828 Cervical Spine Position in the Immobilized Football Player???radiographic Analysis Before and After Helmet Removal

Swenson, Todd M.; Lauerman, William C.; Donaldson, William F.; Blanc, Robert O.; Fu, Freddie H.

doi:10.1249/00005768-199405001-00830

Cited by 18 publications

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“…They reported that immobilizing the lacrosse athlete after helmet removal resulted in 4.76 of cervical flexion (referencing the occiput and C2) and 0.96 of extension (referencing C2 and C7). This is in contrast to the cervical extension found by other researchers 4,6,10,14,16 investigating cervical spine position in immobilized ice hockey and football athletes with shoulder pads and no helmet. In our study, helmet removal resulted in 5.86 more extension in CTA, compared with the FG condition.…”

Section: Discussioncontrasting

confidence: 83%

“…19 This is contrary to current emergency equipment-removal guidelines 8,9,11 that are based on research involving football and hockey helmets. 3,4,6,16 Unlike football and hockey helmets, some lacrosse helmet models (eg, Brine, Riddell, Cascade, a and Warrior b ) have small brims that do not allow the face mask to be tilted up after cutting the side clips (not the recommended way to access the airway). In these models, the face mask must be removed by cutting clips on or under the brim and by unscrewing the chin guard that is attached to the helmet by metal screws.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…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. 3,7,17,18 Immobilization of the lacrosse athlete with the helmet removed to acquire airway access may not be detrimental for the lacrosse athlete because of the lacrosse shoulder pad design.…”

mentioning

confidence: 99%

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

Higgins

Tierney

Driban

et al. 2010

Journal of Athletic Training

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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.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Higgins

Tierney

Driban

et al. 2010

Journal of Athletic Training

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“…3 The prehospital setting presents unique factors that make delivering appropriate care challenging. For example, given that isolated independent removal of football helmets has been shown to move the cervical spine out of neutral alignment, [4][5][6] the National Athletic Trainers' Association 7 recommended that the helmet and shoulder pads remain in place and airway access be achieved via face-mask removal, except under certain circumstances. However, no researchers have published reports comparing helmet removal and facemask removal to support this recommendation.…”

Section: Ore Than 2 Million Athletes Participate Inmentioning

confidence: 99%

Emergent Access to the Airway and Chest in American Football Players

Swartz

Mihalik

Decoster³

et al. 2015

Journal of Athletic Training

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Context: American football has the highest rate of fatalities and catastrophic injuries of any US sport. The equipment designed to protect athletes from these catastrophic events challenges the ability of medical personnel to obtain neutral spine alignment and immobilization during airway and chest access for emergency life-support delivery.Objective: To compare motion, time, and difficulty during removal of American football helmets, face masks, and shoulder pads.Design: Quasi-experimental, crossover study. Setting: Controlled laboratory. Patients or Other Participants: We recruited 40 athletic trainers (21 men, 19 women; age ¼ 33.7 6 11.2 years, height ¼ 173.1 6 9.2 cm, mass ¼ 80.7 6 17.1 kg, experience ¼ 10.6 6 10.4 years).Intervention(s): Paired participants conducted 16 trials in random order for each of 4 helmet, face-mask, and shoulder-pad combinations. An 8-camera, 3-dimensional motion-capture system was used to record head motion in live models wearing properly fitted helmets and shoulder pads.Main Outcome Measure(s): Time and perceived difficulty (modified Borg CR-10).Results: Helmet removal resulted in greater motion than face-mask removal, respectively, in the sagittal (14.888, 95% Conclusions: Protective equipment worn by American football players must eventually be removed for imaging and medical treatment. Our results fill a gap in the evidence to support current recommendations for prehospital emergent management in patients wearing protective football equipment. Helmet face masks and shoulder pads with quick-release designs allow for clinically acceptable removal times without inducing additional motion or difficulty.Key Words: cervical spine injury, sudden cardiac event, protective equipment Key PointsFace-mask removal induced less motion than helmet removal when accessing the airway. Helmet face masks and shoulder pads with quick-release designs allowed for clinically acceptable removal times without inducing additional motion or difficulty. The actual ability to effectively ventilate a patient with a helmet on and face mask removed was not studied and has not been established in the literature.

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Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

Murray

Rust

2017

Wilderness & Environmental Medicine

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828 Cervical Spine Position in the Immobilized Football Player???radiographic Analysis Before and After Helmet Removal

Cited by 18 publications

References 0 publications

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

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

Emergent Access to the Airway and Chest in American Football Players

Cervical Spine Alignment in Helmeted Skiers and Snowboarders With Suspected Head and Neck Injuries: Comparison of Lateral C-spine Radiographs Before and After Helmet Removal and Implications for Ski Patrol Transport

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