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Protective Equipment. Sabino Sports Medicine Connie Rauser. Protective Equipment. Critical in Injury prevention Selection, fitting, maintenance Commitment to athletes’ health & welfare Important in direct contact & collision sports Football, wrestling, lacrosse, hockey

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protective equipment

Protective Equipment

Sabino Sports Medicine

Connie Rauser

protective equipment2
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
safety standards
Safety standards
  • Concerns for material durability standards
    • Who should set standards
    • Mass production of equipment
    • Equipment testing methods
    • Requirements for wearing protective equipment
safety standards4
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
national organizations addressing the issues
National organizations addressing the issues

Engineering, chemistry, biomechanics, anatomy, physiology, physics, computer science

national organizations
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)

national organizations7
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

reconditioning recertification
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

reconditioning recertification9
  • Factors that determine condition of helmet over time
    • Type of helmet
    • Amount of use
    • Intensity of use
reconditioning recertification10

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

legal concerns
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
legal concerns12
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)
off the shelf vs custom protective equipment
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
off the shelf vs custom protective equipment14
Off the Shelf vs. Custom Protective Equipment
  • Customized equipment
    • Constructed according to the individual
    • Specifically sized and designed for protective and supportive needs
head protection
Head Protection

Direct collision sports require head protection due to impacts, forces, velocities and implements

head protection16
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
head protection17
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
head protection18
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
head protection19
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.
helmet fitting
Helmet Fitting

When fitting head/hair should be wet to simulate sweat

Follow manufacturer’s directions

helmet fitting24
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)
helmet fitting25
Helmet Fitting

Certification does no good if helmet is not fit and maintained

ice hockey helmets
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

ice hockey helmets28
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

baseball batting helmets
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)

face protection
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
face protection32
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
face protection33
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
face protection35
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
face protection36
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
face protection37
Face Protection
  • Ear Guards
    • Most sports do not use
    • Wrestling, water polo and boxing utilize to prevent ear irritation and ultimate deformity of ears
face protection38
Face Protection
  • Eye Protection
    • Highest percentage of eye injuries are sports related
    • Generally blunt trauma
face protection39
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
face protection40
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
face protection41
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
face protection42
Face Protection
  • Neck Protection
    • Serve primarily as a reminder to athlete to be cautious rather than providing definitive restrictions
trunk and thorax protection
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
trunk and thorax protection44
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

trunk and thorax protection46
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)
trunk and thorax protection47
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
trunk and thorax protection48
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



trunk and thorax protection51
Trunk and Thorax 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
trunk and thorax protection52
Trunk and Thorax Protection
  • 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)
trunk and thorax protection53
Trunk and Thorax Protection
  • Thorax Protection
    • Thorax protectors and rib belts
    • Protect against external forces
    • Air-inflated interconnected cylinders (jacket design)
hips and buttocks
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
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
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
lower extremity protective equipment57
Lower Extremity Protective Equipment
  • 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
lower extremity protective equipment58
Lower Extremity Protective Equipment
  • 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

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

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

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

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

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

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
elbow wrist and hand protection
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

construction of protective and supportive devices
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

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

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

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
tools for customizing
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

dynamic splints
Dynamic Splints

Used for injuries in hands and fingers

Provides long duration tension on healing structures

Combination of thermomoldable plastic, elastic and Velcro