Context: The National Athletic Trainers' Association position statement on acute management of the cervical spineinjured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols.Objective: To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative packand-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels.Design: Crossover study. Setting: Movement analysis laboratory.Patients or Other Participants: Eight male collegiate football players (age ¼ 21.4 6 1.4 years; height ¼ 1.87 6 0.02 m; mass ¼ 103.6 6 12.5 kg).Intervention(s): Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by packand-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal.Main Outcome Measure(s): We measured head movement relative to sternum movement (translations and rotations). We used 4 3 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs.Results: Protocol HP resulted in a 0.1 6 0.6 cm rise in head position compared with a 1.4 6 0.3 cm drop with protocol HS (P , .001). Protocol HP produced 4.98 less total angular excursion (P , .001) and 2.1 cm less total vertical excursion (P , .001) than protocol HS.Conclusions: The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care.Key Words: National Athletic Trainers' Association position statement, pack and fill, motion analysis, helmet removal Key PointsThe pack-and-fill protocol resulted in less overall motion than removal of the helmet and shoulder pads followed by placing the head on the ground, which is currently endorsed by the National Athletic Trainers' Association. Using pack and fill, the athletic trainers could position the head at release in, on average, nearly the identical position as at initiation. Removal of the helmet and shoulder pads resulted in a drop in linear and angular head position, placing the cervical spine into increased extension.