Erik E. Swartz

National athletic trainers' association position statement: preventing sudden death in sports

OBJECTIVE To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports. BACKGROUND Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes. RECOMMENDATIONS These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine- Injured Athlete

OBJECTIVE To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. BACKGROUND The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. RECOMMENDATIONS Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

Football equipment design affects face mask removal efficiency.

Background Researchers have investigated the performance of face mask removal tools for spine injury management in football but not the effects of football equipment design. Hypotheses Various styles or designs of football helmet equipment (helmets, face masks, loop straps) affect face mask removal efficiency. A cordless screwdriver performs more efficiently than do cutting tools. Study Design Controlled laboratory study. Methods Nineteen certified athletic trainers were randomly assigned to group 1 (cordless screwdriver and the FM Extractor) or group 2 (cordless screwdriver and the Trainers Angel). Subjects randomly performed face mask removal for 6 conditions composed of helmet (3), face mask (3), and loop strap (5) combinations. Time, head movement, perceived difficulty, and success rates were measured. Results Multiple significant differences were found in time, movement, and perceived difficulty between the 6 helmet equipment conditions. The Shockblocker loop strap was consistently superior in all variables regardless of the tool used or the helmet it was attached to. The cordless screwdriver created less movement (mean range from any one plane, 2.8°-13.3°), was faster (mean range, 42.1-68.8 seconds), and was less difficult (mean rating of perceived exertion range, 1.4-2.9) compared to cutting tools (ranges, 4.4°-18.4° in any one plane, 71-174 seconds, rating of perceived exertion, 2.8-7.7). Trial failure was more common with cutting tools than with the screwdriver. Conclusion Differences in football helmet equipment affect face mask removal. The cordless screwdriver is more efficient than the FM Extractor and Trainers Angel. Clinical Relevance Professionals responsible for the care of football athletes must be knowledgeable in the types of equipment used and the best option available for effective airway access.

Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players

OBJECTIVE To test a helmetless-tackling behavioral intervention for reducing head impacts in National Collegiate Athletic Association Division I football players. DESIGN Randomized controlled clinical trial. SETTING Football field. PATIENTS OR OTHER PARTICIPANTS Fifty collegiate football players (intervention = 25, control = 25). INTERVENTION(S) The intervention group participated in a 5-minute tackling drill without their helmets and shoulder pads twice per week in the preseason and once per week through the season. During this time, the control group performed noncontact football skills. MAIN OUTCOME MEASURE(S) Frequency of head impacts was recorded by an impact sensor for each athlete-exposure (AE). Data were tested with a 2 × 3 (group and time) repeated-measures analysis of variance. Significant interactions and main effects (P < .05) were followed with t tests. RESULTS Head impacts/AE decreased for the intervention group compared with the control group by the end of the season (9.99 ± 6.10 versus 13.84 ± 7.27, respectively). The intervention group had 30% fewer impacts/AE than the control group by seasons end (9.99 ± 6.10 versus 14.32 ± 8.45, respectively). CONCLUSION A helmetless-tackling training intervention reduced head impacts in collegiate football players within 1 season.

Electromyography of 3 Scapular Muscles: A Comparative Analysis of the Cuff Link Device and a Standard Push-Up

CONTEXT The Cuff Link is a closed kinetic chain rehabilitation apparatus for the upper extremity. Limited research has established its effectiveness to elicit muscle activation of the scapular muscles. OBJECTIVE To determine if scapular muscle activation differs in response to 2 upper extremity closed kinetic chain exercises: Cuff Link and standard push-up. DESIGN A single-group, repeated-measures design. SETTING Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-eight healthy individuals (13 women: age = 19.69 +/- 1.55 years, height = 167.44 +/- 9.52 cm, mass = 61.00 +/- 8.79 kg; 15 men: age = 22.00 +/- 3.91 years, height = 181.44 +/- 6.60 cm, mass = 82.36 +/- 13.23 kg) with no history of shoulder or low back injury volunteered to participate in this study. INTERVENTION(S) Participants performed 10 trials of complete revolutions on the Cuff Link and 10 full-weight-bearing push-ups. We controlled trial velocity and randomized order. Trunk and shoulder positions were normalized to the participants height. Using surface electromyography, we recorded muscle activity of the serratus anterior, middle trapezius, and lower trapezius. Rectified and smoothed electromyography data for the serratus anterior, middle trapezius, and lower trapezius were normalized as a percentage of the maximal voluntary isometric contractions (%MVIC). MAIN OUTCOME MEASURE(S) Mean muscle activity of the serratus anterior, middle trapezius, and lower trapezius. We used paired-samples t tests to analyze the mean data for each condition. The alpha level was adjusted to .016 to avoid a type I error. RESULTS Middle trapezius %MVIC was greater during push-ups (27.01 +/- 20.40%) than during use of the Cuff Link (11.49 +/- 9.46%) (P = .001). Lower trapezius %MVIC was greater during push-ups (36.07 +/- 18.99%) than during use of the Cuff Link (16.29 +/- 8.64%) (P = .001). There was no difference in %MVIC for the serratus anterior between conditions. CONCLUSIONS The push-up demonstrated greater middle trapezius and lower trapezius activation levels compared with the Cuff Link. However, the push-up had a high participant failure rate. Because serratus anterior activation levels were similar, the Cuff Link may be an appropriate alternative for individuals lacking the upper body strength to perform a push-up.

