Helmet and Shoulder Pad Removal in Suspected Cervical Spine Injury

Peris,; Wf, Donaldson; Towers, Jeffery D; Blanc, Robert O.; Ts, Muzzonigro

doi:10.1097/00007632-200205010-00022

Cited by 30 publications

(30 citation statements)

References 3 publications

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“…11,12,19 Most of the research in this area has been performed using football or hockey equipment. Previous cadaver research 11 using fluoroscopy demonstrated that flexion occurs during football helmet removal in uninjured (5.56) and unstable (9.36) cervical spines.…”

Section: Discussionmentioning

confidence: 99%

“…Significant findings 25 of alterations in the position of adjacent cervical vertebrae have been noted during helmet removal, cervical collar application, and head rest using fluoroscopy in participants wearing hockey and football equipment. Researchers 11,12,25 have also noted that helmet removal resulted in increased cervical traction, which may be harmful in the unstable cervical spine. In research involving human controls, investigators 12 noted no changes in the angulation, disc height, or SAC in the uninjured cervical spine with helmet removal when following the National Athletic Trainers' Association protocol for helmet removal.…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for removing all protective equipment is to prevent further neurologic injury by keeping the spine in a neutral position and by not moving the unstable cervical spine into excessive extension. 4,[6][7][8][9][10][11][12][14][15][16] This may be prudent in football, as research 4,6,14,16 has indicated approximately a 106 increase in cervical extension when immobilizing the athlete without the helmet. Because of equipment structure, helmet removal to achieve airway access in lacrosse may be an option, as the small amount of cervical spine alignment change exhibited by immobilized participants in our study did not affect cervical SAC.…”

Section: Discussionmentioning

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%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…This indicates that removing the helmet may be the best treatment plan until a helmet that properly stabilizes the head can be designed. Peris et al 12 and Prinsen et al 13 investigated motion that occurs during helmet and shoulder pad removal. Peris et al 12 noted that when the IATF 5 guidelines were followed, no significant motion occurred when removing the helmet and shoulder pads.…”

Section: Helmet Fittingmentioning

confidence: 99%

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

Petschauer

Schmitz

Gill

2010

Journal of Athletic Training

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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.

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On-field issues of the C-spine-injured helmeted athlete

Bell

2007

Curr Sports Med Rep

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Football is a violent collision sport and can lead to various serious injuries. Cervical spine injuries are numerous, ranging from bony fractures and dislocations to spinal cord disruption. These injuries can be a devastating and debilitating. Although most injuries that occur are self-limiting there is a significant proportion that can cause permanent disability. Due to the equipment used in football, unique on-field care is implemented in evaluating athletes with possible cervical spine injury. Early preseason preparation and proper on-field intervention can help improve outcomes for these athletes.

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Helmet and Shoulder Pad Removal in Suspected Cervical Spine Injury

Abstract: In the conscious player with no cervical injury the protocol used by the NATA is effective in limiting cervical motion.

Cited by 30 publications

References 3 publications

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

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

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

On-field issues of the C-spine-injured helmeted athlete

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