Meredith A. Petschauer

Head Impact Biomechanics in Women’s College Soccer

INTRODUCTION There are limited nonlaboratory soccer head impact biomechanics data. This is surprising given soccers global popularity. Epidemiological data suggest that female college soccer players are at a greater concussion injury risk than their male counterparts. Therefore, the purposes of our study were to quantify head impact frequency and magnitude during womens soccer practices and games in the National Collegiate Athletic Association and to characterize these data across event type, playing position, year on the team, and segment of game (first and second halves). METHODS Head impact biomechanics were collected from female college soccer players (n = 22; mean ± SD age = 19.1 ± 0.1 yr, height = 168.0 ± 3.5 cm, mass = 63.7 ± 6.0 kg). We employed a helmetless head impact measurement device (X2 Biosystems xPatch) before each competition and practice across a single season. Peak linear and rotational accelerations were categorized based on impact magnitude and subsequently analyzed using appropriate nonparametric analyses. RESULTS Overall, womens college soccer players experience approximately seven impacts per 90 min of game play. The overwhelming majority (~90%) of all head impacts were categorized into our mildest linear acceleration impact classification (10g-20g). Interestingly, a higher percentage of practice impacts in the 20g-40g range compared with games (11% vs 7%) was observed. CONCLUSION Head impact biomechanics studies have provided valuable insights into understanding collision sports and for informing evidence-based rule and policy changes. These have included changing the football kickoff, ice hockey body checking ages, and head-to-head hits in both sports. Given soccers global popularity, and the growing public concern for the potential long-term neurological implications of collision and contact sports, studying soccer has the potential to impact many athletes and the sports medicine professionals caring for them.

Comparison of 3 Airway Access Techniques During Suspected Spine Injury Management in American Football.

OBJECTIVE To determine how head movement and time to access airway were affected by 3 emergency airway access techniques used in American football. DESIGN Prospective counterbalanced design. SETTING University research laboratory. PARTICIPANTS Eighteen certified athletic trainers (ATCs) and 18 noncertified students (NCSs). INTERVENTIONS Each participant performed 1 trial of each of the 3 after airway access techniques: quick release mechanism (QRM), cordless screwdriver (CSD), and pocket mask insertion (PMI). MAIN OUTCOME MEASURES Time to task completion in seconds, head movement in each plane (sagittal, frontal, and transverse), maximum head movement in each plane, helmet movement in each plane, and maximum helmet movement in each plane. RESULTS We observed a significant difference between all 3 techniques with respect to time required to achieve airway access (F(2,68) = 263.88; P < 0.001). The PMI allowed for the quickest access followed by the QRM and CSD techniques, respectively. The PMI technique also resulted in significantly less head movement (F(2,68) = 9.06; P = 0.001) and less maximum head movement (F(2,68) = 13.84; P < 0.001) in the frontal plane compared with the QRM and CSD techniques. CONCLUSIONS The PMI technique should be used to gain rapid airway access when managing a football athlete experiencing respiratory arrest in the presence of a suspected cervical spine injury. In the event the athlete does not present with respiratory arrest, the facemask may be removed carefully with a pocket mask ready. Medical professionals must be familiar with differences in equipment and the effects these may have on the management of the spine-injured athlete.Objective: To determine how head movement and time to access airway were affected by 3 emergency airway access techniques used in American football. Design: Prospective counterbalanced design. Setting: University research laboratory. Participants: Eighteen certified athletic trainers (ATCs) and 18 noncertified students (NCSs). Interventions: Each participant performed 1 trial of each of the 3 after airway access techniques: quick release mechanism (QRM), cordless screwdriver (CSD), and pocket mask insertion (PMI). Main Outcome Measures: Time to task completion in seconds, head movement in each plane (sagittal, frontal, and transverse), maximum head movement in each plane, helmet movement in each plane, and maximum helmet movement in each plane. Results: We observed a significant difference between all 3 techniques with respect to time required to achieve airway access (F2,68 = 263.88; P < 0.001). The PMI allowed for the quickest access followed by the QRM and CSD techniques, respectively. The PMI technique also resulted in significantly less head movement (F2,68 = 9.06; P = 0.001) and less maximum head movement (F2,68 = 13.84; P < 0.001) in the frontal plane compared with the QRM and CSD techniques. Conclusions: The PMI technique should be used to gain rapid airway access when managing a football athlete experiencing respiratory arrest in the presence of a suspected cervical spine injury. In the event the athlete does not present with respiratory arrest, the facemask may be removed carefully with a pocket mask ready. Medical professionals must be familiar with differences in equipment and the effects these may have on the management of the spine-injured athlete.

Effect of ice hockey helmet fit on cervical spine motion during an emergency log roll procedure.

Objective:To investigate cervical spine motion during a log roll technique in ice hockey players under different helmet fit conditions. Design:Prospective counterbalanced design. Setting:University research laboratory. Participants:Eighteen club ice hockey players were recruited to participate in this study. Assessment of Risk Factors:A standard emergency log roll was performed 3 times under each of 3 different helmet fit conditions: properly fit, improperly (competition) fit, and helmet-removed. Main Outcome Measurements:Frontal, sagittal, and transverse plane cervical spine motion were used as outcome measures. Results:Significantly less sagittal and transverse plane motion occurred during the helmet-removed condition. No differences in frontal plane motion among the 3 conditions were observed. Conclusions:Presence of helmet (whether properly fit or not) resulted in increased of sagittal and transverse plane movement. This suggests that when an ice hockey helmet is stabilized, the head within it is not. We recommend the helmet and face shield be removed before performing an emergency prone log roll.