Combined Tool Approach is 100% Successful for Emergency Football Face Mask Removal

Objective:To compare effectiveness of two techniques for removing football face masks: cutting loop straps [cutting tool: FMXtractor® (FMX)] or removing screws with a cordless screwdriver and using the FMXtractor as needed for failed removals [combined tool (CT)]. Null hypotheses: no differences in face mask removal success, removal time or difficulty between techniques or helmet characteristics. Design:Retrospective, cross-sectional. Setting:NOCSAE-certified helmet reconditioning plants. Participants:600 used high school helmets. Interventions:Face mask removal attempted with two techniques. Main Outcome Measurements:Success, removal time, rating of perceived exertion (RPE). Results:Both techniques were effective [CT 100% (300/300); FMX 99.4% (298/300)]. Use of the backup FMXtractor® in CT trials was required in 19% of trials. There was significantly (P < 0.001) less call for the backup tool in helmets with silver screws (6%) than in helmets with other screws (31%). Mean removal time was 44.51 ± 18.79s (CT: 37.84 ± 15.37s, FMX: 51.21 ± 19.54s; P < 0.001). RPE was different between techniques (CT: 1.83 ± 1.20, FMX: 3.11 ± 1.27; P < 0.001). Removal from helmets with silver screws was faster (Silver = 33.38 ± 11.03, Others = 42.18 ± 17.64; P < 0.001) and easier (Silver = 1.42 ± 0.89, Other = 2.23 ± 1.33; P < 0.001). Conclusions:CT was faster and easier than FMX. Most CT trials were completed with the screwdriver alone; helmets with silver screws had 94% screwdriver success. Clinically, these findings are important because this and other research shows that compared to removal with cutting tools, screwdriver removal decreases time, difficulty and helmet movement (reducing potential for iatrogenic injury). The combined-tool approach captures benefits of the screwdriver while offering a contingency for screw removal failure. Teams should use degradation-resistant screws. Clinical Relevance:Sports medicine professionals must be prepared with appropriate tools and techniques to efficiently remove the face mask from an injured football players helmet.

The combined tool approach for face mask removal during on-field conditions

CONTEXT An effective approach to emergency removal of the face mask (FM) from a football helmet should include successful removal of the FM and limitation of both the time required and the movement created during the process. Current recommendations and practice are to use a cutting tool to remove the FM. Researchers recently have suggested an alternate approach that combines the use of a cordless screwdriver and a cutting tool. This combined tool approach has not been studied, and FM removal has not been studied in a practical setting. OBJECTIVE To investigate the effectiveness and speed of using a combined tool approach to remove the FMs from football helmets during on-field conditions throughout the course of a football season. DESIGN Randomized multigroup design. SETTING Practice field of 1 National Collegiate Athletic Association Division II football college. PATIENTS OR OTHER PARTICIPANTS Eighty-four members of 1 football team. INTERVENTION(S) We used a battery-operated screwdriver for FM removal and resorted to using a cutting tool as needed. MAIN OUTCOME MEASURE(S) We tracked FM removal success and failure and trial time and compared results based on helmet characteristics, weather variables, and the seasonal timing of the removal trial. RESULTS Of the 84 players, 76 were available for data-collection trials. Overall, 98.6% (75/76) of FM removal trials were successful and resulted in a mean removal time of 40.09 +/- 15.1 seconds. We found no differences in FM removal time throughout the course of the season. No differences in effectiveness or trial time were found among helmet characteristics, weather variables, or the timing of the trial. CONCLUSIONS Combining the cordless screwdriver and cutting tool provided a fast and reliable means of on-field FM removal in this Division II setting. Despite the excellent overall result, 1 FM was not removed in a timely manner. Therefore, we recommend that athletic trainers practice helmet removal to be prepared should FM removal fail.

