Examining the Need for Specifying Educational
Content for Cervical Spine Immobilization Skills in
Athletic Training Education Programs

A THESIS
Submitted to the Faculty of the School of Graduate
Studies and Research
of California University of Pennsylvania in partial
fulfillment of the requirements for the degree of
Master of Science

by
Eric D. Gelinas

Research Advisor, Dr. Linda Meyer
California, Pennsylvania
2009

iii

ACKNOWLEDGEMENTS

I would first like to thank my Mom, Dad, and younger
brother Steve. More than anyone else, they have helped me
become who I am today. In so many ways, they pushed me to
become a righteous person and a moral human being. They
have picked me up when I was down and made me feel
better. They asked me to strive to succeed and always
knew that if I try my hardest, that failing every now
again was ok, as long as I learned from my mistakes. I
owe a lot to them, my biggest fans.
I would like to thank my committee chairperson Dr.
Linda P. Meyer, for guiding me through this, and the rest
of my professors and classmates at both Cal U and UNE.
They have helped me become the athletic trainer that I am
today.
Lastly, I would like to thank my fiancé Cassi-Mae.
She has gone over and beyond to make my life as enjoyable
as possible. I don’t think I would have survived the rest
of the school without her. Even though she might say she
never helped me out, just being by my side, she did. Mae
you are wonderful and I can’t wait to spend the rest of
my life with you. Thank-you, I love you.

iv
TABLE OF CONTENTS

Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS .

. . . . . . . . . . . . . iv

LIST OF TABLES

. . . . . . . . . . . . . . . vii

INTRODUCTION .

. . . . . . . . . . . . . . . 1

METHODS .

. . . . . . . . . . . . . . . . . 4

Research Design . . . . . . . . . . . . . . . 4
Subjects .

. . . . . . . . . . . . . . . . 5

Instruments .

. . . . . . . . . . . . . . . 5

Procedures . . . . . . . . . . . . . . . . . 6
Hypotheses . . . . . . . . . . . . . . . . . 7
Data Analysis .
RESULTS .

. . . . . . . . . . . . . . 8

. . . . . . . . . . . . . . . . . 9

Demographic Data .

. . . . . . . . . . . . . 9

Hypothesis Testing .

. . . . . . . . . . . . 12

Additional Findings . . . . . . . . . . . . . 17
DISCUSSION .

. . . . . . . . . . . . . . . . 20

DISCUSSION OF RESULTS .
Conclusions .

. . . . . . . . . . . 20

. . . . . . . . . . . . . . . 28

Recommendations . . . . . . . . . . . . . . . 29

v
REFERENCES. . . . . . . . . . . . . . . . . . 31
APPENDICES .

. . . . . . . . . . . . . . . . 32

APPENDIX A: Review of Literature .

. . . . . . . 33

Introduction . . . . . . . . . . . . . . . . 34
Spinal Injuries in Athletics .

. . . . . . . . 35

Mechanisms of Injury. . . . . . . . . . . . . 38
Management of Spinal Injuries .

. . . . . . 41

Face Mask Removal . . . . . . . . . . . . . 48
Summary . . . . . . . . . . . . . . . . . . 53
APPENDIX B: The Problem . . . . . . . . . . . . 54
Statement of the Problem . . . . . . . . . . . 55
Definition of Terms . . . . . . . . . . . . . 55
Basic Assumptions . . . . . . . . . . . . . . 57
Limitations of the Study . . . . . . . . . . . 57
Significance of the Study

. . . . . . . . . . 57

APPENDIX C: Additional Methods .

