The Effect of Football Shoulder Pad Removal
Technique and Equipment Removal Training on Cervical Spine Motion, Time to Task
Completion, and Perceived Task Difficulty

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

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

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?

by: Catherine E. Lewis and
Adam B. Rosen
by: Jeffrey Driban



Lenhardt, 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