title: The effect of protective equipment on cervical spine alignment in collegiate lacrosse players.
abstract: BACKGROUND
  Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known.
  
  
  OBJECTIVE
  Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Sagittal plane cervical spine alignment was evaluated in 16 uninjured male collegiate lacrosse players using computed tomography. Patients were immobilized in the supine position on a standard spine board. Testing was performed without equipment, with both helmet and shoulder pads in place, and with the helmet removed. Angular measurements of the cervical spine were made and analyzed.
  
  
  RESULTS
  The presence of both the helmet and shoulder pads caused an increase in overall cervical extension (mean, 6 degrees ) compared with the absence of both pieces of equipment (P = .002). Helmet removal alone resulted in a mean increase in cervical flexion of 4.7 degrees in the upper cervical spine compared with the presence of both pieces of equipment (P = .011). Compared with the absence of equipment, shoulder pads caused increased cervical flexion in the lower cervical spine (mean, 4.4 degrees ; P = .036).
  
  
  CONCLUSIONS
  Protective equipment worn by lacrosse athletes causes statistically significant increases in cervical extension, and its removal causes statistically significant increases in cervical flexion. This alteration is different from that previously reported for protective equipment in football and ice hockey.
  
  
  CONCLUSIONS
  The authors' recommendation is that both lacrosse helmets and shoulder pads be left in place until they can be completely removed in a controlled fashion. The effect of external equipment on neck position is different for lacrosse compared with football and ice hockey.
authors.affiliation: Milton S. Hershey Medical Center, University Park, PA, USA. psherbondy@psu.edu
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sherbondy
authors.forename: Jay N
authors.initials: JN
authors.lastname: Hertel
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Sebastianelli
mesh_terms: D000704:Analysis of Variance; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006260:Head Protective Devices / Q000009:adverse effects; D006801:Humans; D007103:Immobilization / Q000379:methods; D008297:Male; D019838:Neck Injuries; D011187:Posture; D011482:Protective Devices / Q000009:adverse effects; D015865:Racquet Sports / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients / Q000379:methods