ch 7

Report
Chapter 7: Protective Gear
and Sports Equipment
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Selection, fitting and maintenance of
protective equipment are critical in injury
prevention
• Athletic trainers must have knowledge of
protective equipment available for different
sports and proper fitting procedures
• Protection is critical in contact and collision
sports
• Athletic trainers must also have knowledge
of how and when protective equipment
should be used to facilitate rehabilitation
© 2011 McGraw-Hill Higher Education. All rights reserved.
Safety Standards for
Equipment and Facilities
• Concerns relative to materials, durability,
establishment of standards, manufacturing,
testing methods, and requirements for use
• Must be in place relative to maintenance
• Concern should be protective ability not
appearance of equipment
• A number of groups and agencies are
involved in standardizing sports equipment
and facilities
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Legal Concerns
• Increasing amount of litigation regarding
equipment
– Must foresee all uses and misuses and
warn user against potential risks inherent
in equipment misuse
• If equipment results in injury due to
defect or inadequacy for intended use
manufacturer is liable
• If equipment is modified --modifier
becomes liable
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• To avoid litigation, individuals should
follow specific use instructions of
equipment exactly
– If the athletic trainer’s modification results
in injury the AT and the institution are
subject to a suit (tort)
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Equipment Reconditioning
and Recertification
• National Operating Committee on
Standards for Athletic Equipment
established voluntary testing standards
in an effort to reduce head injuries
• Established for football helmets,
baseball/softball helmets, lacrosse
helmets/facemasks
• Takes into consideration type of helmet
and amount of and intensity of usage
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• NOCSAE helmet standard
– Not a warranty
– Indicates that helmet met requirements of
performance tests when manufactured/reconditioned
• Helmets should undergo regular
recertification and reconditioning
– Will allow equipment to meet necessary
standards for multiple seasons
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Off the Shelf vs. Custom
Protective Equipment
• Off the shelf equipment
– Pre-made and packaged
– Can be used immediately
• Neoprene sleeves, inserts, ankle braces
– May pose problem relative to sizing
• Customized equipment
– Constructed according to the individual
– Specifically sized and designed for
protective and supportive needs
© 2011 McGraw-Hill Higher Education. All rights reserved.
Head Protection
• Direct collision sports require head
protection due to impacts, forces,
velocities and implements
• Football Helmets
– NOCSAE develop standards for football
helmet certification
– Must be protective against concussive force
– While helmets must be certified, they may not
always be fail-safe
– Athletes and parents must be aware of
inherent risks
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– Each helmet must have visible exterior
warning label
• Label indicates that helmet should not be used
to strike an opponent due to risk of injury
• Also indicates risk of injury accidentally and
that athlete plays at own risk while using helmet
– Athlete must be aware of risks and what
label indicates
• Athlete reads and signs statement regarding
warning label
– There are a number of helmet
manufacturers, and even more have
closed due to lawsuits and liability cases
© 2011 McGraw-Hill Higher Education. All rights reserved.
© 2011 McGraw-Hill Higher Education. All rights reserved.
© 2011 McGraw-Hill Higher Education. All rights reserved.
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-1
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– Football helmets generally have air or fluid-filled
pockets to absorb force
• Riddell Revolution has made revolutionary changes
– Computer designed helmet that extends further past the
jaw for additional protection and stability
– The distance between the helmet and head has been
increased
– Padding inflates to fit the player’s head shape
– The face guard system has isolated attachment points
from the shell, reducing jarring from low-level impacts to
the face guard
• Xenith helmet has thermoplastic airflow shock
absorbers in a flexible cap
– Said to adapt to force of impact and dissipate energy
– Decreases acceleration of head and reduces jarring
associated with concussions
© 2010 McGraw-Hill Higher Education. All rights reserved.
Figure 7-2
© 2011 McGraw-Hill Higher Education. All rights reserved.
Helmet Fitting
• When fitting head/hair should be wet to
simulate sweat
• Follow manufacturer’s directions
• Must routinely check fit
– Snug fit (credit card test)
– With change in altitude bladder helmets must be
rechecked
– Chin straps (2, 4, or 6 strap systems)
– Jaw pads are essential (prevent lateral rocking)
• Certification is of no avail if helmet is not fit
and maintained
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-3
© 2011 McGraw-Hill Higher Education. All rights reserved.
