.68 per 100,000. Not only is the material used important, but the protective design also proves essential in head injury prevention. Competition among leading helmet manufacturers has benefited the ultimate goal of injury prevention. However, just as significant in decreasing the incidence and severity of head injury is the implementation of newer rules and regulations in teaching, coaching, and governing tackling techniques.
  
  
  CONCLUSIONS
  Helmet use in conjunction with more stringent head injury guidelines and rules has had a tremendous impact in decreasing head injury severity in football. Modifications of current testing models may further improve helmet design and hence further decrease the incidence and severity of head injury sustained while playing football.
authors.affiliation: Division of Neurosurgery, University of California at San Diego School of Medicine, San Diego, California, USA. mlevy@chsd.org
authors.forename: Michael L
authors.initials: ML
authors.lastname: Levy
authors.forename: Burak M
authors.initials: BM
authors.lastname: Ozgur
authors.forename: Cherisse
authors.initials: C
authors.lastname: Berry
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: Michael L J
authors.initials: ML
authors.lastname: Apuzzo
mesh_terms: D001265:Athletic Injuries / Q000266:history*; D001924:Brain Concussion / Q000266:history*; D005538:Football / Q000266:history*; D006260:Head Protective Devices / Q000266:history*; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D019876:Sports Equipment / Q000266:history*; D014481:United States