1. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 6: Selecting and Using Protective Sports Equipment

2. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

6. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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 protect 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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

11. 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

12. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

13. 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)

14. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

15. 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)

16. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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 for adolescents

17. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

18. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

19. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

20. –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

21. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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) –Polycarbonate lens is virtually unbreakable –May have polarizing/tinting ability –Plastic lenses while lightweight are easy to scratch

22. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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

23. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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

24. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

25. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

26. 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

27. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Non-cantileveredCantilevered

28. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

29. 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

30. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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)

31. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Hips and Buttocks Required in collision and high-velocity sports Boxing, snow skiers, equestrians, jockeys and water skiers Girdle and belt types

32. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Groin and Genitalia Sports involving high velocity projectiles Require cup protection for male participants Stock item that fits into jockstrap or athletic supporter

33. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

34. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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 be 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

35. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

36. 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

37. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. –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 fascitis, heel spurs, Achilles tendonitis and heel bursitis –Used to help compress fat pad, providing more cushion during weight bearing

38. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

39. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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 Shin and Lower Leg –Often overlooked –Commercially marketed, hard molded shin guards are used in field hockey and soccer

40. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Ankle Braces

41. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. Shin GuardsThigh Pads

42. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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 concern about their efficacy in reducing injuries

43. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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

44. © 2005 The McGraw-Hill Companies, Inc. All rights reserved.

45. 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

46. © 2005 The McGraw-Hill Companies, Inc. All rights reserved. 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