Sports injuries are very common in both contact sports and non contact sports. In the USA more than 3.5 million children under the age of 14 receive medical treatment related to sports injuries each year. High school athletes account for about 2 million injuries each year. According to CDC, more than half of the sports injuries in children are preventable. Hootman et al collected data over A 16 year period and found that injury rates were statistically more significant in games than in practice. They calculated the injuries per 1000 A-E (athlete-exposure per game or practice), and they reported about 13.8 injuries per 1000 A-E in games, and about 4.0 injuries per 1000 A-E in practice.
Sports can be briefly categorized into contact/collision sports, limited-contact sports and non-contact sports. Injuries in contact sports and adventurous sports can be fatal. Although death from sports injury is very rare, sports and recreational injuries account for about 21% of traumatic brain injuries among American children. One of the important aspects in sports medicine and in the prevention of athletic injuries is protective gears. The physical therapist’s role is to ensure safety, prevention of injuries and protecting existing injuries. Knowledge on different types of athletic equipment available may help physical therapists in proper selection and fitting of the equipment, as this can play a key role in preventing injuries
There are various regulatory bodies/organizations who undertake the responsibility of the durability of the equipment and have a set standards for the equipment. US athletic equipment standards are issued by NOCSAE (National Operating Committee on Standards for Athletic Equipment), and ASTM (American Society for Testing and Materials) is another regulatory body. NOCSAE is most widely recognized certification. The committee started initially with the primary focus on football helmets and its effectiveness in reducing injuries. All helmets has to be reconditioned and re-certified every year. It also requires manufacturers to post a warning on the football helmet. Other governing bodies are, ISO (International Organization of Standardization), ANSI (American National Standard Institute), and CPSC (Consumer Product Safety Commission)
Highly resilient materials are used when protection from repeated impacts is required. Non-resilient materials can be used when one time or occasional impact is expected. Different types of protective materials include:
- Foam – Two main type: open-cell and closed-cell. Open-cell foams are low density materials, have the capacity to absorb fluids and are commonly used to pad a bony prominence or hard edges of protective equipment. Open-cell do not have good shock absorbing qualities. Closed-cell has superior shock absorbing abilities, resilience to absorption of fluid and is more preferred.
- Air management pads are a relatively new type used when maximal shock absorption is required in lightweight gear.
- Gel like Orthogel is useful in absorbing shock. Gel is useful for protecting bony areas such as the foot, hand and AC joint. It can be cut as a horseshoe pad to treat ankle sprain, which can be used with cryotherapy. Lack of longevity is a draw-back associated with gel.
- Felt is extremely useful for creating various types of supports and protective pads. It is used for arch supports and as horseshoe to reduce edema to treat an ankle sprain.
- Thermoplastics can be used for splints and custom pad. It can be divided into plastic and rubber. Plastic is more appropriate for small splints, such as on the hand. Working temperature for this materials range from 150 to 180 degrees F.
- Casting material like silicone elastomer is popular in fabricating soft splints for hands or wrist injuries.
List of sports requiring head protection include: Amateur boxing, baseball, cycling, football, ice hockey, men’s’ lacrosse, softball, cricket and whitewater sports.
- Athlete should be aware of inspection of helmet before usage as: Check foam padding for proper placement and any deterioration. Check for cracks. Check for any alteration. Check for inflation in air-padded helmets. Check fastening.
- A helmet is not legal for use if the warning label adopted by NOCSAE is not visible.
- Revolution helmet by Riddell has shown to reduce the risk of concussion by as much as 31 percent.
- Helmet fitting – Athlete should wet the hair (to simulate sweat) or wear the hair the way it will be worn during the season during helmet fitting. (A) Should fit snugly. (B) Should cover the base of the skull. (C) Should not come down over the eyes. (D) Ear holes should line up external ear canals. (E) Face mask should not move with external force. Four-snap chin strap keeps the helmet from tilting forward and backward. (F) Should not shift when manual pressure is applied.
Ice Hockey Helmet – Must only absorb singular as opposed to multiple impacts in football. Helmet should also protect the head from low-mass, high-velocity impact forces (like hit with stick or puck) in addition to high-mass, low velocity (like fall). Must be certified by Canadian standards association (CSA). Use of full-face shield reduces the number and severity of facial injuries.
Baseball Helmets – should absorb high-velocity impacts. Ability to prevent head injury is questionable.
- Main purpose is to protect against projectile, carried objects and collisions with other players.
- Junior A hockey players wearing no face visor were 4.7 times more likely to suffer eye and face injuries.
- NCAA require goal keepers to wear throat protection as well as face protection.
- Men’s lacrosse rule mandate helmets and face masks with a NOCSAE standard.
- Single strap allows some rotation of the helmet but is usually adequate in maintaining the appropriate position of the helmet on the top of the head. Used in sports like cycling and kayaking.
- Four-point chin strap used in sports like football and lacrosse, which are secured by either the high hookup or the low hookup. Decrease the angle of low hookup means that there is less chance of the chin strap rotating off the chin.
Eye and Ear Protection
- Special precautions should be taken in sports like ice hockey, men’s and women’s lacrosse, baseball, basketball, squash and handball.
- Types of eye protectors: Total head protector (used in football, lacrosse, hockey), full-face protector (used in fencing, catching or umpiring), separate eye protector (used in ski racing, auto racing, cycling, and horseback riding), Partial eye protection (used in boxing). Sports eye protectors (used in baseball, soccer, cross country skiing).