Ice Hockey Helmets
• Undergone extensive testing in an effort to
upgrade and standardize
• Must withstand high velocity impacts (stick
or puck) and high mass low velocity impacts
• Helmet will disperse force over large area
and decelerate forces that would act on
head (energy absorption liner)
• Helmets must be approved by Canadian
Standards Association or the Hockey
Equipment Certification Council
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-4
© 2011 McGraw-Hill Higher Education. All rights reserved.
Baseball Batting Helmets
• Must withstand high velocity impacts
• Research has indicated that helmet
does little to dissipate energy of ball
• Possible solution would be to add
additional external padding
• Helmet must still carry NOCSAE stamp
(similar to football label)
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-5
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Cycling Helmets
• Designed to protect
head during one
single impact
• Many states require
the use of cycling
helmets
– Especially in
adolescents
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Lacrosse Helmets
• Required for all male
lacrosse players
• Women’s lacrosse only
requires protective eye
guard
• Made of hard plastic with
wire mesh face guard
• Designed to absorb
repeated impact from hard,
high velocity projectiles
• Goalie helmet add throat
protector
Figure 7-7
© 2011 McGraw-Hill Higher Education. All rights reserved.
Soccer Headgear
• Designed to reduce incidence of
concussions due to heading ball
• Consists of headband with foam
padding
• No research to support
effectiveness in reducing
incidence of concussions
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Other Helmets
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Face Protection
– Face Guard
• Has reduced the number of facial injuries
• Number of concussions has increased because
head is most often used in initial contact
• There are a variety of protective options
depending on sport and position
• Proper mounting of the mask must occur with
no additional attachments that would invalidate
the manufacturer’s warranty
• All mountings must be flush to the helmet
© 2011 McGraw-Hill Higher Education. All rights reserved.
• In high school hockey, face masks are required
(with white plastic coating) that meet Hockey
Equipment Certifications Council and American
Society for Testing Materials
• Opening can not allow passage of sticks or
pucks
• Additional polycarbonate face shields are also
available
• The use of throat protectors is also mandated
at some levels
– Throat Protection
• Laryngotracheal injuries, while uncommon can
be fatal
• Baseball catchers, lacrosse goalies and ice
hockey goalies are most at risk
– Should be mandatory in these sports
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-8, 7-9, 7-10
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Mouth Guards
• Most dental injuries can be prevented with
appropriate customized intraoral mouth guards
• Protect teeth, minimize lip lacerations, absorb shock
of chin blows, and prevent concussions
• Should fit comfortably, not impede speech or
breathing
• Should extend back as far as last molar
• Constructed of flexible resilient material formed to fit
teeth and upper jaw
• Do not cut down mouth guard as it voids warranty
for dental protection and could become dislodged
and disrupt breathing
• Three types
– Stock
– Commercial (formed following submersion in water)
– Custom (fabricated from dental mold)
• Mandated use in high school and collegiate levels
© 2011 McGraw-Hill Higher Education. All rights reserved.
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– Ear Guards
• Most sports do not use
• Wrestling, water polo and boxing utilize
to prevent ear irritation and ultimately
deformity of ears
– Eye Protection
• Highest percentage of eye injuries are
sports related
• Generally blunt trauma
• Glasses
– May slip on sweat, become bent, fog, detract from peripheral
vision or be difficult to wear with headgear
– Properly fitting glasses can provide adequate protection
– Lens should be case hardened to cause crumbling and not
splintering on contact (disadvantage = increased weight)
– May have polarizing/tinting ability
– Plastic lenses while lightweight are easy to scratch
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Contact Lenses
• Become part of the eye and move with it
• Corneal and sclera lenses
• Peripheral vision, astigmatisms and corneal
waviness is limited
• Will not fog and can be tinted
• Disadvantages include cost, corneal irritation,
possibility of coming dislodged
• Soft hydrophilic lenses and disposable lenses
are very popular
• Introduction of surgical techniques
– Radial keratectomy
– Laser in-situ keratomileusis (LASIK)
– Safe and effective in improving faulty vision
© 2011 McGraw-Hill Higher Education. All rights reserved.
– Eye and Glasses Guards
• Necessary in sports with fast moving projectiles
• Athletes not wearing glasses should wear
closed eye guards to protect orbital cavity
• While eye guards afford great protection, they
can limit vision
• Polycarbonate eye shield have been developed
for numerous pieces of head gear
– Neck Protection
• Serve primarily as a reminder to athlete to be
cautious rather than providing definitive
restrictions
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-13
© 2011 McGraw-Hill Higher Education. All rights reserved.
