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An Evaluation of Head Movement in Backboard-Immobilized Helmeted Football, Lacrosse, and Ice Hockey Players

Waninger, Kevin N. MD*; Richards, James G. PhD; Pan, Wayne T. MD; Shay, Andy R.; Shindle, Mike K.

Clinical Journal of Sport Medicine: April 2001 - Volume 11 - Issue 2 - p 82-86
Clinical Investigations

Objective Improper handling of an unstable neck injury in the prehospital setting may result in iatrogenically induced neurologic injury. Due to helmet design, stabilization of the cervical spine in American football does not require routine removal of the helmet and shoulder pads prior to transport. Adequate data is not available evaluating hockey and lacrosse helmets. This study compares the amount of head movement in American football, lacrosse, and ice hockey helmets during head and neck stabilization procedures.

Study Design Prospective.

Participants 12 ice hockey, 9 football, and 9 lacrosse athletes from an National Collegiate Athletic Association Division 1 program.

Setting On-campus biomechanical laboratory with three HiRes cameras, routinely tested for accuracy.

Methods Athletes were immobilized on backboards as per protocol. Three motion analysis HiRes cameras follow retroreflective markers placed on the helmet and bite mouthplate to measure relative head and helmet motion.

Main Outcome Measures Helical angles determine the relative range of motion of the head inside the helmets.

Results The mean range of head motion for football players was 4.88° (n = 9, SD 2.07), lacrosse players 6.56° (n = 9, SD 1.61), and ice hockey players 5.54° (n = 12, SD 1.19). These results were not significantly different (p > 0.05).

Conclusions The rotational head motion seen inside standard immobilized lacrosse and ice hockey helmets is similar to that seen in football helmets. This supports the safety of prehospital stabilization of the potential cervical spine-injured ice hockey and lacrosse athletes with in-line stabilization and helmet in place. Extrapolation of data may not be applicable to other helmet designs, and future studies are needed to determine the safety of emergency procedures in all helmet designs.

*Department of Emergency Medicine, Saint Luke's Hospital, Bethlehem, Pennsylvania; †Department of Biomechanics, University of Delaware, Newark, Delaware; and ‡Department of Orthopedics, Loma Linda University, Loma Linda, California, U.S.A.

Received April 3, 2000; accepted December 20, 2000.

Address correspondence and reprint requests to Kevin N. Waninger, MD, MS, Department of Emergency Medicine, Saint Luke's Hospital, 801 Ostrum Street, Bethlehem, PA 18015, U.S.A. E-mail:

© 2001 Lippincott Williams & Wilkins, Inc.