1. Chapter 6: Selecting and Using Protective Sports Equipment

2. Selection, fitting and maintenance of protective equipment are critical in injury prevention
Athletic trainers and coaches must have knowledge of protective equipment available for different sports and proper fitting procedures
Protection is critical in contact and collision sports

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

4. Equipment Reconditioning and Recertification
NOCSAE has established test standards in order to reduce head injuries
Set minimum safety requirements for helmets and masks for football, baseball/softball and lacrosse
Accepted standards for various regulatory bodies in sports
Type of helmet, amount of use/intensity will determine condition of help over a period of time

5. NOCSAE label does not warranty helmets
Indicates helmet met requirements when manufactured or reconditioned
NOCSAE recommends reconditioning and recertification of equipment
Consumer should use discretion based on use
Helmets undergoing reconditioning can meet performance for many seasons depending on model & usage
Will help equipment last longer
If not kept clean various skin conditions and infections can be unnecessarily transferred

6. 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

7. 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

8. 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

9. 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

10. 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

12. 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

14. 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 (CSA)

16. Baseball/Softball 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)

17. Cycling Helmets Designed to protect the head during one single impact
Football, baseball and hockey helmets are more durable and can survive repeated blows
Many states require use of cycling helmets, especially in adolescents

18. Lacrosse Helmets
Required for male lacrosse players; females must wear protective eye-guard
Hard plastic with wire mess cage
Must have center bar running from top to bottom to absorb repeated, high velocity blows
Four point buckling system to keep helmet in place and ensure better fit

19. 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

20. 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

22. 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

23. Mandated use in high school and collegiate levels
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
Mouth guards wear down over the course of a season
Coaches should routinely inspect mouth guards to determine if replacement is necessary

24. Eye Protection Devices
Ear Guards
Most sports do not use
Wrestling, water polo and boxing utilize to prevent ear irritation and ultimate deformity of ears
Eye Protection Devices
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)
Polycarbonate lens is virtually unbreakable
May have polarizing/tinting ability
Plastic lenses while lightweight are easy to scratch

25. 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

26. Eye and Glasses Guards Neck Protection
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

27. 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

29. 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

31. 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

32. Rib Protection Types available Thorax protectors and rib belts
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)
Rib Protection
Thorax protectors and rib belts
Protect against external forces
Air-inflated interconnected cylinders (jacket design)

33. Hips and Buttocks Required in collision and high-velocity sports
Boxing, snow skiers, equestrians, jockeys and water skiers
Girdle and belt types

34. Groin and Genitalia Sports involving high velocity projectiles
Require cup protection for male participants
Stock item that fits into jockstrap or athletic supporter

35. 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

36. 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
Last – form on which shoe is built
May be straight, semi-curved, curved
Straight = flat arch or run on inside of foot (pronator)
Semi-curved = foot to fit normal arch
Curved = more forefoot stability, high arch (supinator)

38. 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

39. 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

40. Cleated and specialty shoes may present problems with fitting
Playing surfaces and activities must be considered
Heel Cups
Used for a variety of conditions including plantar fasciitis, heel spurs, Achilles tendonitis and heel bursitis
Used to help compress fat pad, providing more cushion during weight bearing

41. 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

42. Ankle Supports Shin and Lower Leg
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
Shin and Lower Leg
Often overlooked
Commercially marketed, hard molded shin guards are used in field hockey and soccer

43. Ankle Braces

44. Shin Guards

45. Thigh and Upper Leg Knee Braces 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 concern about their efficacy in reducing injuries

46. Types of Braces Rehabilitative: Functional:
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

48. 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

49. 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