Trunk and Thorax Protection
• Essential in many sports
• Must protect regions that are exposed
to the impact of forces
– External genitalia, bony protuberances,
shoulders, ribs, and spine
• While equipment may provide armor, it
may also be used as an implement
• Question must be asked concerning
necessity of equipment and its role in
producing trauma
© 2011 McGraw-Hill Higher Education. All rights reserved.
Figure 7-14
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Football Shoulder Pads
– Two types
• Cantilevered - bulkier and used by those engaged
in blocking and tackling
• Non-cantilevered - do not restrict motion
(quarterback and receivers)
– Rules of fitting
• Width of shoulders must be measured
• Inside of pad should cover tip of shoulder in line
with lateral aspect of shoulder
• Epaulets and cups must cover deltoid and allow
motion
• Neck opening must allow athlete to raise arms over
head w/out pads sliding forward and back
• With split clavicle pads, channel for top of shoulder
must be in proper position
© 2011 McGraw-Hill Higher Education. All rights reserved.
Non-cantilevered
Cantilevered
Figure 7-15
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Figure 7-16
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• Straps underneath arms should hold pads firmly
in-place, w/out soft tissue restriction
– Combinations of padding (football and
hockey) may be used to supplement
padding and protection
Figure 7-17
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Sports Bras
– Significant effort has
been made to develop
athletic support for
women
– Most designed to
minimize excessive
vertical and horizontal
movements that occur
with running and
jumping
– To be effective, should
hold breasts to chest,
preventing stretching of
Cooper’s ligament
Figure 7-19
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– Non-supportive bras, can
cause rubbing and
abrading of skin and
nipples due to
construction
– Types available
• Compressive (bind breasts
to chest wall - recommended
for medium size breast)
• Support (heavy duty with
additional upward support for
larger breasts)
• Lightweight elastic
(compression and support
not as critical for smaller
breasts)
Figure 7-19
• Thorax and Rib
Protection
– Thorax protectors
and rib belts
– Protect against
external forces
– Air-inflated
interconnected
cylinders (jacket
design)
Hips and Buttocks
• Required in collision and
high-velocity sports
• Boxing, snow skiers,
equestrians, jockeys and
water skiers
• Girdle and belt types
Figure 7-21
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Groin and Genitalia
• Sports involving high velocity projectiles
• Require cup protection for male
participants
• Stock item that fits into jockstrap or
athletic supporter
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Lower Extremity Protective
Equipment
• Socks
– Poorly fit socks can cause abnormal stress
on the foot
– Should be clean, dry and w/out holes
– Different types for different activities
– Composition
• Cotton can be bulky
• Cotton/poly blend are lighter and dry faster
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• Shoe selection
– Number of options for multiple activities
– Shoe will breakdown and degrade over time
• Running shoes for example will last between 350550 miles
• Shoes may need to be constantly replaced if very
active
– Guidelines for selection
• Toe Box - space for toes (1/2 to 3/4 inch of space
from toes to front of shoe)
• Sole - provide shock absorption and durable
– Spongy layer to absorb force
– Midsole that cushions midfoot and toes
– Hard rubber which contacts the ground
• Heel Counter - prevents medial and lateral roll of
foot
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• Shoe Uppers - top of shoe
made with combination of
materials, designed for
appropriate ventilation, drying
and support
• Shank – Part of sole between
heel and metatarsal heads
• Last – Form on which shoe is
built; may be straight (good for
pronators), semi-curved or
curved (good for supinators)
• Arch Support - durable but soft
and supportive to foot
• Price- due to impact on
performance and injury
prevention, may be worth the
extra investment
Figure 7-23
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• Shoe fitting
– Measure both feet, as there will be slight
differences
– Approximate conditions of use
– Fit at the end of day due to gradual
increase in volume due to weight bearing
– Should be snug but allow ample movement
of foot and toes
– Should break at widest part, coinciding with
ball of foot
– Must also consider width of shank, nonyielding nature of sole and function of arch
support
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– Cleated and specialty shoes may present
problems with fitting
– Playing surfaces and activities must be
considered
Figure 7-24
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• Foot Orthotics
– Device for correcting
biomechanical problems
that exist in foot that can
cause injury
– Plastic, thermoplastic,
rubber, Sorbothane,
leather support or readymade products
– Can also be customized
by physician, podiatrist,
athletic trainer or
physical therapist
Figure 7-25
• More expensive
