Protective Equipment

1. Protective Equipment Sabino Sports Medicine Connie Rauser

2. Protective Equipment • Critical in Injury prevention • Selection, fitting, maintenance • Commitment to athletes’ health & welfare • Important in direct contact & collision sports • Football, wrestling, lacrosse, hockey • Needed in sports that have indirect contact • Basketbal, soccer

3. Safety standards • Concerns for material durability standards • Who should set standards • Mass production of equipment • Equipment testing methods • Requirements for wearing protective equipment

4. Safety standards • Needed for protective equipment maintenance • To keep it in good repair • To determine when to throw it away • Old, worn out, & ill-fitting equipment is passed down from varsity to younger players increasing risk of injury

5. National organizations addressing the issues Engineering, chemistry, biomechanics, anatomy, physiology, physics, computer science

6. National organizations American National Standards Institute American Society for Testing Materials Athletic Equipment Manufacturers Association Hockey Equipment Certification Council National Athletic Trainers Association (NATA) National Collegiate Athletic Association (NCAA)

7. National Organizations National Association of Intercollegiate Athletics (NAIA) National Federation of State High School Athletic Association National Operating Committee on Standards for Athletic Equipment (NOCSAE) Sporting Goods Manufacturers Association U.S. Consumer Product Safety Commission

8. Reconditioning & Recertification NOCSAE established voluntary test standards developed to reduce head injuries by establishing minimum safety requirements for football helmets/face masks, baseball/softball batting helmets, baseballs & softballs, lacrosse helmets/face masks. Adopted by NCAA and NFSHSA

9. Reconditioning/Recertification • Factors that determine condition of helmet over time • Type of helmet • Amount of use • Intensity of use

10. Reconditioning/Recertification NOCSAE helmet standard is not a warranty It is a statement that says a particular helmet has met the requirements of performance tests when it was manufactured or retested

11. 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

12. Legal Concerns • If equipment is modified --modifier becomes liable • 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)

13. 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

14. Off the Shelf vs. Custom Protective Equipment • Customized equipment • Constructed according to the individual • Specifically sized and designed for protective and supportive needs

15. Head Protection Direct collision sports require head protection due to impacts, forces, velocities and implements

16. Head Protection • 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

17. Head Protection • 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

18. Head Protection • 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

19. Head Protection • All helmets must have a NOCSAE certification • Warning: Do not strike an opponent with any part of this helmet or face mask. This is a violation of football rules and may cause you to suffer severe brain or neck injury: including paralysis or death. Severe brain or neck injury may also occur accidentally while playing football. NO HLEMET CAN PREVENT ALL SUCH INJURIES. USE THIS HELMET AT YOUR OWN RISK.

23. Helmet Fitting When fitting head/hair should be wet to simulate sweat Follow manufacturer’s directions

24. Helmet Fitting • 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)

25. Helmet Fitting Certification does no good if helmet is not fit and maintained

27. 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

28. Ice Hockey Helmets 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

30. 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)

31. 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

32. Face Protection • 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

33. Face Protection • 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

35. Face Protection • 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

36. Face Protection • Do not cut down mouth guard as it void 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

37. Face Protection • Ear Guards • Most sports do not use • Wrestling, water polo and boxing utilize to prevent ear irritation and ultimate deformity of ears

38. Face Protection • Eye Protection • Highest percentage of eye injuries are sports related • Generally blunt trauma

39. Face Protection • 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

40. Face Protection • 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

41. Face Protection • 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

42. Face Protection • Neck Protection • Serve primarily as a reminder to athlete to be cautious rather than providing definitive restrictions

43. 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

44. Trunk and Thorax Protection 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

46. Trunk and Thorax Protection • 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)

47. Trunk and Thorax Protection • 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

48. Trunk and Thorax Protection • 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

49. Cantilevered Non-cantilevered