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)

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 –National Operating Committee on Standards for Athletic Equipment (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)

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 void 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 ultimate 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

–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-cantileveredCantilevered

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 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 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, non- yielding 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 GuardsThigh 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