. . . . . . . . 59

Panel of Expert Letter (C1) . . . . . . . . . . 60
Cover Letter (C2) . . . . . . . . . . . . . . 62
ATEP Directors Survey (C3) . . . . . . . . . . 64
IRB: California University of Pennsylvania (C4) . . 70
ATEP Directors Comments to Why They Are Unable to
Obtain Required Equipment (C5)

. . . . . . . . 76

ATEP Directors Comments about Study (C6)

. . . . 79

Pilot Study Results (C7) . . . . . . . . . . . 82

vi
ABSTRACT . . . . . . . . . . . . . . . . . . 85
REFERENCES . . . . . . . . . . . . . . . . . 87

vii
LIST OF TABLES

Table

Page

Range of Years Accredited . . . . . . . . . . 10

Range Number of Students Graduating . . . . . . 10

NATA District . . . . . . . . . . . . . . . 11

Sport and NCAA Division . . . . . . . . . . . 11

A One-Way ANOVA for Hours in Lecture on Cervical
Spine Immobilization Techniques

. . . . . . . 13

Tukey’s HSD for Comparing Time in Lecture

. . . 13

A One-Way ANOVA for Hours in Lab on Cervical Spine
Immobilization Techniques . . . . . . . . . . 14

Tukey’s HSD for Comparing Time in Lab . . . . . 14

A One-Way ANOVA for Hours in Clinical Experience on
Cervical Spine Immobilization Techniques . . . . 16

10. Tukey’s HSD for Comparing Time in Clinical
Experience . . . . . . . . . . . . . . . . 16
11. Semester AT Students are Taught Cervical Spine
Immobilization Skills

. . . . . . . . . . . 17

12. Reasons for Inability to Obtain Required Sports
Equipment

. . . . . . . . . . . . . . . . 18

13. Program Director’s Opinion on How AT Students Are
Prepared to Immobilize the Cervical Spine for All
Three Equipment Intensive Sports . . . . . . . 19

viii
14. Program Director’s Opinion on How Educational
Competencies Emphasize Immobilization Skills on All
Three Equipment Intensive Sports . . . . . . . 19
15. Program Director’s Opinion on How AT Students Are
Prepared to Immobilize the Cervical Spine for All
Three Equipment Intensive Sports . . . . . . . 27

1
INTRODUCTION

The concern of a potential cervical spinal injury is
always in the back of the mind of an athletic trainer
covering a sporting event. According to Vaccaro et al. 10%
of all the cervical spine injuries in the United States
occur in athletics.1 The major life consequences these
injuries can have on an athlete are the reason for concern.
Proper management of the injured athlete is essential to
reduce further injury. Protocols for the assessment and
management of cervical spinal injuries can be helpful in
crucial decision making, especially in sports involving
protective equipment that may need to be removed in order
to perform life-saving procedures or for proper
immobilization.
Since there are various contact sports today, the need
for an athletic trainer to cover those sports is great. The
athletic trainer needs to be aware of all the protocols
required, regardless of sport, to safely remove protective
equipment if a cervical spine injury were to occur.
According to studies looking at the National Collegiate
Athletic Association (NCAA) Injury Surveillance System
(ISS) done during 1988-1989 through 2003-2004, head and
neck injuries are one of the most prevalent injuries in

2
football, men’s lacrosse, and men’s hockey. Dick et al.
reported that, during fall games of football, 6.8% of all
injuries that occur are to the head and are concussion
related.2 Dick et al. also reported in another study that,
during games of men’s lacrosse, 8.4% of all injuries that
occur are to the head and are concussion related.3 Ice
hockey injuries were also examined. Agel et al. reported
that, during games of men’s hockey, 9.0% of all injuries
that occur are to the head and are concussion related.4 With
these numbers, the question is, have athletic trainers been
taught the protocols for all of the contact equipment
sports?
Most studies today recommend leaving the helmet and
shoulder pads on when cervical spine (CS) immobilizing, if
no respiratory distress is present.

