Position of the cervical vertebrae during helmet removal and cervical collar application in football and hockey.

There is lack of consensus among prehospital personnel (athletic therapists, paramedics, sport physiotherapists) concerning specific aspects of initial care and assessment of injured athletes presenting signs and symptoms of a cervical spine injury (CSI). In instances of serious injury involving the head and/or spine, complicated by altered levels of consciousness, protective equipment such as helmets and shoulder pads may provide a hinderance to prompt, safe and efficient management. Specifically, there is disagreement concerning the need or advisability of removing protective head gear, as in the case of football and hockey athletes. Using the technique of fluoroscopy, the cervical spine displacement of 21 male football and hockey athletes was determined while wearing protective shoulder pads and protective head equipment at the following times (a) during helmet removal, (b) during cervical collar application, and (c) as the helmetless head was allowed to rest. Subsequent frame-by-frame video arthokinematic analysis, using computer-assisted digitization, showed significant alterations in the position of adjacent cervical vertebrae during helmet removal, cervical collar application, and head rest. Results suggest that stabilization and transportation of football and hockey athletes with suspected CSI in their respective protective equipment is recommended in order to reduce the risk of further trauma by unnecessary cervical spine motion.