KIN 189 – Prevention and Care of Athletic Injuries

Protective Equipment

Energy Absorption and Force Dissipation

• Protective splints

• Material properties

• Classification of materials

• Fabricating splints and braces

Protective Splints Concepts

• Goal/s of splints are to protect, stabilize or immobilize injured area

• Purpose of fixation is to limit motion occurring in area and dissipate forces away from area

• Must understand applied anatomy to determine best style/type of brace

• Must understand properties of materials

Material Properties

• Density• Strength• Rigidity• Conformability• Self-adherence• Durability• Ease of fabrication• Availability and cost

Density

• Weight of material in relation to volume or amount that will be used

• Must consider type/velocity of contact you’re trying to protect from when choosing materials of different density

• Denser materials offer very good protection, but often can come at the expense of bulk and/or weight – best material is one that has as low a density as possible and still affords the desired level of protection

Density

• Various padding materials typically applied underneath hard shells designed to distribute forces

• High density materials– Some foams, viscoelastic materials, silicone

elastomer material

• Medium density materials– Fiberglass, thermoplastics, ortho felt, some foams

• Low density materials– Some foams, cotton padding, neoprene/rubber

Strength

• Maximum external stress/load a material can withstand

• Important to ensuring that splint will function as intended

• Some materials may be strong enough for ADLs, but unable to withstand high impact and some may be able to provide appropriate support but not be conducive to activity

Rigidity

• aka “stiffness” – the amount of bending or compression that occurs in response to a measured amount of applied stress

• Modulus of elasticity– High modulus = more stiffness– Low modulus = less stiffness, more shock

absorption

• Rigidity depends on type, thickness and shape of material – bulk consideration

Conformability

• Ease with which material forms to body part

• Material that is too strong, dense and/or stiff may fail to provide protection because it cannot conform to body part sufficiently

Self-Adherence

• Strength with which the material bonds to itself – determines integrity and durability

• Materials like Velcro are often utilized to bond non-adherent materials together around a body part/joint (irregular surfaces)

Durability

• Ability of material to withstand repeated stress during activity – greater durability = greater longevity of use

• Especially important consideration when working within budgetary constraints

Ease of Fabrication

• Relates to time, equipment and skill needed to shape material for protection and comfort

• Often times, materials require heating in order to be fabricated appropriately – access to heating element?– Mouthpieces

Availability and Cost

• Typically the most significant obstacles for use of splinting materials

• Must be able to work within limitations of budget and/or inventory/access and do best job possible given resources available

Classification of Materials

• No-heat (layered)

• Low heat

• Moderate heat

• High temperature

No-Heat (Layered) Materials

• No heat required to form products into appropriate protective application

• Examples– Athletic tape– Self-adherent wraps– Fiberglass casting material– Silicon (soft-cast) material– Plaster

Low-Heat Products

• Low temperatures required (hot water/oven) to form materials for protective application

• Once material cools down, retains new shape in original rigid state

• Examples– Orthoplast (rubber based)– Polyform (plastic based)– Aquaplast (elastic based)

Moderate and High Temperature Materials

• Not typically used in clinical situations to fabricate protective devices, but used by manufacturers of equipment – temps are dangerous for clinical environment

• One application is in the modification of a manufactured brace for a better fit by using heat gun (temp ~800 degrees!)

Fabricating Splints and Braces

• Not all clinicians able to master the “art” of protective device fabrication – requires practice

• Generally a simple process, but can involve complex steps that are beyond the abilities of some clinicians

Protective Equipment for the Head and Face

• Helmets (football, ice hockey, batting, other)

• Face guards– Specific details regarding helmets/face guards

and fitting guidelines in future class meeting

• Eyewear• Ear wear• Mouthguards• Throat and neck protectors

Eye Wear

• Despite relative prominence of eye injuries, eye protection not required in any sport

• Goggles (swimmer’s vs. skiers)– Typically for comfort due to environment vs. true

protection, can facilitate contact wear• Face shield

– Secondary protection from direct trauma, can be tinted for some sensitive conditions

• Spectacles/glasses– Should be made of plastic/polycarbonate, able to

withstand force of racquetball traveling 90mph, can incorporate Rx

Ear Wear

• Specialized protective devices for amateur boxing, wrestling, water polo, rugby

• Protective cup designed to minimize trauma to external ear – auricular hematoma (Cauliflower ear)

Mouthguards

• Required in football, ice hockey, field hockey and lacrosse – must be visible (colored)

• Minimizes risk of dental and oral soft tissue injuries and also can impact severity or occurrence of concussion/TMJ/jaw injuries

• When properly fitted, does not interfere with breathing or speech

Mouthguards

• “Cutting down” mouthguards invalidates warranties, increases risk of injury and can become an potential oral airway obstruction

• Thermal-set, mouth-formed style (“dip and suck”) vs. custom fabricated– Thermal set is easy, cost-effective and effective– Custom requires training, often must have mold

crafted by dentist, more expensive, best protection

Throat and Neck Protectors

• Minimize risk of injury to significant airway structures

• Required in softball/baseball (catchers) and often used in fencing, lacrosse, field hockey and ice hockey

