The Effect of Football Shoulder Pad Removal Technique and Equipment Removal Training on Cervical Spine Motion, Time to Task Completion, and Perceived Task Difficulty
Lenhardt C, Mihalik J, Lynall R, Fraser M, Petschauer M, and Swartz E. Athletic Training & Sports Health Care. 2015; 7(6):232-41.
Take Home Message: Practice is necessary for efficient equipment removal in American football. Frequent training reduces removal time and motion of the spine in injured athletes.
In an emergency situation in American football where the cervical spine must be stabilized, rapid removal of shoulder pads and helmets may be necessary. In the event of a suspected spine injury, the most recent National Athletic Trainers’ Association Inter-Association Consensus Statement recommends the practice of safe, rapid removal of protective equipment by Athletic Trainers (ATs) before transport when appropriate. However, while swift removal is necessary minimizing excessive movement of the cervical spine is paramount to ensure no further damage to the spinal cord is rendered. Therefore, Lenhardt and colleagues compared head motion of patient models, total amount of time to completion of removal, and perceived task difficulty for: 1) the elevated torso method and 2) the flat torso method using traditional shoulder pads, and 3) the Riddell RipKord shoulder pads among ATs with and without reinforced training four weeks after an initial training session. Thirty-one Certified ATs and one senior student (12 male, 20 female) with ~3.4 years of experience in an equipment-intensive sport environment attended two sessions. The first session involved training in three different equipment removal techniques in a randomized order (flat-torso traditional, elevated-torso traditional and Riddell Ripkord™). Four weeks later at a second session, the investigators randomly placed the participants in the control or reinforced-training group. The reinforced-training group received repeated verbal instruction but not hands-on practice before performing the equipment removal techniques while the control group did not receive any additional instructional content. Researchers collected range of motion in three planes of the head and thorax via a motion capture system. In addition, they also assessed the time of removal and perceived exertion of the participants. Overall, the rate of perceived exertion for the Riddell RipKord was lower than the perceived exertion reported by the ATs for the other two removal techniques. The researchers also found repeat testing improved the speed of removal for all techniques. The Riddell Ripkord time was ~10 seconds less than the other two techniques; however, the authors believed that such a small decrease in time might not be clinically meaningful. Head-to-thorax motion varied among all three methods; however, compared with the control participants the reinforced-training group reduced spine frontal and sagittal plane motion by approximately 1.5° during the flat-torso removal technique. While statistically significant, the clinical importance of this finding remains unclear.
This study provides excellent foundational knowledge for healthcare providers for safe and effective protective equipment removal. The research highlights the need for repetition and not just initial training. Practice should promote comfort with emergency protocols therefore facilitating a reduction in “skill decay”. The best course of action when deciding to remove the helmet and shoulder pads will ultimately be based on the confidence of the professional and the amount of trained rescuers available. The most recent consensus statement recommends three trained rescuers at minimum while four is ideal and more practical to assist in proper removal of most shoulder pad systems. Healthcare practitioners should be cautious since the variation in cervical stabilization techniques can effect removal time and cervical spine motion. Lastly, substantial differences are present when testing in a controlled laboratory environment versus the unpredictability of field of play, which the authors acknowledge. Despite that limitation, this study highlights that ATs should periodically review equipment removal strategies to ensure proficiency.
Questions for Discussion: Are you more comfortable with the flat torso or the elevated torso method of equipment removal? Why do you prefer this technique?
Written by: Catherine E. Lewis and Adam B. Rosen
Reviewed by: Jeffrey Driban
NATA Executive Summary of Appropriate Care of the Spine Injured Athlete Inter-Associate Consensus StatementLenhardt, C., Mihalik, J., Lynall, R., Fraser, M., Petschauer, M., & Swartz, E. (2015). The Effect of Football Shoulder Pad Removal Technique and Equipment Removal Training on Cervical Spine Motion, Time to Task Completion, and Perceived Task Difficulty Athletic Training & Sports Health Care, 7 (6), 232-241 DOI: 10.3928/19425864-20151029-04