title: Cervical spine motion during football equipment-removal protocols: a challenge to the all-or-nothing endeavor.
abstract: BACKGROUND
  The National Athletic Trainers' Association position statement on acute management of the cervical spine-injured athlete recommended the all-or-nothing endeavor, which involves removing or not removing both helmet and shoulder pads, from equipment-laden American football and ice hockey athletes. However, in supporting research, investigators have not considered alternative protocols.
  
  
  OBJECTIVE
  To measure cervical spine movement (head relative to sternum) produced when certified athletic trainers (ATs) use the all-or-nothing endeavor and to compare these findings with the movement produced using an alternative pack-and-fill protocol, which involves packing the area under and around the cervical neck and head with rolled towels.
  
  
  METHODS
  Crossover study.
  
  
  METHODS
  Movement analysis laboratory.
  
  
  METHODS
  Eight male collegiate football players (age = 21.4 ± 1.4 years; height = 1.87 ± 0.02 m; mass = 103.6 ± 12.5 kg).
  
  
  METHODS
  Four ATs removed equipment under 4 conditions: removal of helmet only followed by placing the head on the ground (H), removal of the helmet only followed by pack-and-fill (HP), removal of the helmet and shoulder pads followed by placing the head on the ground (HS), and removal of the helmet and shoulder pads followed by pack-and-fill (HSP). Motion capture was used to track the movement of the head with respect to the sternum during equipment removal.
  
  
  METHODS
  We measured head movement relative to sternum movement (translations and rotations). We used 4 × 4 analyses of variance with repeated measures to compare discrete motion variables (changes in position and total excursions) among protocols and ATs.
  
  
  RESULTS
  Protocol HP resulted in a 0.1 ± 0.6 cm rise in head position compared with a 1.4 ± 0.3 cm drop with protocol HS (P < .001). Protocol HP produced 4.9° less total angular excursion (P < .001) and 2.1 cm less total vertical excursion (P < .001) than protocol HS.
  
  
  CONCLUSIONS
  The pack-and-fill protocol was more effective than shoulder pad removal in minimizing cervical spine movement throughout the equipment-removal process. This study provides evidence for including the pack-and-fill protocol in future treatment recommendations when helmet removal is necessary for on-field care.
authors.affiliation: Sportsmedicine Department, Mercyhurst University, Erie, PA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Jacobson
authors.forename: Michael
authors.initials: M
authors.lastname: Cendoma
authors.forename: Jacob
authors.initials: J
authors.lastname: Gdovin
authors.forename: Kevin
authors.initials: K
authors.lastname: Cooney
authors.forename: Dustin
authors.initials: D
authors.lastname: Bruening
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000502:physiology*; D018592:Cross-Over Studies; D019416:Head Movements / Q000502:physiology*; D006260:Head Protective Devices; D006801:Humans; D008297:Male; D012916:Soccer / Q000502:physiology*; D013124:Spinal Injuries / Q000517:prevention & control