(Inside Science) -- Benjamin Franklin once said that an ounce of prevention is worth a pound of cure -- words of wisdom that ring as true in today's fields of public health as they did in the streets of colonial Philadelphia. The burden of accident and injury is cheaper to deal with through prevention -- whether in the modern hospital, the everyday workplace or the fields of competitive sports. The same is true for soldiers in a war zone. Outcomes are better. Lives may be saved. And there may be no physical insult for which this adage rings truer than that of traumatic brain injury.
"Obviously, the best-case scenario is not to sustain the concussion or TBI in the first place,” said David Okonkwo, clinical director at the UPMC Brain Trauma Research Center.
The use of technology to reduce head injuries in professional football has a long history dating to the emergence of college football in the late 19th century. Padded leather helmets were developed after the turn of the century to protect players against skull fractures. Over the decades this same technology improved: stronger materials, innovations like chin straps, and the development and evolution of face masks. But how much protection is enough?
"We don't see skull fractures in football, but what we do see is that even in a helmet, your brain still moves around quite a bit within the skull, and that's how you suffer the concussion," said Mark Proctor, neurosurgeon-in-chief at Boston Children's Hospital.
Proctor and his colleagues see 400 to 500 people every month at the brain injury center he directs. Most of them present with injuries that are sports-related. He points to the promise of new and improved helmet designs companies are working on that may better absorb some of the energy of an impact and not impart it to the brain.
"I do think that we'll probably see better protective equipment and things that are actually starting to be able to absorb the rotational components, either through the construction, new technology [or] people talking about nanoparticles, that sort of immediately move to that part of the helmet that needs the most protection. So I think we'll see technologies that are able to help mitigate against some of this,” said Proctor.
Another modern innovation that is currently evolving is the mouthguard. Some believe they may help to prevent concussion by reducing the forces that are distributed to the brain when the head sustains a blow. But this is controversial.
"So, the theory there is that the blow comes up through the jaw and is imparted on the base of the skull. But that's not how most concussions occur.
"There's clearly people who push mouthguards as a way of preventing concussion. We know they're super effective against serious dental injury. But there's not good evidence yet that they're preventing concussion,” said Proctor.
Some companies, in any case, are moving ahead with mouthguards designed with the intent of reducing the risk of concussion.
"And there are multiple versions of this that are in development and getting close to being brought to market that are looking to incrementally lower your risk,” said Okonkwo.
Enormous public attention has fallen upon concussion in sports, particularly football in recent years. But traumatic brain injury has also emerged as a signature injury of overseas military conflicts.
"The combination of those two facts has led to the Department of Defense, the National Institutes of Health, and other funding agencies substantially increasing the resources that are devoted to research in the field of traumatic brain injury and concussion," said Okonkwo.
"Because we're involved in so many skirmishes that the -- we're seeing a lot of folks come back with blast injuries,” said Proctor.
Researchers say the military focus on traumatic brain injury and concussion may be as relevant to the civilian world of competitive sports as it is to soldiers in a war zone.
"Obviously, the mechanism by which a TBI or a concussion is sustained in theater during war is different from that sustained on a soccer field or a football field. However, some of the biological substrates behind that share real similarities, and some of the clinical manifestations of those injuries share a tremendous amount of overlap,” said Okonkwo.
And if advances in understanding and technology for soldiers helps athletes, the same may be true in reverse.
"There are also many efforts undergoing on the civilian side, whether it is looking at helmet design or mouthguards or other forms of technologies that can limit the risk of a blow to the head, precipitating a concussion. That will have direct relevance in the civilian world, and if one of those spills over into something that could benefit our soldiers, it's going to happen," said Okonkwo.
In the end, Okonkwo said, one of the best forms of preventions is perhaps the oldest of all: avoiding injury by establishing safe play and adhering to it.