Chapter 7: Protective Sports Equipment

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Chapter 7 Protective Sports Equipment
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• 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

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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

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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

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• To avoid litigation, athletic trainer should
  follow specific use instructions of equipment
  exactly
• If the athletic trainers modification results in
  injury the ATC and the institution are subject to
  a suit (tort)

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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

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• 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

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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

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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

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• 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

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Helmet Fitting

• When fitting head/hair should be wet to simulate
  sweat
• Follow manufacturers 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

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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

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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)

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Cycling Helmets

• Designed to protect head during one single impact
• Many states require the use of cycling helmets
• Especially in adolescents

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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
  manufacturers warranty
• All mountings must be flush to the helmet

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• 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

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• 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

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• 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

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• 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

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• 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

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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

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• 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

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Non-cantilevered
Cantilevered
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• 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 Coopers ligament

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• 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)

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Hips and Buttocks

• Required in collision and high-velocity sports
• Boxing, snow skiers, equestrians, jockeys and
  water skiers
• Girdle and belt types

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Groin and Genitalia

• Sports involving high velocity projectiles
• Require cup protection for male participants
• Stock item that fits into jockstrap or athletic
  supporter

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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

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• 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

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• 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

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• 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

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• 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

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• 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

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Ankle Braces
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Shin Guards
Thigh Pads
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• 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

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• 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

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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

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• 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

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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

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• 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

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• 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

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• 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

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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

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Felt
Foam Casting
Material
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Dynamic Splints

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