• Cervical neck rolls/collars designed to limit motion of cervical spine – most common in football– Can enhance protection from burners/stingers, but must

accompany properly fitted shoulder pads

Protective Equipment for the Trunk and Upper Extremities

• Shoulder protection– Specific details regarding shoulder pads and

fitting guidelines in future class meeting

• Elbow, forearm, wrist and hand protection

• Thorax, rib and abdominal protection

• Sports bras

• Lumbosacral protection

Elbow, Forearm, Wrist and Hand Protection

• Areas susceptible to compression and shearing forces in most activities

• Unable to wear rigid protection unless covered by foam padding to minimize risk of injury to others

• Elbow inflammation often assisted by counterforce straps (“tennis elbow”)

• Forearm/wrist/hand often protected with specialized pads and/or gloves

Thorax, Rib and Abdominal Protection

• Required thorax/abdominal protectors for baseball/softball catchers

• Fencers and goalies in many other sports (hockey, lacrosse) as well as QB/WR/RB in football also wear some kind of thorax and abdominal protection

Sports Bras

• Provide additional support to prevent excessive vertical/horizontal breast motion during exercise/activity

• Especially applicable for larger breasted women (C cup or higher)

• Support vs. compression styles in many choices of material for individual preference

Lumbosacral Protection

• Weight training belts designed for additional support/rigidity during heavy lifting activities

• Abdominal/lumbosacral binders used to increase proprioception and intra-abdominal pressure to relieve compressive forces on vertebral column

Protective Equipment for the Lower Extremities

• Hip and buttock protection• Thigh protection• Knee and patella protection• Leg protection• Ankle protection• Foot protection• Shoes• Orthotics

Hip and Buttock Protection

• Padded, rigid inserts required in most collision/contact sports to protect pelvis and sacrum/coccyx

• Male genital region best protected by protective cup in athletic supporter

Thigh Protection

• Padded rigid inserts most common in football

• Typically fit into pockets/”girdle” and minimize risk of direct trauma to quadriceps

• Neoprene sleeves can provide compression and warmth secondary to muscular strains

Knee and Patella Protection

• Prophylactic knee braces– Lateral and bilateral bar designs, metal hinges held in

place by straps/tape, limit hyperextension– Some studies have shown no impact on number or

severity of knee injuries and may actually contribute to higher incidence of injury

• Functional knee braces (“ACL”)– Designed to control tibial translation and rotational

stresses – may be OTC but typically custom fit– Historically required post-ACLR, but recent movement

away from use of brace – no guarantees of increased stability

Knee and Patella Protection

• Rehabilitative braces– Straight immobilizer style with metal rods on sides in

foam secured with straps– Hinged style (sleeve or wrap-around) that can adjust

ROM per symptoms/goals

• Patellofemoral protection– Generally designed to dissipate forces, maintain

patellar alignment and improve patellar tracking– Horseshoe type device incorporated into sleeve– Also use strap device to address patellar tendonitis

Leg Protection

• Most common example is soccer style shin guards – hard outer shell with padded liner

• Shin protectors also required in baseball and softball for catchers, goalies in ice hockey, field hockey and lacrosse

• Cover anterior tibia – held in place by straps or stirrups

Ankle Protection

• 3 common styles of ankle braces– Lace-up – provides best support and protection for all

ankle motions, easily readjusted for fit/comfort– Semirigid (“Active Ankle”) – inversion/eversion

protection only, OK for little change of direction activities (VB)

– Stirrup (“Air Cast”) – must use shoe for effective application

• Braces are more effective at minimizing ankle injuries, are easier to wear/apply, don’t irritate skin and are more cost effective than traditional taping techniques

Foot Protection

• Shoes should cushion impact forces and support foot during stance and push-off phases of gait

• Cleated shoes should have cleats under weight-bearing portions of the foot – should not be felt through the sole of the shoe– Long outer cleats with short inner cleats

increases torsional forces and increases risk of ACL injury

Shoes

• Components of shoes– Sole: inner (liner interfaces with foot), middle (many materials –

gel/air/etc. to absorb shock), outer (typically rubber, interfaces with surfaces, style dependent upon activity)

– Heel counter: provides stability to minimize ankle injury, varies by activity applications

– Toe box: all toes should fully extend and wiggle in shoe– Upper: varied materials and laces – designed to hold shoe in

place and facilitate cooling/protection/weight issues

• Activities with high impact should have additional heel cushioning/support

• Individuals with toe abnormalities should have wider toe box

Orthotics

• Devices used in treatment of foot/gait abnormalities and related conditions

• Some are OTC, but most require Rx and fitting by qualified personnel

• 3 categories– Orthotics to change foot function– Protective orthotics– Orthotics that combine functional control with

protection

Orthotics

• 3 types/materials– Rigid: designed to control motion, designed from firm

material (plastic, polycarbon), worn most in dress/walking shoes

– Soft: used to absorb shock, improve balance and relieve pressure sites, designed from soft materials (neoprene, felt, foam), break down easily and must be replaced

– Semirigid: used to provide dynamic balance of foot during activity, designed from layers of soft material reinforced by hard/rigid materials, most common application