5-8

Football equipment

has been well examined, but there are few protocols that
describe when there is an emergency situation in which the
equipment of hockey and men’s lacrosse needs to be removed
from the athlete. This creates a deficit in the acute care
skills of athletic trainers.
This lack of knowledge and training for many athletic
trainers indicates there is a need for these skills to be
taught in athletic training education programs (ATEP). As
of now, the athletic training competencies state that

3
athletic training students must be able to “establish and
maintain an airway in a patient wearing shoulder pads,
headgear, or other protective equipment and/or with a
suspected spine injury.”9 The problem is the competencies do
not state which specific type of shoulder pads and headgear
should be used, leaving the ATEP to choose which equipment
they wish to utilize. If CS immobilization skills were
taught for the three equipment intensive sports in their
ATEP, then it can be assumed that athletic training
students will then be prepared for emergency situations in
these equipment intensive sports.
The goal this study is to determine if athletic
training students are being taught football, ice hockey,
and men’s lacrosse immobilization and equipment management
techniques. By surveying athletic training education
programs regarding which immobilization techniques are
taught, a better understanding can be made if there is a
need for specifying the educational content of acute care
of injuries, as it relates to equipment removal for these
sports, in the athletic training competencies.

4
METHODS

The purpose of this study is to examine the need for
specifying the educational content that athletic training
students are taught in acute care of injuries, pertaining
to immobilizing cervical spine injured athletes wearing
protective equipment, in the athletic training
competencies. This section will include the following
sections: Research Design, Subjects, Instruments,
Procedure, and Data Analysis.

Research Design

A descriptive design was used for this study. The
dependent variable is the athletic training education
program’s teaching methods. The independent variable is the
acute care protocols for cervical spine injured equipment
wearing athletes that is required by the National Athletic
Trainers’ Association (NATA) education council to be taught
at the athletic training education programs.

5
Subjects

320 Athletic training education program directors (DI,
DII, & DIII) were asked to volunteer in a survey for this
study. The response rate was 40.3% (N = 129). Informed
Consent was implied with completion and return of survey.

Instruments

An original survey was created. The ATEP Directors
Survey (Appendix C3) was distributed to the athletic
training education program directors through the web server
program SurveyMonkey.com. The survey underwent expert
review and piloting prior to distribution. The survey
consisted of demographic questions regarding the programs,
teaching methods for acute care and immobilization
techniques for contact equipment athletes, and suggestions
to specify competencies for acute care and CS
immobilization proficiencies for contact equipment
athletes. The data will automatically be calculated by
Survey Monkey and placed into a spreadsheet format for the
researcher to utilize in analysis. The survey consisted of
27 questions and required 10-15 minutes to complete. A
cover letter explaining the study was also uploaded with
the survey.

Procedure

The ATEP Director’s Survey was examined by a panel of
experts to determine the validity of the survey. The panel
consisted of experts in field of context for the survey.
Survey design and sport specifics were a part of their
expertise. Once the panel approved the survey, the
California University of Pennsylvania’s Institutional
Review Board for Protection of Human Subjects form
(Appendix C4) was sent for approval before the study began.
After approval, the survey was sent to 30 NATA district two
programs as a pilot test to determine the reliability of
the survey. The results proved reliable due to the analysis
of the data. The survey was then sent to 320 program
directors in athletic training education programs of
Division I, II, and III via email. A cover letter (Appendix
C2) was sent explaining the study to the ATEP directors. A
link on the cover letter provided the program directors
direct access to begin the survey. Email addresses were
obtained through the Commission on Accreditation of
Athletic Training Education (CAATE) website. The researcher
determined and allowed three weeks for the program
directors to complete the survey. Once every week, during
the three weeks, a follow up email was sent to the ATEP

7
directors explaining the study and providing a link to the
survey. This email reminded the program directors who had
not yet taken the survey that is was still open. The email
also stated that if the ATEP director had already taken the
survey, then they do not need to take it again. Once the
surveys were completed by the program directors, the
answers were submitted back through SurveyMonkey.com. The
web server program automatically organized, calculated, and
placed all data in an excel spreadsheet for import to SPSS
16.0. Data analysis was then performed after the three week
period for survey submission had passed.

Hypotheses

The following hypothesis is based on the review of
literature.
H1: Athletic training students spend more hours in
lecture for football cervical spine immobilization skills
than for lacrosse and ice hockey cervical spine
immobilization skills.
H2: Athletic training students spend more hours in lab
for football cervical spine immobilization skills than for
lacrosse and ice hockey cervical spine immobilization
skills.

