Kin 189 Protective Equipment


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Kin 189 Protective Equipment

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