Maintaining Neutral Sagittal Cervical Alignment After Football Helmet Removal During Emergency Spine Injury Management

Study Design. Descriptive laboratory study. Objective. To determine whether the placement of padding beneath the occiput after helmet removal is an effective intervention to maintain neutral sagittal cervical spine alignment in a position comparable with the helmeted condition. Summary of Background Data. Current on-field recommendations for managing football athletes with suspected cervical spine injuries call for face mask removal, rather than helmet removal, because the combination of helmet and shoulder pads has been shown to maintain neutral cervical alignment. Therefore, in cases when helmet removal is required, recommendations also call for shoulder pad removal. Because removal of equipment causes motion, any technique that postpones the need to remove the shoulder pads would reduce prehospital motion. Methods. Four lateral radiographs of 20 male participants were obtained (age = 23.6 ± 2.7 years). Radiographs of participants wearing shoulder pads and helmet were first obtained. The helmet was removed and radiographs of participants with occipital padding were obtained immediately and 20 minutes later and finally without occipital padding. Cobb angle measurements for C2–C6 vertebral segments were determined by an orthopedic spine surgeon blinded to the studys purpose. Intraobserver reliability was determined using intraclass coefficient analysis. Measurements were analyzed using a 1×4 repeated-measures analysis of variance and post hoc pairwise comparisons with Bonferroni correction. Results. Intraobserver analysis showed excellent reliability (intraclass correlation = 1.0; 95% confidence interval [CI], 0.999–1.0). Repeated-measures analysis of variance detected significant differences (F3,17 = 13.34; P < 0.001). Pairwise comparisons revealed no differences in cervical alignment (all measurements reported reflect lordosis) when comparing the baseline helmeted condition (10.1° ± 8.7°; 95% CI, 6.0–14.1) with the padded conditions. Measurements taken after removal of occipital padding (14.4° ± 8.1°; 95% CI, 10.6–18.2) demonstrated a significant increase in cervical lordosis compared with the immediate padded measurement (9.5° ± 6.9°; 95% CI, 6.3–12.7; P = 0.011) and the 20-minute padded measurement (6.5° ± 6.8°; 95% CI, 3.4–9.7; P < 0.001). Conclusion. Although face mask removal remains the standard, if it becomes necessary to remove the football helmet in the field, occipital padding (along with full body/head immobilization techniques) may be used to limit cervical lordosis, allowing safe delay of shoulder pad removal.

Emergency face-mask removal effectiveness: a comparison of traditional and nontraditional football helmet face-mask attachment systems

CONTEXT Football helmet face-mask attachment design changes might affect the effectiveness of face-mask removal. OBJECTIVE To compare the efficiency of face-mask removal between newly designed and traditional football helmets. DESIGN Controlled laboratory study. SETTING Applied biomechanics laboratory. PARTICIPANTS Twenty-five certified athletic trainers. INTERVENTION(S) The independent variable was face-mask attachment system on 5 levels: (1) Revolution IQ with Quick Release (QR), (2) Revolution IQ with Quick Release hardware altered (QRAlt), (3) traditional (Trad), (4) traditional with hardware altered (TradAlt), and (5) ION 4D (ION). Participants removed face masks using a cordless screwdriver with a back-up cutting tool or only the cutting tool for the ION. Investigators altered face-mask hardware to unexpectedly challenge participants during removal for traditional and Revolution IQ helmets. Participants completed each condition twice in random order and were blinded to hardware alteration. MAIN OUTCOME MEASURE(S) Removal success, removal time, helmet motion, and rating of perceived exertion (RPE). Time and 3-dimensional helmet motion were recorded. If the face mask remained attached at 3 minutes, the trial was categorized as unsuccessful. Participants rated each trial for level of difficulty (RPE). We used repeated-measures analyses of variance (α  =  .05) with follow-up comparisons to test for differences. RESULTS Removal success was 100% (48 of 48) for QR, Trad, and ION; 97.9% (47 of 48) for TradAlt; and 72.9% (35 of 48) for QRAlt. Differences in time for face-mask removal were detected (F(4,20)  =  48.87, P  =  .001), with times ranging from 33.96 ± 14.14 seconds for QR to 99.22 ± 20.53 seconds for QRAlt. Differences were found in range of motion during face-mask removal (F(4,20)  =  16.25, P  =  .001), with range of motion from 10.10° ± 3.07° for QR to 16.91° ± 5.36° for TradAlt. Differences also were detected in RPE during face-mask removal (F(4,20)  =  43.20, P  =  .001), with participants reporting average perceived difficulty ranging from 1.44 ± 1.19 for QR to 3.68 ± 1.70 for TradAlt. CONCLUSIONS The QR and Trad trials resulted in superior results. When trials required cutting loop straps, results deteriorated.

In vivo biomechanical measurements of a football player's C6 spine fracture.

Sports are a common cause of spine injuries. Video footage documented an 18-year-old football player who sustained a cervical spine fracture during a head-down tackling maneuver. A telemetry system in the players helmet measured the location and magnitude of the impact that caused the injury.