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• Heel Cups
– Used for a variety of conditions including
plantar fasciitis, heel spurs, Achilles tendonitis
and heel bursitis
– Hard plastic or spongy rubber used to help
compress fat pad, providing more cushion
during weight bearing
• Off-the-shelf Foot Pads
– General public use, not designed for athletic use
– With adequate funding, provides advantage of
saving time
– Manufactured for numerous structural conditions
– Commonly used before customized devices are
made
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• Ankle Braces
– Alone or with tape -- they are increasingly
popular
– Significant debate over efficacy
– Little or no impact on performance
– Compared to tape, the device will not loosen
significantly with use
– Research also looking at impact on
proprioceptive effects
– Evidence to support use for prevention
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Ankle Braces
Figure 7-27
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Shin and Lower
Leg
– Anterior aspect of
leg is exposed to
direct blows
– Commercially
marketed, hard
molded shin guards
are used in field
hockey and soccer
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• Thigh and Upper Leg
– Necessary in collision sports
– Pads slip into ready made uniform pockets
– Customized pads may need to be held in
place with tape and/or wraps
– Neoprene sleeves can also be used for
support of injuries
Figure 7-29
© 2011 McGraw-Hill Higher Education. All rights reserved.
• Knee Braces
– Used prophylactically to prevent injuries to
MCL
– AOSSM has expressed concerns to efficacy
in doing so
– May positively influence joint position sense
Figure 7-30
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• Types of Braces
– Rehabilitative:
• Widely used following surgery
• Allows controlled progressive immobilization
• Adjustable
– Functional:
• Used during and following rehab to provide
functional support
• Ready-made and customized
– Neoprene (w/ medial and lateral support)
• Used by those that have sustained collateral
ligament injuries
• Some are also used to provide support in those
that have patellofemoral conditions
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Elbow, Wrist and Hand
Protection
• While the elbow is less commonly injured it is
susceptible to instability, contusions, and muscle
strain
• A variety of products are available to protect the
elbow
Figure 7-31
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• Wrist, hand and
finger injuries are
often trivialized but
can be functionally
disabling
• Susceptible to
fracture, dislocation,
ligament sprains
and muscle strains
• Gloves and splints
are available for
protection and
immobilization
Figure 7-32
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Construction of Protective and
Supportive Devices
• An athletic trainer should be able to
design and construct protective devices
• Must have knowledge of theoretical
basis of padding construction
• Art form based on science
• A variety of materials are available
– Hard and soft materials
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• Soft materials
– Gauze: versatile, can be used for protection
or absorption
– Cotton: cheapest and more widely used
(absorbent, holds emollients and offers mild
padding
– Adhesive felt (moleskin, spongy rubber):
– Felt: matted wool fibers, pressed in a variety
of thicknesses
• Semi-resilient, providing firm pressure
• Absorbent and clings to skin (less tendency to
move)
• Must be replaced daily due to absorbent qualities
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– Foam: many uses with many densities
• Resilient, non-absorbent material that protects
against compressive force
• Open vs. closed cells (return to shape)
• Thermomoldable
• Some have viscoelastic polymers and are
energy absorbent
• Non-yielding Materials
– Thermomoldable plastics
• Used in orthotics, braces, splints and for
shielding body parts
• Casting, support for foot, protect contusions
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Figure 7-33 & 7-34
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• Types
– Heat forming - heat and can be molded
(Orthoplast)
– Heat plastic foams- different densities due
to the addition of liquids, gas, or crystals
» Commonly used in shoe inserts
– Casting Materials
• Casting has long been a practice in sports
medicine
• Fiberglass is the material of choice, which uses
resin and catalytic converter, plus water to
produce hardening
• Effective shell for splinting and padding
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Figure 7-36
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Tools for Customizing
• Adhesives (glues and cements)
• Adhesive tapes
• Heat Source (used to form
thermomoldable plastics/foams)
• Shaping Tools (scissors, blades, knives)
• Fastening material (variety of devices
including snaps, Velcro, rivets, laces
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Dynamic Splints
• Used for injuries to
the hands and
fingers
• Provides long
duration tension on
healing structures
• Combination of
thermomoldable
plastic, elastic and
Velcro
Figure 7-38
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