Transcript Chapter 7: Protective Sports Equipment

Chapter 7: Protective Sports
Equipment
• 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
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
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
• To avoid litigation, athletic trainer should
follow specific use instructions of
equipment exactly
– If the athletic trainer’s modification results in
injury the ATC and the institution are subject to
a suit (tort)
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
• 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
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
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
– 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
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
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
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)
Cycling Helmets
• Designed to protect
head during one single
impact
• Many states require
the use of cycling
helmets
– Especially in
adolescents
Face Protection
• Four categories
– 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
• 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
– 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
– 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
– 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 kerotectomy
– Laser in-situ kertomileusis (LASIK)
– Safe and effective in improving faulty vision
– 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
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
• 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
Non-cantilevered
Cantilevered
• Straps underneath arms should hold pads firmly inplace, w/out soft tissue restriction
– Combinations of padding (football and hockey)
may be used to supplement padding and
protection
• 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
– 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)
• 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
Groin and Genitalia
• Sports involving high velocity projectiles
• Require cup protection for male participants
• Stock item that fits into jockstrap or athletic
supporter
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
• Shoe selection
– Number of options for multiple activities
– 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
• Shoe Uppers - top of shoe made with combination of
materials, designed for appropriate ventilation, drying
and support
• Arch Support - durable but soft and supportive to foot
• Price- due to impact on performance and injury
prevention, may be worth the extra investment
• 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
– Cleated and specialty shoes may present
problems with fitting
– Playing surfaces and activities must be
considered
• Foot Orthotics
– Device for correcting biomechanical problems
that exist in foot that can cause injury
– Plastic, thermoplastic, rubber, sorbethane,
leather support or ready-made products
– Can also be customized by physician,
podiatrist, athletic trainer or physical therapist
• More expensive
• Heel Cups
– Used for a variety of conditions including plantar
fascitis, 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
• Ankle Supports
– 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
• Shin and Lower Leg
– Often overlooked
– Commercially marketed, hard molded shin
guards are used in field hockey and soccer
Ankle Braces
Shin Guards
Thigh Pads
• 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
• Knee Braces
– Used prophylactically to prevent injuries to MCL
– AOSSM has expressed concerns to efficacy in
doing so
– May positively influence joint position sense
• 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
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
• 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
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 is available
– Hard and soft materials
• 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
• Semiresilient providing firm pressure
• Absorbent and clings to skin (less tendency to move)
• Must be replaced daily due to absorbent qualities
– 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
• Three types
– Heat forming - heat and can be molded (Orthoplast)
– Heat setting - rigid and difficult to form and may require a
mold
– 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
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
Felt
Foam
Casting Material
Dynamic Splints
• Used for injuries in
hands and fingers
• Provides long duration
tension on healing
structures
• Combination of
thermomoldable
plastic, elastic and
Velcro