8
H3: Athletic training students spend more hours in
clinical experience for football cervical spine
immobilization skills than for lacrosse and ice hockey
cervical spine immobilization skills.

Data Analysis

All data was analyzed by SPSS version 16.0 for windows
at a level of significance at 0.05.

The research

hypotheses were analyzed using three, one-way analysis of
variance to determine if athletic training students were
spending more hours in lecture, lab, and clinical
experience for football CS immobilization skills than for
men’s lacrosse and hockey CS immobilization skills.

9
RESULTS

Purpose of Study

The goal this study is to determine if athletic
training students are being taught various sport CS
immobilization and equipment management techniques. By
surveying ATEP directors on how their students are taught
CS immobilization techniques, a better understanding can be
made if there is a need for specifying the educational
content of acute care of injuries in the athletic training
competencies.

Demographic Information

320 Athletic training education program directors (DI,
DII, & DIII) were asked to volunteer in an original survey
for this study. Out of the 320 ATEP directors survey,
40.3 % (N = 129) responded to the survey. Table 1
represents the range of years that schools have been
accredited by the overseeing accrediting body.

10
Table 1. Range of Years Accredited
Range of Years
Frequency
1-5
36

Percentage
27.9

6-10

38.7

11-15

6.9

16-20

3.1

21-25

8.5

>25

14.7

Table 2. represents the range number of students
graduating from athletic training education programs in
this study.
Table 2. Range Number of Students Graduating
Range of Students
Frequency
Percentage
1-5
36
27.9
6-10

39.5

11-15

19.3

16-20

4.6

21-25

5.4

>25

3.1

Table 3. represents the number of
universities/colleges of each NATA district that
participated in the study. Note that District 2 ATEP
directors were used in the pilot study. The response rate
was 53.3% (N = 16).

11
Table 3. NATA district
Frequency

N = ATEP
in
District

Percentage
in
District

Percentage
Overall
Districts
10.1

11.6

29.4

24.1

38.7

15.5

37.1

6.9

64.3

8.5

61.1

13.9

2.3

37.5

District

*Were involved in pilot study and not used for experiment

Table 4. represents which contact sport each
university/college does or does not have and which NCAA
division they are associated with.
Table 4. Sport and NCAA division
Sport
Div.I
Div.II
Div.III
Football
45
27
32

Club
1

None
24

M. Lacrosse

Hockey

12
Hypothesis Testing

The level of significance used for testing the
hypothesis was set at an alpha level of .05.
Hypothesis 1: Athletic training students will spend
more hours in lecture for football CS immobilization skills
then for lacrosse and ice hockey CS immobilization skills.
A one-way ANOVA was performed comparing time spent in
lecture for football CS immobilization skills to that of
men’s lacrosse and ice hockey CS immobilization skills.
Conclusion 1: A significant difference was found among
time spent in lecture for the three contact sports
(F(2,384) = 136.98, P < .001). Tukey’s HSD was used to
determine the differences between hours spent in lecture
teaching CS immobilization skills for all three sports
(Table 6). The analysis showed that athletic training
students averaged more hours in lecture on football CS
immobilization skills (2.68 ± 1.978) than men’s lacrosse
(0.32 ± .765) and ice hockey (0.38 ± .792) (Table 5).
Out of the 129 ATEP directors, 86 responded stating
that CS immobilization skills for men’s lacrosse were not
taught in lecture. The remaining 43 respondents averaged
1.25 ± 1.06 hours in lecture. Out of the 129 ATEP
directors, 84 responded that CS immobilization skills for

