Chapter 6: Selecting and Using Protective Sports Equipment

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

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

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

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

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

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

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

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 (CSA)

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)

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

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

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

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

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

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 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

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

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

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

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)

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 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)

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 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

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

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

Ankle Braces

Shin Guards

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

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

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