CHAPTER 3: Prevention and

management of musculoskeletal injuries

Protective Equipment
 Protective Gear and Sports Equipment
• Selection, fitting and maintenance of protective equipment are critical in
injury prevention
• Athletic trainers must have knowledge of protective equipment available
for different sports and proper fitting procedures
• Protection is critical in contact and collision sports
• Athletic trainers must also have knowledge of how and when protective
equipment should be used to facilitate rehabilitation
 Safety Standards for Equipment and
Facilities
• Concerns relative to materials, durability, establishment of standards,
manufacturing, testing methods, and requirements for use
• Must be in place relative to maintenance
• Concern should be protective ability not appearance of equipment
• A number of groups and agencies are involved in standardizing sports
equipment and facilities
 Off the Shelf vs. Custom Protective
Equipment
• Off the shelf equipment
• Pre-made and packaged
• Can be used immediately
• Neoprene sleeves, inserts, ankle braces
• May pose problem relative to sizing
• Customized equipment
• Constructed according to the individual
• Specifically sized and designed for protective and supportive needs
 HEAD PROTECTION
• Direct collision sports require head protection due to impacts, forces, velocities and implements.
• Must be protective against concussive force
• While helmets must be certified, they may not always be fail-safe
• Athletes and parents must be aware of inherent risks
• Each helmet must have visible exterior warning label
• Label indicates that helmet should not be used to strike an opponent due to risk of injury
• Also indicates risk of injury accidentally and that athlete plays at own risk while using helmet
• Athlete must be aware of risks and what label indicates
• Athlete reads and signs statement regarding warning label
• There are a number of helmet manufacturers, and even more have closed due to lawsuits and liability cases
 GUIDELINES FOR SELECTING HEAD
PROTECTION
1. The helmet should fit comfortably around all parts of the player’s
2. Head Cover the base of the skull
3. Helmet not come down over the eyes.
4. Two finger widths above eyes
5. The ear holes should match the lineup
6. Face mask should attached securely to the helmet
7. Helmet should not shift when manual pressure is applied
8. It should not recoil on impact
9. The chin strap should be an equal distance from the center of the helmet.
 FACE PROTECTION
• Face Guard
• Mouth Guards
• Ear Guards
• Eye protection
• Neck Protection
• Throat protection
 Trunk and Thorax Protection

• Essential in many sports

• Must protect regions that are exposed to the impact of forces
• shoulders, ribs, and spine
• While equipment may provide armor, it may also be used as an tools
• Question must be asked concerning necessity of equipment and its role in
producing trauma
 Rules of fitting

1. Width of shoulders must be measured

2. Inside of pad should cover top of shoulder in line with lateral aspect of shoulder
3. Straps and cups must cover deltoid and allow motion
4. Neck opening must allow athlete to raise arms over head w/out pads sliding forward and
back
5. With split clavicle pads, channel for top of shoulder must be in proper position
6. Straps underneath arms should hold pads firmly in-place, w/out soft tissue restriction
7. Combinations of padding (football and hockey) may be used to supplement padding and
protection
 Lower Extremity Protective Equipment
1. Socks
• Poorly fit socks can cause abnormal stress on the foot
• Should be clean, dry and w/out holes
• Different types for different activities
• Composition
• Cotton can be bulky
• Cotton/poly blend are lighter and dry faster
 2. Shoe selection
• Number of options for multiple activities
• Shoe will breakdown and degrade over time
• Running shoes for example will last between 350-550 miles
• Shoes may need to be constantly replaced if very active
Guideline for shoe selection

• Toe Box - space for toes (1/2 to 3/4 inch of space from toes to front of shoe)
• Sole - provide shock absorption and durable
• Spongy layer to absorb force
• Midsole that cushions midfoot and toes
• Hard rubber which contacts the ground
• Heel Counter - prevents medial and lateral roll of foot
• Shoe Uppers - top of shoe made with combination of materials, designed for appropriate ventilation, drying and support
• Shank – Part of sole between heel and metatarsal heads
• Last – Form on which shoe is built; may be straight (good for pronators), semi-curved or curved (good for supinators)
• Arch Support - durable but soft and supportive to foot
• Price- due to impact on performance and injury prevention, may be worth the extra investment
Criteria for selecting proper running shoe
1. Have strong heel counter that fit well around the foot
2. Have good flexibility in the forefoot where toes bend
3. Have midsole that is moderately soft but does not platen easily
4. Have heel counter that is attached to the sole
5. Preferably have fairly high heel for the individual with a tight Achilles
tendon
 Shoe fitting
1. Measure both feet, as there will be slight differences
2. Fit at the end of day due to gradual increase in volume due to weight bearing
3. Should be comfortable but allow ample movement of foot and toes
4. Should break at widest part, coinciding with ball of foot
5. Must also consider width of shank, non-yielding nature of sole and function of
arch support
6. Cleated and specialty shoes may present problems with fitting
7. Playing surfaces and activities must be considered
 Foot Orthotics
• Device for correcting biomechanical problems that exist in foot that can
cause injury
• Plastic, thermoplastic, rubber, Sorbothane, leather support or ready-made
products
• Can also be customized by physician, podiatrist, athletic trainer or
physical therapist
• More expensive
 Heel Cups

• Used for a variety of conditions including plantar fasciitis, heel spurs, Achilles
tendonitis and heel bursitis
• Hard plastic or spongy rubber used to help compress fat pad, providing more
cushion during weight bearing
 Off-the-shelf Foot Pads
• General public use, not designed for athletic use
• With adequate funding, provides advantage of saving time
• Manufactured for numerous structural conditions
• Commonly used before customized devices are made
 Ankle Braces
• Alone or with tape -- they are increasingly popular
• Significant debate over efficacy
• Little or no impact on performance
• Compared to tape, the device will not loosen significantly with use
• Research also looking at impact on proprioceptive effects
• Evidence to support use for prevention
 Shin and Lower Leg
• Anterior aspect of leg is exposed to direct blows
• Commercially marketed, hard molded shin guards are used in field hockey
and soccer
 Thigh and Upper Leg
• Necessary in collision sports
• Pads slip into ready made uniform pockets
• Customized pads may need to be held in place with tape and/or wraps
• Neoprene sleeves can also be used for support of injuries
 Knee Braces
• Types of Braces
• Rehabilitative:
• Widely used following surgery
• Allows controlled progressive immobilization
• Adjustable
• Functional:
• Used during and following rehab to provide functional support
• Ready-made and customized
• Neoprene (w/ medial and lateral support)
• Used by those that have sustained collateral ligament injuries
• Some are also used to provide support in those that have patellofemoral conditions
 Elbow, Wrist and Hand Protection
• While the elbow is less commonly injured it is susceptible to instability,
contusions, and muscle strain
• A variety of products are available to protect the elbow
• Wrist, hand and finger injuries are often trivialized but can be functionally
disabling
• Susceptible to fracture, dislocation, ligament sprains and muscle strains
• Gloves and splints are available for protection and immobilization