A Medical Position on the Topic
of Headgear in Pole Vaulting
Spencer Chang, M.D. and Wilson SooHoo, M.D.

The topic of helmets is one that should be very carefully considered. We feel that the first thing that should be investigated is whether a helmet will make pole vaulting a safer and better event, not a less safe and more dangerous one. Our concerns from a medical standpoint are described below.

The stakes to the sport of pole vaulting are enormous. There are rumors of states either considering dropping the pole vault from high school competition or not allowing pole vault competition for girls. Part of the reason is cost, but the other reason, and probably the excuse that will be used, is perceived danger to athletes. If a helmet standard is adopted in haste, it turns out to be the wrong standard and athlete gets killed because of it, then officials could claim that the pole vault is unsafe both with and without headgear and would have an easier time canceling competition in our sport.

Issues pole vault helmet research should take into account:
1) The benefits of preventing a few athletes from suffering major acute injuries must be balanced against the potential for chronic injuries to a large number of athletes. It should be remembered that only a very few athletes miss the pit and strike their heads, and that even for these individuals, such an occurrence is uncommon. In contrast, the vast majority of the vaulters land safely on the pit up to thirty times per workout. During every one of these safe landings the back of the head strikes a soft pit. A helmet can magnify this impact, and the cumulative effects of these landings must be taken into account. Back in the mid-nineties, when Jan Johnson was talking about helmets, Wilson was one of the early adopters and started wearing a helmet (a ProTec skateboard model) while vaulting. This lasted only for one session because he did not like the feeling that his brain was rattling within his cranium. A helmet potentially could result in increased jarring of the brain and low-grade trauma, even when a vault goes perfectly. Therefore, the potential cumulative effects, over years, of helmets on the head and brain during routine safe landings should be considered and the forces involved should be compared to those involved in boxing.

2) The possibility of cervical hyperflexion injuries must be considered. Landing on one's neck is far more common occurrence than missing a pit and striking one's head. This can occur in the following circumstances:
a) overeating backwards after clearing (or not clearing) a crossbar;
b) landing in a pit while still rotating backward after breaking a pole; and
c) landing in a pit while still rotating backward after losing grip of the pole shortly after takeoff.

It is possible that the added padding posterior to the occiput could result in a forced hyperflexion injury of the neck should the vaulter land high up on his/her shoulders and neck/head after over-rotating on a vault. Two neck injuries noted in a current study of catastrophic vaulting injuries were the result of such hyperflexion injuries. In another study, a collegiate female landed high up on her shoulders and neck/head, causing a hyperflexion injury of the neck resulting in transient paresthesias to all of her limbs for 30 minutes. This situation may have been exacerbated by the added flexion caused by a helmet.

Further studies regarding the efficacy of helmets or potential for further injury need to be conducted. These should include biomechanical studies with simulated impact scenarios from typical improper landings, and radiographic studies to determine the effect that a helmet might cause on increasing neck flexion with an over-rotation type landing. Spencer is attempting to procure materials and funding for such a study.

Spencer's preliminary study done with lateral cervical radiographs demonstrated that a typical skateboard helmet added 10¡ of added flexion from the C2-C5 levels. The increase in flexion was primarily at the C3-C4 levels. This increase in flexion was the same in both a flat supine position and a rotated backwards position. This study needs to be done on more volunteers to determine if this pattern holds true. If so, the helmet has a potential to dramatically increase the flexion of the neck with an over-rotated landing. The concern is that since the added flexion is relatively high in the cervical spine the potential injuries would be very severe. A C4 quadriplegic would most likely be ventilator-dependent and not have the function of his or her deltoids. In a study of cervical spine injuries in children aged 1 to 17, the mortality rates were 4.3% for the C3 level, and 3.7% for the C4 level.

Dr. Robert Cantu, a famous neurosurgeon and one of the leading specialists in sports related head and neck injuries, also has expressed his concerns about the helmet in the pole vault. He believes that the helmet increases the risk of hyperflexion neck injuries and therefore is against its use (2002, personal communication).

3) The helmet could catch on loose fabric of the pit when a pole breaks. This should not be a major obstacle, especially if the helmet were made thin, but should be accounted for. In the accidents mentioned above resulting from a pole breaking (2b) or an athlete losing grip and landing in a pit on his/her neck (2c), the athlete will still have horizontal velocity when striking the pit. If the lower posterior lip of the helmet were to catch on the fabric lining on the top of the pit, which is often loose on aging pits, it could result in traction of the cervical area. This could markedly exacerbate any potential hyperflexion injury and increase the chances of a true anterior cervical dislocation.

4) Athletes landing on the edge of a pit and then falling out will still have horizontal velocity, so any biomechanical or impact studies should take into account this added energy and not just the acceleration/velocity due to gravity.

5) A new set facilities standards is being proposed, which includes the padding of hard surfaces around the vault area and around the planting box in addition to enlargement of the primary landing area. The proposal is for at least two inches of padding, which is thicker than any helmet should be and can be made thicker if a safety task force so decides.