Thursday, March 19, 2015
Nearly 12,000 new cases of spinal cord injuries occur each year, with sports-related events causing approximately 7.6 percent of them. Of those attributed to athletics, football tallies the largest number of catastrophic cervical spine injuries, reports the National Spinal Cord Injury Statistical Center.
Researchers at Mercyhurst University and Shriners Hospitals for Children-Erie, along with Sports Medicine Concepts of Livonia, N.Y., are looking to tackle those statistics with a pioneering study that continues to gain momentum across multiple fronts, from the fields of NFL stadiums to the pages of the Journal of Athletic Training, the official publication of the National Athletic Trainers Association.
The study establishes proper protocols for managing the on-field emergency care of football players with apparent cervical cord injuries. Headed by Mercyhurst Sports Medicine Department Chair Bradley Jacobson, the research team includes Kevin M. Cooney, PT, manager of the Shriners Movement Analysis Lab, biomechanist Dustin Bruening, Ph.D. (formerly of Shriners Hospital), Mike Cendoma, CEO of Sports Medicine Concepts, and Mercyhurst graduate Jacob Gdovin, now a Ph.D. student in biomechanics at Old Miss.
They assert that proper pre-hospital on-field medical care of the spine-injured athlete, including equipment removal, is critical in limiting secondary cervical spine injury while also allowing access to the airway and chest compressions.
“Our belief is that as the word continues to get out, the protocols we’ve established will go a long way toward minimizing such devastating football injuries,” Jacobson said. “Ultimately, this will improve the health of athletes, from Little Gridders to the NFL.”
The team’s findings were shared in a Journal of Athletic Training article, “Cervical Spine Motion during American Football Equipment Removal Protocols: A Challenge to the All-or-Nothing Endeavor,” and published in the January/February 2014 issue. The authors recently received notice that their article had won the journal’s coveted “Outstanding Research Manuscript” award for 2014.
“This is a great tribute to our collaboration and to the outstanding resources we have in Erie, including the expertise of Mercyhurst’s Sports Medicine Department and that of the Shriners Hospitals for Children, particularly the technology at their Movement Analysis Lab,” said Jacobson, who served as lead author on the article. Cendoma, Cooney, Bruening, and Gdovin are co-authors. Cooney added, “This collaboration represents the unique ability to take concept to reality. When Brad and Mike approached us with the concept of the pack-and-fill protocol, which challenged convention, we realized we had the team and tool to prove their theory was correct. Receiving an award for this publication is the icing on top of an already rewarding experience.”
Jacobson explained that if an injured athlete’s airway is not accessible, the conventional protocol is to remove the helmet and shoulder pads.This is called the all-or-nothing endeavor. “Our pack-and-fill technique utilizes material such as toweling to fill the void between the head and neck of the athlete and the spine board while removing the helmet and leaving the shoulder pads on the athlete,” Jacobson said. “Our research demonstrated significant less movement of the head and neck when utilizing the pack-and-fill technique as compared to the all-or-nothing endeavor.”
Cendoma, who has been consulting with the NFL since 1995 on a variety of injuries, concussions and spinal cord trauma among them, arranged for Jacobson and Gdovin to present their on-field protocols to the New York Giants, Houston Texans, New York Jets, Dallas Cowboys and Indianapolis Colts in 2012. The daylong sessions were directed at team neurosurgeons, orthopedic surgeons, athletic trainers and paramedics.
“Because these types of injuries are infrequent, the protocols for handling them probably aren’t practiced as much as they should be,” Jacobson said. “How to remove equipment with minimal movement to the player; how to access exposure to the chest for compressions and the airway for ventilations while stabilizing the head and neck efficiently … Every staff member needs to know his or her specific role. And, while each NFL team has its own ways of doing this, we have found some work better than others.”
Those methods, Jacobson said, are now taught to every Mercyhurst athletic training student, some of whom have gone on to graduate programs and are sharing the knowledge and continuing researching on the topic.
“Ultimately, our goal is to standardize emergency management protocols with these cases, and with the recent recognition we received from the Journal of Athletic Training, we are optimistic that we can continue to make gains,” he said.
Jacobson added that the award-winning research team is attempting to arrange another research project that would build on the current study, although he would not elaborate on specifics at this early date.