An Evaluation of Head Movement in Backboard-Immobilized Helmeted Football, Lacrosse, and Ice Hockey Players

Context: Proper management of cervical spine injuries in men's lacrosse players depends in part upon the ability of the helmet to immobilize the head.Objective: To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete.Design: Crossover study. Setting: Sports medicine research laboratory.Patients or Other Participants: Eighteen healthy collegiate men's lacrosse players.Intervention(s): Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions.Main Outcome Measure(s): Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet).Results: Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the nohelmet condition (P , .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P , .0001).Conclusions: Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.Key Words: stabilization, emergency management, protective equipment Key PointsN In all 3 planes (sagittal, frontal, and transverse), range of motion between the head and thorax was greater in both the properly and improperly fitted helmets than in the no-helmet condition.N Head-to-thorax range of motion in the sagittal plane was greater with the improperly fitted helmet than with the fitted helmet.N Helmet-to-thorax range of motion did not differ between the properly and improperly fitted helmets for the 3 planes. N Greater range of motion was available between the head and thorax than between the helmet and thorax, regardless of helmet fit, indicating that the head was moving inside the helmet.

Section: Head-to-helmet Movementcontrasting

confidence: 99%

Section: T He National Center For Catastrophic Sports Injurymentioning

confidence: 99%

Helmet Fit and Cervical Spine Motion in Collegiate Men's Lacrosse Athletes Secured to a Spine Board

Petschauer

Schmitz

Gill

2010

“…If the helmet is removed, the head and neck usually fall into an extended position, [4][5][6][7][8][9][10] possibly further complicating an existing cervical spine injury. 11 As such, most experts agree that when a football or ice hockey player has sustained a possible cervical spine injury, either the helmet should be left in place while the face mask or visor is removed 2,3,[12][13][14][15][16][17] or both helmet and shoulder pads should be removed simultaneously. 3 As technology advances, sport equipment evolves.…”

mentioning

confidence: 99%

The Assessment of Airway Maneuvers and Interventions in University Canadian Football, Ice Hockey, and Soccer Players

Delaney

Al-Kashmiri

Baylis

et al. 2011

Context: Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment. Objective: To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment. Design: Crossover study. Setting: University sports medicine clinic. Patients or Other Participants: A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players. Intervention(s): Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained. Main Outcome Measure(s): The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale. Results: All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players. Conclusions: Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.

“…[1][2][3][4][5][6][7] The all-or-none principle (ie, keeping both the shoulder pads and helmet on or removing both helmet and shoulder pads) currently guides all equipment-removal decisions to access the airway. 8,9 Clinicians are instructed not to remove the helmet without removing the shoulder pads because of the fear of further compromising the spinal cord.…”

mentioning

confidence: 99%

“…8,9 Clinicians are instructed not to remove the helmet without removing the shoulder pads because of the fear of further compromising the spinal cord. 2,3,[5][6][7][8][9][10][11][12][13][14][15][16] This guideline is based primarily on research 3,4,6,16 with football equipment indicating that immobilizing an athlete without a helmet but with the shoulder pads detrimentally affects cervical spine alignment. Football shoulder pads substantially raise the thoracic region, causing the cervical spine to extend 4,6,11 if the helmet is removed and, therefore, decreasing cervical spinal cord space.…”

mentioning

confidence: 99%

Lacrosse Equipment and Cervical Spinal Cord Space During Immobilization: Preliminary Analysis

Higgins

Tierney

Driban

et al. 2010

Context: Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC).Objective: To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete.Design: Observational study. Setting: Outpatient imaging center.Patients or Other Participants: Ten volunteer lacrosse athletes (age 5 20.7 6 1.87 years, height 5 180.3 6 8.3 cm, mass 5 91 6 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI).Intervention(s): The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition.Main Outcome Measure(s): The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3-C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 3 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA.Results: We found no equipment 3 level interaction effect (F 3.7,72 5 1.34, P 5 .279) or equipment main effect (F 2,18 5 1.20, P 5 .325) for the SAC (no equipment 5 5.04 6 1.44 mm, SP 5 4.69 6 1.36 mm, FG 5 4.62 6 1.38 mm). The CTA was greater (ie, more extension; critical P 5 .0167) during the SP (32.646 6 3.96) condition than during the no-equipment (25.346 6 2.36; t 9 5 7.67, P 5 .001) or FG (26.816 6 5.16; t 9 5 4.80, P 5 .001) condition.Conclusions: Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.