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Kin 189  Protective Equipment
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Kin 189 Protective Equipment

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  • 1. KIN 189 – Prevention and Care of Athletic Injuries Protective Equipment
  • 2. Energy Absorption and Force Dissipation
    • Protective splints
    • Material properties
    • Classification of materials
    • Fabricating splints and braces
  • 3. Protective Splints Concepts
    • Goal/s of splints are to protect, stabilize or immobilize injured area
    • Purpose of fixation is to limit motion occurring in area and dissipate forces away from area
    • Must understand applied anatomy to determine best style/type of brace
    • Must understand properties of materials
  • 4. Material Properties
    • Density
    • Strength
    • Rigidity
    • Conformability
    • Self-adherence
    • Durability
    • Ease of fabrication
    • Availability and cost
  • 5. Density
    • Weight of material in relation to volume or amount that will be used
    • Must consider type/velocity of contact you’re trying to protect from when choosing materials of different density
    • Denser materials offer very good protection, but often can come at the expense of bulk and/or weight – best material is one that has as low a density as possible and still affords the desired level of protection
  • 6. Density
    • Various padding materials typically applied underneath hard shells designed to distribute forces
    • High density materials
      • Some foams, viscoelastic materials, silicone elastomer material
    • Medium density materials
      • Fiberglass, thermoplastics, ortho felt, some foams
    • Low density materials
      • Some foams, cotton padding, neoprene/rubber
  • 7. Strength
    • Maximum external stress/load a material can withstand
    • Important to ensuring that splint will function as intended
    • Some materials may be strong enough for ADLs, but unable to withstand high impact and some may be able to provide appropriate support but not be conducive to activity
  • 8. Rigidity
    • aka “stiffness” – the amount of bending or compression that occurs in response to a measured amount of applied stress
    • Modulus of elasticity
      • High modulus = more stiffness
      • Low modulus = less stiffness, more shock absorption
    • Rigidity depends on type, thickness and shape of material – bulk consideration
  • 9. Conformability
    • Ease with which material forms to body part
    • Material that is too strong, dense and/or stiff may fail to provide protection because it cannot conform to body part sufficiently
  • 10. Self-Adherence
    • Strength with which the material bonds to itself – determines integrity and durability
    • Materials like Velcro are often utilized to bond non-adherent materials together around a body part/joint (irregular surfaces)
  • 11. Durability
    • Ability of material to withstand repeated stress during activity – greater durability = greater longevity of use
    • Especially important consideration when working within budgetary constraints
  • 12. Ease of Fabrication
    • Relates to time, equipment and skill needed to shape material for protection and comfort
    • Often times, materials require heating in order to be fabricated appropriately – access to heating element?
      • Mouthpieces
  • 13. Availability and Cost
    • Typically the most significant obstacles for use of splinting materials
    • Must be able to work within limitations of budget and/or inventory/access and do best job possible given resources available
  • 14. Classification of Materials
    • No-heat (layered)
    • Low heat
    • Moderate heat
    • High temperature
  • 15. No-Heat (Layered) Materials
    • No heat required to form products into appropriate protective application
    • Examples
      • Athletic tape
      • Self-adherent wraps
      • Fiberglass casting material
      • Silicon (soft-cast) material
      • Plaster
  • 16. Low-Heat Products
    • Low temperatures required (hot water/oven) to form materials for protective application
    • Once material cools down, retains new shape in original rigid state
    • Examples
      • Orthoplast (rubber based)
      • Polyform (plastic based)
      • Aquaplast (elastic based)
  • 17. Moderate and High Temperature Materials
    • Not typically used in clinical situations to fabricate protective devices, but used by manufacturers of equipment – temps are dangerous for clinical environment
    • One application is in the modification of a manufactured brace for a better fit by using heat gun (temp ~800 degrees!)
  • 18. Fabricating Splints and Braces
    • Not all clinicians able to master the “art” of protective device fabrication – requires practice
    • Generally a simple process, but can involve complex steps that are beyond the abilities of some clinicians
  • 19. Protective Equipment for the Head and Face
    • Helmets (football, ice hockey, batting, other)
    • Face guards
      • Specific details regarding helmets/face guards and fitting guidelines in future class meeting
    • Eyewear
    • Ear wear
    • Mouthguards
    • Throat and neck protectors
  • 20. Eye Wear
    • Despite relative prominence of eye injuries, eye protection not required in any sport
    • Goggles (swimmer’s vs. skiers)
      • Typically for comfort due to environment vs. true protection, can facilitate contact wear
    • Face shield
      • Secondary protection from direct trauma, can be tinted for some sensitive conditions
    • Spectacles/glasses
      • Should be made of plastic/polycarbonate, able to withstand force of racquetball traveling 90mph, can incorporate Rx
  • 21. Ear Wear
    • Specialized protective devices for amateur boxing, wrestling, water polo, rugby
    • Protective cup designed to minimize trauma to external ear – auricular hematoma (Cauliflower ear)
  • 22. Mouthguards
    • Required in football, ice hockey, field hockey and lacrosse – must be visible (colored)
    • Minimizes risk of dental and oral soft tissue injuries and also can impact severity or occurrence of concussion/TMJ/jaw injuries
    • When properly fitted, does not interfere with breathing or speech
  • 23. Mouthguards
    • “ Cutting down” mouthguards invalidates warranties, increases risk of injury and can become an potential oral airway obstruction
    • Thermal-set, mouth-formed style (“dip and suck”) vs. custom fabricated
      • Thermal set is easy, cost-effective and effective
