A History & Report About Protection Of The Skull And Brain By Reduction Of Velocity Forces To The TMJ
BPI joins the National Federation of High Schools (NFHS), along with other organizations, in being part of the solution to protect and reduce injury causing jaw-joint and base of skull impact for high school athletes.In nearly two decades and three independent biomechanical studies sponsored by NFL Charities and NOCSAE in 1993, performed by Wayne State in 2005, and a study fully funded by the NFL with Biokinetics in 2011, the relative effectiveness of the dual arch mouth guard (more properly identified as a “jaw-joint protector” as opposed to a “mouth guard” for protecting teeth) was well established. The latest tests in 2011, using two different head forms with articulated jaws with instrumentation above the condyle and into the TMJ (i.e. Temporal Mandibular Joint) measuring linear force, validated using an impact force standard for all head-contact sports, including football helmets.
BPI’s line of proprietary jaw joint protection devices (i.e. Brain-Pad Jaw-Joint ProtectorTM) was first designed for a professional boxer, Jesse Ferguson, in the late 1980’s who was having symptoms of a lack of balance and nausea every time an impact was delivered to the left side of his jaw. When this intra-oral appliance (i.e. the precursor product to the Brain-Pad Jaw-Joint ProtectorTM) was introduced to him and stabilized his lower jaw by positioning it slightly down and forward, his symptoms did not continue and he continued his career as a professional boxer for eight more years.
To reiterate: the Brain-Pad Jaw-Joint ProtectorTM is a dual arch mandibular orthotic that positions the jaw in a slightly down and forward position and achieves stabilization through its design, reducing and redirecting force from the impact to the jaw away from the TMJ, base of skull, and brain. The Brain-Pad appliance and the molars, which are the strongest bones in the skull, primarily absorb the impact forces.
As a result of the early work done by BPI, Dr. Voight Hodgson, the technical director of NOCSAE (National Operating Committee for Standards in Athletic Equipment) and a professor at Wayne State University, became very interested in jaw interaction and the implication of impact to this region of the head looking at the mandible impacting the fossa and the transfer of force and impact to the basal skull and brain region. Another major concern by Dr. Hodgson was chinstrap loading and the detrimental forces affecting a number of cranial nerves that control sensory and motor functions. Brain Pad believes that its Brain-Pad Jaw Joint ProtectorTM addresses both of these issues.
In 2003 a benchmark was established by a study conducted by Biokinetics of Canada, authored by Dr Elliot Pellman that established 9.3 ± 1.9 m/sec of velocity impact as creating concussive forces. In 2005, at Wayne State University, using the head form with an articulated jaw, BPI revisited this and found similar results as in 1993 study, with impact forces being delivered directly to the facemask and also direct to the chin. Both studies found that the Brain-Pad Jaw Joint ProtectorTM reduced jaw-transmitted forces more than any other mouth guard or any other oral protection device.
In 2010 the Oklahoma Athletic Associations hosted the first symposium on jaw-joint related concussions with leading experts in the subject matter and began to focus scientific attention on this long-neglected and vital joint (i.e. the TMJ).
Then in 2011, in a fully funded by the NFL study using a new head form with a articulated jaw at Biokinetics in Canada, it was shown that the Brain-Pad Jaw-Joint Protector was measurably superior at withstanding/reducing a 9.5 m/sec of velocity impact than other leading retail mouth guards. In fact, the study showed, when compared to wearing no mouth guard at all, those other mouth guards actually increased velocity impact forces rather than decreased velocity impact forces. BPI realizes that no one product is capable of preventing all concussions but any product, such as the Brain-Pad Jaw-Joint ProtectorTM, that substantially reduces impact forces to the thin base of the skull can only be a benefit to the athlete.
With brain injuries, especially head trauma, on the minds of all parents, the only acceptable result that protective sports equipment can be allowed to do is to bring about a reduction of velocity impact forces.
We have, in our scientific community, a great understanding of linear impact forces, which were greatly aided by the auto industry’s crash test programs. However, lateral, angular, and rotational forces are not understood as well. Current helmet testing protocols and equipment date from the late 1960’s and should be updated to observe more than just skull fractures.
Brain Pad has always been the leader in advancing the science of velocity impact reduction, and as a result of that commitment, Brain Pad contacted Applied Research (“ARA”) to develop a full computational model that will be both analytical and predictive to finally understand individual tissue strain, lateral force, angular force, and rotational force.
ARA and BPI briefed the Military, NFLPA, and Congress about the potential benefit available to the US Government in both military and commercial (i.e. sports) applications. Although the briefing was well received, available funding could not be found. This study would have been the most advanced study ever done, taking advantage of the billions of dollars that have been spent trying to understand concussion mechanics to build a true digital model which could reflect, track, project, and describe potential concussion-producing forces. This research effort could lead to the establishment of realistic and effective standards for protective military and sports equipment design.
It is time for everyone (i.e. athletes, coaches, trainers, sports medicine doctors, sports equipment manufacturers, regulating agencies, and state and federal governments) to work together to understand the potential causes and detrimental effects of concussions and to establish realistic standards of design to reduce, as much as possible, the incidence of potential brain injuries.
As an example of effective regulation, most of the international combat arts associations (i.e. International Kickboxing Federation, International Sport Combat Association, International Sport Karate and Kickboxing Association, and Kick International) take the Brain-Pad Jaw-Joint Protector’s role in reducing jaw forces to the brain very seriously with mandated use during competitions and unpaid endorsements from participants. It is time that amateur and professional helmeted sports leagues and associations do likewise.