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Synopsis: Helmets and shoulder pads should be kept on the unconscious or potential spine injured hockey player.
Source: Laprade RF, et al. Cervical spine alignment in the immobilized ice hockey player. A computed tomographic analysis of the effects of helmet removal. Am J Sports Med 2000;28(6):800-803.
Helmets and shoulder pads are standard gear for the ice hockey player. The purpose of this article was to determine if removal of the ice hockey helmet would increase the lordosis of the cervical spine if the shoulder pads remained on. Ten adult male volunteers averaging 22 years of age without a history of c-spine injury underwent computed tomography (CT) scans of the c-spine. Each individual was studied under three conditions 1) helmet and shoulder pads on; 2) helmet and shoulder pads off; 3) helmet off and shoulder pads on.
The results showed a significant increase in lordosis between C-2 and C-7 when the helmet was removed compared to when the helmet and pads were left on. Additionally, the C 6-7 segmental level revealed an increase in lordosis when compared to other levels if the helmet was removed compared to when the pads and helmet were left on.
Although lots of literature addresses how to handle the football player with a cervical spine injury, little literature addresses how to best protect the cervical spine in the hockey player. Laprade and colleagues point out that c-spine injury occurs three times more often in hockey than in football.1 Similar but less bulky shoulder pads and a helmet protect the hockey player. However, the shoulder pads are large enough to potentially harm the cervical spine if an injured hockey player has the helmet removed and the c-spine increases in lordosis.
Intuitively, I have established a protocol with our hockey players that the helmets are not to be removed unless the shoulder pads are removed at the same time. This is only to be done if an airway cannot be established or if the transport of the patient cannot be safe because of poor fitting equipment. The shoulder pads should then be removed together with the helmet with some type of stable padding placed around the head to keep the shoulders and neck in constant and stable alignment. If for some reason the helmet is ever removed without removing the shoulder pads, then the head must be supported with firm padding to maintain proper alignment.
This article will now be the landmark article defining what precautions need to be performed to maintain alignment of the c-spine in the unconscious or c-spine injured hockey player. The same rule applies that we know works with football players—the helmet and shoulder pads should be on or off as a unit and are best left on if possible.
1. Tator CH, et al. Spinal injuries in ice hockey players, 1966-1987. Can J Surg 1991;34:63-69.