- Sports eye protector: Class I – a molded single unit lens and frame, Class II – lens mounted in a separate frame, Class III – protector that contains no lens that is used alone or over eyeglasses.
- Use of goggles in women’s lacrosse became mandatory in 2004.
- Eye protectors with shatterproof polycarbonate or CR 36 prescription lenses give good protection during sports activities.
- “One-eyed” Athlete – Athlete is considered “one-eyed” if the corrected vision is 20/200 or less in one eye. Athlete should not participate in extremely high risk sports like boxing.
- “Cauliflower Ear” – Hematoma in the outer ear, may occur without use of appropriate equipment.
- Ear protection is required in sports like boxing, wrestling, and water polo, because of high incidence of ear injury in these sports.
- NCAA require participants to wear mouth guards for the sports such as football.
- There is no consistent evidence suggesting that mouth guards help in preventing concussion, but there is substantial evidence which states that properly fitted mouth guards help in reducing dental injuries.
- Types of mouth guard: “boil and bite” and custom-made.
- Studies suggests that mouth guards do not prevent or reduce the incidence of concussions.
- No significant difference between “boil and Bite” mouth guard and manufactured one.
- Simple “boil and bite” mouth guards are effective and can be bought in bulk to fit an entire team.
- Mouth guards should fit comfortably, not impede speech or breathing, and should extend back as far as last molar.
Neck, Chest and Upper Extremities Protection
Most neck protection does not protect from cervical injuries such as “burners”. Most neck protectors serve as more of a reminder to use proper technique while tackling.
Football shoulder pads
- Football shoulder pads are split in to two types – Cantilevered and non-cantilevered (flat).
- Players performing primarily tackling and blocking are given cantilevered pads. They get the name because of the hard plastic bridge they make over the superior aspect of the shoulder to protect the chest and the back. They come in three types – inside, outside and double cantilevered.
- Players such as quarterbacks and receivers are given non-cantilevered pads because they provide more freedom of movement. They are lightweight and less restricting. They are becoming popular for offensive lineman who principally use their hands to block.
- Football pads provide the ultimate protection for the shoulder, clavicle, sternum and scapula. Attachment can be added to provide protection to the cervical spine, upper extremity, abdomen, ribs, flank and back.
- Anterior and posterior padding extends lower to protect the sternum and ribs of lineman, linebackers and fullbacks.
- Defensive ends require the greater protection of larger cups and flaps for tackling.
- Offensive backs and receivers require smaller shoulder cups and flaps to allow them greater mobility when passing and catching.
- Rules of fitting – Width of shoulders must be measured. (C) Inside of pad should cover tip of shoulder in line with lateral aspect of shoulder. (D) Epaulets and cups must cover deltoid and allow motion. Neck opening must allow athlete to raise arms over head w/out pads sliding forward and back. With split clavicle pads, channel for top of shoulder must be in proper position.
In collegiate and professional football, no rigid material can be worn at the elbow or below unless it is adequately padded with closed-cell foam.
Chest protection is also very commonly used. Baseball catchers, Lacrosse and Ice hockey goalies at every level of play are required to wear a chest protector. Most of these chest guards do nothing more than prevent mild contusions. In animal models it has shown that chest protectors are ineffective in preventing ventricular fibrillation triggered by blows to the chest.
Sports that use a high-velocity projectile such as a baseball, lacrosse ball or hockey puck require protection of the genitalia for the male participants known as Jocks.
Lower Extremities Protection
Thigh and hip protection
- It is necessary in contact sports such as hockey and football. Deep quadriceps contusions are common in all contact sports. Thigh pads should be centered over the quadriceps muscle group approximately 6 to 7 inches above the kneecap.
- Knee protection like knee pads may be used for football and volleyball. Kneepads help to dissipate blunt force trauma but do nothing against twisting or medial and lateral forces.
- Knee braces are categorized into: prophylactic, functional or rehabilitative.
- Prophylactic knee braces are commonly seen as hinged braces on the lateral aspect of knees of football lineman. There is lack of conclusive evidence that knee braces reduce the incidence or severity of the injury. Recent research states that prophylactic knee bracing should neither be discouraged nor recommended for use by college football players.
- Functional knee braces are designed to restore functional stability to the knee after an athlete has suffered a ligamentous disruption. The Lenox hill-type derotation brace has been widely used to provide stability in the ACL-deficient or reconstructed knee. It has been shown that bracing the ACL-deficient knee does reduce anterior translation during non-weight-bearing and weight-bearing activity.
- Rehabilitative knee brace is mainly used post-surgical to provide rigid immobilization at selected angle, to permit controlled range of the motion through predetermined arch or to provide protection from accidental loading in non-weight bearing patients.
Shin guards – Soccer, Ice hockey and field hockey players as well as baseball catchers are required to wear shin guards in intercollegiate play.
- Ankle stabilizers, both rehabilitative and functional are extremely popular in athletics.
- Studies have shown that taping and bracing of ankles has no effect on ankle instability.
- A lace-up brace does decrease the forces placed on the ankle during sudden inversion, but a semi-rigid brace provides the best protection and was more effective in preventing rear foot motion.
- A systematic review of the literature has found that semi-rigid ankle bracing does reduce the incidence of ankle sprains, and reduces recurrent sprains.
- Bracing ankles can help save time and money and be just as effective as taping.