Cervical Spine Motion During Football Equipment-Removal Protocols: A Challenge to the All-or-Nothing Endeavor.

HEAD physiology; FOOTBALL injuries; CERVICAL vertebrae; STERNUM; PHYSICAL training & conditioning; ANALYSIS of variance; ANTHROPOMETRY; CROSSOVER trials; EMERGENCY medical services; PROTECTIVE clothing; STATISTICS; DATA analysis; BODY movement; CONTINUING education units; REPEATED measures design; MOTION capture (Human mechanics); DATA analysis software; DESCRIPTIVE statistics; PHYSIOLOGY; SPORTS injuries treatment

Context: The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols. Objective: To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels. Design: Crossover study. Setting: Movement analysis laboratory. Patients or Other Participants: Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg). Intervention(s): Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal. Main Outcome Measure(s): We measured head movement relative to sternum movement (translations and rotations). We used 4 x 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs. Results: Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.98 less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS. Conclusions: The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care. [ABSTRACT FROM AUTHOR]

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