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January 23, 2011

New recommendations for on-field treatment of neck injuries

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Most of us have witnessed it in person or on television – a football player lying injured on the field as emergency medics prepare to lift him onto a stretcher. When the player is an adult and thought to have a neck injury, the emergency on-field treatment policy is clear: leave his helmet and shoulder pads in place during on-field stabilization and transport. However, guidelines have been less certain for handling young athletes in the same situation, and EMTs have had the option to remove helmets that appear too large. New research from the University of Virginia Health System suggests that removing equipment may place young athletes at risk for further injury.

“Our findings make it clear that EMTs should leave in place a child’s helmet and shoulder pads, unless the child has a breathing problem that can’t be handled by facemask removal alone. Equipment should only be removed in the Emergency Department by a team of specialists,” explains David Diduch, MD,  professor of Orthopaedic Surgery and Team Physician at UVA.  He noted that initial treatment is critical to avoiding paralysis or neurological damage.

Compared to adults, growing boys have a larger head size relative to their torso. Before  their study, the UVA researchers assumed that differences in body proportions made it necessary to remove an injured child’s helmet on the field. “Our hypothesis was that removing the helmet would help to keep the boy’s neck from bending forward,” notes Dr. Diduch. Study results, which were presented at a national medical conference in early March 2008, proved that hypothesis wrong.

During the study, researchers took three different X-rays of 31 uninjured boys between the ages of 8 and 14. All played in the local Pop Warner Football League, which loaned the equipment used in the study. The children had X-rays taken lying down without equipment, while wearing both helmet and shoulder pads, and while wearing only shoulder pads.

The X-rays showed that when a player wore both his helmet and shoulder pads, his spinal alignment remained similar to when he did not wear equipment. Alignment changes occurred when the boys removed their helmets and wore only shoulder pads.

“We concluded that these alignment changes were unacceptable. Removing the helmet of a boy with a suspected neck injury is more risky than leaving it on during transport to the hospital,” says Dr. Diduch. “The study clearly demonstrated that on-field guidelines for children should be the same as those for adults.”

Participation in sports – especially contact and collision sports like football, ice hockey and lacrosse – is the third leading cause of pediatric neck injuries, ranking just below car accidents and falls. According to Dr. Diduch, study findings may not be applicable to ice hockey and lacrosse because equipment thickness is different than football gear.

Other study collaborators were Gehron Treme, MD, Jennifer Hart, PA-C, ATC, Mark Romness, MD and Joseph M. Hart, PhD, ATC. Entitled, “Radiographic Cervical Spine Alignment in the Youth Football Athlete: Recommendations for Emergency Transportation,” their study was presented at the 2008 American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine meeting in San Francisco.

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