Helmet fit and cervical spine motion in collegiate men’s lacrosse athletes secured to a spine board.

CONTEXT Proper management of cervical spine injuries in mens lacrosse players depends in part upon the ability of the helmet to immobilize the head. OBJECTIVE To determine if properly and improperly fitted lacrosse helmets provide adequate stabilization of the head in the spine-boarded athlete. DESIGN Crossover study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Eighteen healthy collegiate mens lacrosse players. INTERVENTION(S) Participants were asked to move their heads through 3 planes of motion after being secured to a spine board under 3 helmet conditions. MAIN OUTCOME MEASURE(S) Change in range of motion in the cervical spine was calculated for the sagittal, frontal, and transverse planes for both head-to-thorax and helmet-to-thorax range of motion in all 3 helmet conditions (properly fitted, improperly fitted, and no helmet). RESULTS Head-to-thorax range of motion with the properly fitted and improperly fitted helmets was greater than in the no-helmet condition (P < .0001). In the sagittal plane, range of motion was greater with the improperly fitted helmet than with the properly fitted helmet. No difference was observed in helmet-to-thorax range of motion between properly and improperly fitted helmet conditions. Head-to-thorax range of motion was greater than helmet-to-thorax range of motion in all 3 planes (P < .0001). CONCLUSIONS Cervical spine motion was minimized the most in the no-helmet condition, indicating that in lacrosse players, unlike football players, the helmet may need to be removed before stabilization.

Delivering Chest Compressions and Ventilations With and Without Men's Lacrosse Equipment

CONTEXT   Current management recommendations for equipment-laden athletes in sudden cardiac arrest regarding whether to remove protective sports equipment before delivering cardiopulmonary resuscitation are unclear. OBJECTIVE   To determine the effect of mens lacrosse equipment on chest compression and ventilation quality on patient simulators. DESIGN   Cross-sectional study. SETTING   Controlled laboratory. PATIENTS OR OTHER PARTICIPANTS   Twenty-six licensed athletic trainers (18 women, 8 men; age = 25 ± 7 years; experience = 2.1 ± 1.6 years). INTERVENTION(S)   In a single 2-hour session, participants were block randomized to 3 equipment conditions for compressions and 6 conditions for ventilations on human patient simulators. MAIN OUTCOME MEASURE(S)   Data for chest compressions (mean compression depth, compression rate, percentage of correctly released compressions, and percentage of optimal compressions) and ventilations (ventilation rate, mean ventilation volume, and percentage of ventilations delivering optimal volume) were analyzed within participants across equipment conditions. RESULTS   Keeping the shoulder pads in place reduced mean compression depth (all P values < .001, effect size = 0.835) and lowered the percentages of both correctly released compressions ( P = .02, effect size = 0.579) and optimal-depth compressions (all P values < .003, effect size = 0.900). For both the bag-valve and pocket masks, keeping the chinstrap in place reduced mean ventilation volume (all P values < .001, effect size = 1.323) and lowered the percentage of optimal-volume ventilations (all P values < .006, effect size = 1.038). Regardless of equipment, using a bag-valve versus a pocket mask increased the ventilation rate (all P values < .003, effect size = 0.575), the percentage of optimal ventilations (all P values < .002, effect size = 0.671), and the mean volume ( P = .002, effect size = 0.598) across all equipment conditions. CONCLUSIONS   For a mens lacrosse athlete who requires cardiopulmonary resuscitation, the shoulder pads should be lifted or removed to deliver chest compressions. The facemask and chinstrap, or the entire helmet, should be removed to deliver ventilations, preferably with a bag-valve mask.

Acute effects of posture shirts on rounded-shoulder and forward-head posture in college students

CONTEXT Rounded-shoulder and forward-head posture can be contributing factors to shoulder pain. Corrective techniques such as manual therapy and exercise have been shown to improve these altered postures, but there is little evidence that corrective garments such as posture shirts can alter posture. OBJECTIVES To determine the acute effects of corrective postureshirt use on rounded-shoulder and forward-head posture in asymptomatic college students. DESIGN Repeated-measures intervention study with counterbalanced conditions. SETTING Research laboratory. PARTICIPANTS 24 members of the general student body of a university, 18-25 y old, with a forward shoulder angle (FSA) >52° and no history of upper-extremity surgery, scoliosis, active shoulder pain, or shoulder pain in the previous 3 mo that restricted participation for 3 consecutive days. INTERVENTIONS Photographic posture assessment under a control condition, under a sham or treatment condition (counterbalanced), under another control condition, and treatment or sham. MAIN OUTCOME MEASURES FSA and forward head angle (FHA) calculated from a lateral photograph. RESULTS FSA decreased relative to the control condition while participants wore the sham shirt (P = .029) but not the corrective posture shirt (P = 1.00). FHA was unchanged between groups (P = .371). CONCLUSIONS Application of a corrective posture shirt did not acutely alter FSA or FHA, while application of a sham shirt may decrease FSA at rest.