1. Chapter 7: Protective Sports Equipment

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

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. 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

5. 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)

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

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

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

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

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

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

16. 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)

18. Cycling Helmets Designed to protect head during one single impact
Many states require the use of cycling helmets
Especially in adolescents

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
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

23. Ear Guards Eye Protection 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

24. 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

25. 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

26. 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

28. 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

29. Non-cantilevered
Cantilevered

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. Thorax and Rib Protection
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)

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
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

38. 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

39. 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

40. Off-the-shelf Foot Pads
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

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
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

43. Ankle Braces

44. Shin Guards
Thigh Pads

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 concerns to efficacy in doing so
May positively influence joint position sense

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

50. 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

51. 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

52. Non-yielding Materials
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

53. Casting Materials 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

54. 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

55. Felt
Foam Casting Material

56. Dynamic Splints Used for injuries in hands and fingers
Provides long duration tension on healing structures
Combination of thermomoldable plastic, elastic and Velcro