      • Custom requires training, often must have mold crafted by dentist, more expensive, best protection
  • 24. Throat and Neck Protectors
    • Minimize risk of injury to significant airway structures
    • Required in softball/baseball (catchers) and often used in fencing, lacrosse, field hockey and ice hockey
    • Cervical neck rolls/collars designed to limit motion of cervical spine – most common in football
      • Can enhance protection from burners/stingers, but must accompany properly fitted shoulder pads
  • 25. Protective Equipment for the Trunk and Upper Extremities
    • Shoulder protection
      • Specific details regarding shoulder pads and fitting guidelines in future class meeting
    • Elbow, forearm, wrist and hand protection
    • Thorax, rib and abdominal protection
    • Sports bras
    • Lumbosacral protection
  • 26. Elbow, Forearm, Wrist and Hand Protection
    • Areas susceptible to compression and shearing forces in most activities
    • Unable to wear rigid protection unless covered by foam padding to minimize risk of injury to others
    • Elbow inflammation often assisted by counterforce straps (“tennis elbow”)
    • Forearm/wrist/hand often protected with specialized pads and/or gloves
  • 27. Thorax, Rib and Abdominal Protection
    • Required thorax/abdominal protectors for baseball/softball catchers
    • Fencers and goalies in many other sports (hockey, lacrosse) as well as QB/WR/RB in football also wear some kind of thorax and abdominal protection
  • 28. Sports Bras
    • Provide additional support to prevent excessive vertical/horizontal breast motion during exercise/activity
    • Especially applicable for larger breasted women (C cup or higher)
    • Support vs. compression styles in many choices of material for individual preference
  • 29. Lumbosacral Protection
    • Weight training belts designed for additional support/rigidity during heavy lifting activities
    • Abdominal/lumbosacral binders used to increase proprioception and intra-abdominal pressure to relieve compressive forces on vertebral column
  • 30. Protective Equipment for the Lower Extremities
    • Hip and buttock protection
    • Thigh protection
    • Knee and patella protection
    • Leg protection
    • Ankle protection
    • Foot protection
    • Shoes
    • Orthotics
  • 31. Hip and Buttock Protection
    • Padded, rigid inserts required in most collision/contact sports to protect pelvis and sacrum/coccyx
    • Male genital region best protected by protective cup in athletic supporter
  • 32. Thigh Protection
    • Padded rigid inserts most common in football
    • Typically fit into pockets/”girdle” and minimize risk of direct trauma to quadriceps
    • Neoprene sleeves can provide compression and warmth secondary to muscular strains
  • 33. Knee and Patella Protection
    • Prophylactic knee braces
      • Lateral and bilateral bar designs, metal hinges held in place by straps/tape, limit hyperextension
      • Some studies have shown no impact on number or severity of knee injuries and may actually contribute to higher incidence of injury
    • Functional knee braces (“ACL”)
      • Designed to control tibial translation and rotational stresses – may be OTC but typically custom fit
      • Historically required post-ACLR, but recent movement away from use of brace – no guarantees of increased stability
  • 34. Knee and Patella Protection
    • Rehabilitative braces
      • Straight immobilizer style with metal rods on sides in foam secured with straps
      • Hinged style (sleeve or wrap-around) that can adjust ROM per symptoms/goals
    • Patellofemoral protection
      • Generally designed to dissipate forces, maintain patellar alignment and improve patellar tracking
      • Horseshoe type device incorporated into sleeve
      • Also use strap device to address patellar tendonitis
  • 35. Leg Protection
    • Most common example is soccer style shin guards – hard outer shell with padded liner
    • Shin protectors also required in baseball and softball for catchers, goalies in ice hockey, field hockey and lacrosse
    • Cover anterior tibia – held in place by straps or stirrups
  • 36. Ankle Protection
    • 3 common styles of ankle braces
      • Lace-up – provides best support and protection for all ankle motions, easily readjusted for fit/comfort
      • Semirigid (“Active Ankle”) – inversion/eversion protection only, OK for little change of direction activities (VB)
      • Stirrup (“Air Cast”) – must use shoe for effective application
    • Braces are more effective at minimizing ankle injuries, are easier to wear/apply, don’t irritate skin and are more cost effective than traditional taping techniques
  • 37. Foot Protection
    • Shoes should cushion impact forces and support foot during stance and push-off phases of gait
    • Cleated shoes should have cleats under weight-bearing portions of the foot – should not be felt through the sole of the shoe
      • Long outer cleats with short inner cleats increases torsional forces and increases risk of ACL injury
  • 38. Shoes
    • Components of shoes
      • Sole: inner (liner interfaces with foot), middle (many materials – gel/air/etc. to absorb shock), outer (typically rubber, interfaces with surfaces, style dependent upon activity)
      • Heel counter: provides stability to minimize ankle injury, varies by activity applications
      • Toe box: all toes should fully extend and wiggle in shoe
      • Upper: varied materials and laces – designed to hold shoe in place and facilitate cooling/protection/weight issues
    • Activities with high impact should have additional heel cushioning/support
    • Individuals with toe abnormalities should have wider toe box
  • 39. Orthotics
    • Devices used in treatment of foot/gait abnormalities and related conditions
    • Some are OTC, but most require Rx and fitting by qualified personnel
    • 3 categories
      • Orthotics to change foot function
      • Protective orthotics
      • Orthotics that combine functional control with protection
  • 40. Orthotics
    • 3 types/materials
      • Rigid: designed to control motion, designed from firm material (plastic, polycarbon), worn most in dress/walking shoes
      • Soft: used to absorb shock, improve balance and relieve pressure sites, designed from soft materials (neoprene, felt, foam), break down easily and must be replaced
      • Semirigid: used to provide dynamic balance of foot during activity, designed from layers of soft material reinforced by hard/rigid materials, most common application