1. Chapter 7: Protective Gear and Sports Equipment © 2011 McGraw-Hill Higher Education. All rights reserved.

2. 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.

3. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

4. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

5. 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) © 2011 McGraw-Hill Higher Education. All rights reserved.

6. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

7. NOCSAE helmet standard –Not a warranty –Indicates that helmet met requirements of performance tests when manufactured/re- conditioned Helmets should undergo regular recertification and reconditioning –Will allow equipment to meet necessary standards for multiple seasons © 2011 McGraw-Hill Higher Education. All rights reserved.

8. 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.

9. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

10. –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.

11. Figure 7-1 © 2011 McGraw-Hill Higher Education. All rights reserved.

12. –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.

13. Figure 7-2 © 2011 McGraw-Hill Higher Education. All rights reserved.

14. 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.

15. Figure 7-3 © 2011 McGraw-Hill Higher Education. All rights reserved.

16. 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.

17. Figure 7-4 © 2011 McGraw-Hill Higher Education. All rights reserved.

18. 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.

19. Figure 7-5 © 2011 McGraw-Hill Higher Education. All rights reserved.

20. Cycling Helmets Designed to protect head during one single impact Many states require the use of cycling helmets –Especially in adolescents Figure 7-6 © 2011 McGraw-Hill Higher Education. All rights reserved.

21. 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.

22. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

23. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

24. 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.

25. Figure 7-8, 7-9, 7-10 © 2011 McGraw-Hill Higher Education. All rights reserved.

26. –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.

27. –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.

28. –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.

29. –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.

30. Figure 7-13 © 2011 McGraw-Hill Higher Education. All rights reserved.

31. 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.

32. Figure 7-14 © 2011 McGraw-Hill Higher Education. All rights reserved.

33. 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.

34. Non-cantileveredCantilevered Figure 7-15 © 2011 McGraw-Hill Higher Education. All rights reserved.

35. Figure 7-16 © 2011 McGraw-Hill Higher Education. All rights reserved.

36. 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 © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-17

37. 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 © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-19

38. –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

39. Thorax and Rib Protection –Thorax protectors and rib belts –Protect against external forces –Air-inflated interconnected cylinders (jacket design) Figure 7-20

40. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

41. Groin and Genitalia Sports involving high velocity projectiles Require cup protection for male participants Stock item that fits into jockstrap or athletic supporter © 2011 McGraw-Hill Higher Education. All rights reserved.

42. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

43. Shoe selection –Number of options for multiple activities –Shoe will breakdown and degrade over time Running shoes for example will last between 350- 550 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

44. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

45. 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, non- yielding nature of sole and function of arch support © 2011 McGraw-Hill Higher Education. All rights reserved.

46. –Cleated and specialty shoes may present problems with fitting –Playing surfaces and activities must be considered © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-24

47. Foot Orthotics –Device for correcting biomechanical problems that exist in foot that can cause injury –Plastic, thermoplastic, rubber, Sorbothane, leather support or ready- made products –Can also be customized by physician, podiatrist, athletic trainer or physical therapist More expensive © 2010 McGraw-Hill Higher Education. All rights reserved. Figure 7-25

48. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

49. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

50. Ankle Braces Figure 7-27 © 2011 McGraw-Hill Higher Education. All rights reserved.

51. 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 Figure 7-28 © 2010 McGraw-Hill Higher Education. All rights reserved.

52. 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 © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-29

53. Knee Braces –Used prophylactically to prevent injuries to MCL –AOSSM has expressed concerns to efficacy in doing so –May positively influence joint position sense © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-30

54. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

55. 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 © 2011 McGraw-Hill Higher Education. All rights reserved. Figure 7-31

56. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

57. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

58. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

59. –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 © 2011 McGraw-Hill Higher Education. All rights reserved.

60. Figure 7-33 & 7-34 © 2011 McGraw-Hill Higher Education. All rights reserved.

61. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

62. Figure 7-36 © 2011 McGraw-Hill Higher Education. All rights reserved.

63. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.

64. 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 © 2011 McGraw-Hill Higher Education. All rights reserved.