Jacobson Bradley, Cendoma Michael, Gdovin Jacob, Cooney Kevin, Bruening Dustin
Sportsmedicine Department, Mercyhurst University, Erie, PA.
J Athl Train. 2014 Jan-Feb;49(1):42-8. doi: 10.4085/1062-6050-48.6.11. Epub 2013 Dec 30.
The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols.
To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels.
Crossover study.
Movement analysis laboratory.
Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg).
INTERVENTION(S): Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal.
MAIN OUTCOME MEASURE(S): We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs.
Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS.
The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care.
美国国家运动训练师协会关于颈椎受伤运动员急性处理的立场声明建议采用“全有或全无”的方法，即对于装备齐全的美式橄榄球和冰球运动员，要么同时摘除头盔和肩垫，要么都不摘除。然而，在支持性研究中，研究人员并未考虑其他方案。
测量认证运动训练师（AT）采用“全有或全无”方法时产生的颈椎运动（头部相对于胸骨），并将这些结果与采用替代的填充包扎方案产生的运动进行比较，该方案是用卷起来的毛巾填充颈部和头部下方及周围区域。
交叉研究。
运动分析实验室。
八名男性大学橄榄球运动员（年龄 = 21.4 ± 1.4岁；身高 = 1.87 ± 0.02米；体重 = 103.6 ± 12.5千克）。
四名AT在四种情况下摘除装备：仅摘除头盔后将头部放在地上（H）、仅摘除头盔后进行填充包扎（HP）、摘除头盔和肩垫后将头部放在地上（HS）、摘除头盔和肩垫后进行填充包扎（HSP）。在摘除装备过程中，使用动作捕捉来跟踪头部相对于胸骨的运动。
我们测量了头部相对于胸骨运动的情况（平移和旋转）。我们使用重复测量的4×4方差分析来比较不同方案和AT之间的离散运动变量（位置变化和总偏移）。
与HS方案导致头部位置下降1.4 ± 0.3厘米相比，HP方案使头部位置上升了0.1 ± 0.6厘米（P < .001）。与HS方案相比，HP方案产生的总角偏移少4.9°（P < .001），总垂直偏移少2.1厘米（P < .001）。
在整个装备摘除过程中，填充包扎方案在最小化颈椎运动方面比摘除肩垫更有效。本研究为在现场护理需要摘除头盔时，将填充包扎方案纳入未来治疗建议提供了证据。
