Abstract & Commentary
Synopsis: The helmet and shoulder pads should be left on during spine-board immobilization of the injured football player.
Source: Tierney RT, et al. Head position and football equipment influence cervical spinal-cord space during immobilization. Journal of Athletic Training. 2002;37(2):185-189.
Tierney and colleagues assessed the effect of head position and football equipment (helmet and shoulder pads) on cervical spinal cord space in subjects lying supine on a spine board. Magnetic resonance imaging (MRI) data from 12 subjects were analyzed for sagittal space available for the cord (SAC), sagittal diameter of the spinal cord, and cervical-thoracic angle. The MRI scans were evaluated midsagittally at each spinal level (C3-C7). The sagittal-diameter spinal canal and spinal cord measurements were taken at the midpoint of the vertebral body, and were traced manually. The spinal-canal diameter was measured as the shortest distance from the vertebral body to the spinolaminar line. The spinal-cord diameter was measured at the appropriate spinal levels. The SAC was determined by subtracting the sagittal-cord diameter from the corresponding sagittal-canal diameter. The cervical-thoracic angle was determined by drawing a line parallel with the dorsal aspect of the C2 and C3 vertebral bodies and a line parallel with the dorsal aspects of the T1 and T2 vertebral bodies.
Subjects were positioned supine on the spine board, and were MRI scanned at 0 cm, 2 cm, and 4 cm of occiput elevation with occipital padding with no helmet and shoulder pads and with helmet and shoulder pads. The sagittal-diameter spinal-cord values ranged from 6.22-8.89 mm, and the cervical-thoracic angle averages ranged from 15.43-22.88°. The findings were that the SAC was significantly greater for 0-cm than for 2-cm and 4-cm positions. The SAC was significantly greater for the equipment condition than for the 2-cm and 4-cm positions. There was no significant difference in SAC between 0-cm and the equipment condition.
Comment by David Perrin, PhD, ATC
The 0-cm of occipital padding was the most extended position assessed in this study. This position produced the greatest sagittal space available for the cord, and there was no difference between this position and the equipment condition. This supports the recommendation that the football helmet and shoulder pads should both be left on during management and immobilization of the spinal cord injured football player. This recommendation is consistent with the Inter-Association Task Force for the Appropriate Care of the Spine-Injured Athlete.1
Access to the airway of the football player immobilized with the helmet in place can be obtained by removal of the facemask. Various instruments are available for this removal, including polyvinyl chloride pipe cutters, an anvil pruner, screwdrivers, EMT shears, rotary cutting devices, the Trainer’s Angel, and the Face Mask Extractor.2 The sports medicine team, on a regular basis and in advance of an actual neck injury, should practice the technique. It is also essential that the sports medicine team be on the same page with the local EMS in management of the spine-injured football player so that a debate about removal of the helmet doesn’t occur during management of an actual injury.
At some point, the football helmet and shoulder pads must be removed, and this most appropriately occurs in the emergency room. It is not surprising that typical emergency room personnel are not trained in removal of this equipment in a manner that minimizes cervical spine motion. Consequently, it is imperative that a member of the sports medicine team trained in the proper technique of helmet and shoulder pad removal accompanies the injured athlete to the medical facility to provide assistance. Proper management of the potentially spine-injured athlete on the field and in the medical facility can prevent a serious injury from becoming catastrophic.
Dr. Perrin, Dean, School of Health and Human Performance, University of North Carolina Greensboro, is Associate Editor of Sports Medicine Reports.
References
1. Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. General Guidelines. Available at: http://nata.org.
2. Swartz EE, et al. A 3-dimensional analysis of facemask removal tools in inducing helmet movement. Journal of Athletic Training. 2002;37(2):178-184.
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