13
ice hockey were not taught in lecture. The remaining 45
respondents averaged 1.21 ± 0.74 hours in lecture.
Table 5. A One-Way ANOVA for Hours in Lecture on CS
immobilization techniques.
HRLec
Sum of
df
MS
F
Squares
Between
468.159
2
234.080 136.980
Groups
Within
656.201
384
1.709
Groups
386
Total
1124.360
Table 6. Tukey’s HSD for Comparing Time in Lecture
(1 = Football, 2 = Men’s Lacrosse, 3 = Ice Hockey)
Mean
(I)
(J)
Diff.
Std. Sig.
Lower
Sport
Sport
(I-J)
Error
Bound
HRLec
1
2
2.364* .163 .000
1.98
3
2.302* .163 .000
1.92
2
1
-2.364* .163 .000
-2.75
3
-.062
.163 .923
-.44
3
1
-2.302* .163 .000
-2.68
2
.062
.163 .923
-.32

P
.000

Upper
Bound
2.75
2.68
-1.98
.32
-1.92
.44

*The mean difference is significant at the .05 level.

Hypothesis 2: Athletic training students will spend
more hours in lab for football CS immobilization skills
then for lacrosse and ice hockey CS immobilization skills.
A one-way ANOVA was performed comparing time spent in lab
for football CS immobilization skills to that of men’s
lacrosse and ice hockey CS immobilization skills.
Conclusion 2: A significant difference was found among
time spent in lab for the three contact sports
(F(2,384) = 129.296, P < .001). Tukey’s HSD was used to
determine the differences between hours spent in lab

14
teaching CS immobilization skills for all three sports
(Table 8). The analysis showed that athletic training
students averaged more hours in lab on football CS
immobilization skills (3.88 ± 3.322) than men’s lacrosse
(0.29 ± 1.058) and ice hockey (0.30 ± .842) (Table 7).
Out of the 129 ATEP directors, 86 responded stating
that CS immobilization skills for men’s lacrosse were not
taught in lab. The remaining 43 respondents averaged 1.72 ±
2.06 hours in lab. Out of the 129 ATEP directors, 84
responded that CS immobilization skills for ice hockey were
not taught in lab. The remaining 45 respondents averaged
1.95 ± 1.21 hours in lab.
Table 7. A One-Way ANOVA for Hours in Lab on CS
Immobilization Techniques
HRLab
Sum of
df
MS
F
Squares
Between
1109.056
2
554.582 129.296
Groups
Within
1646.903
384
4.289
Groups
386
Total
2755.959
Table 8. Tukey’s HSD for Comparing Time in Lab
(1=Football, 2=Men’s Lacrosse, 3=Ice Hockey)
Mean
(I)
(J)
Diff.
Std. Sig.
Lower
Sport
Sport
(I-J)
Error
Bound
HRLab
1
2
3.597* .258 .000
2.99
3
3.585* .258 .000
2.98
2
1
-3.597* .258 .000
-4.20
3
-.012
.258 .999
-.62
3
1
-3.585* .258 .000
-4.19
2
.012
.258 .999
-.60
*The mean difference is significant at the .05 level.

P
.000

Upper
Bound
4.20
4.19
-2.99
.60
-2.98
.62

15
Hypothesis 3: Athletic training students will spend
more hours in clinical experience for football CS
immobilization skills then for lacrosse and ice hockey CS
immobilization skills. A one-way ANOVA was performed
comparing time spent in lab for football CS immobilization
skills to that of men’s lacrosse and ice hockey CS
immobilization skills.
Conclusion 3: A significant difference was found among
time spent in clinical experience for the three contact
sports (F(2,384)= 75.824, P < .001). Tukey’s HSD was used
to determine the differences between hours spent in
clinical teaching CS immobilization skills for all three
sports (Table 10).

The analysis showed that athletic

training students averaged more hours in clinical
experience on football CS immobilization skills (3.62 ±
4.020) than men’s lacrosse (0.32 ± 1.481) and ice hockey
(0.25 ± .728) (Table 9).
Out of the 129 ATEP directors, 86 responded stating
that CS immobilization skills for men’s lacrosse were not
taught in clinical experience. The remaining 43 respondents
averaged 2.59 ± 3.52 hours in clinical experience. Out of
the 129 ATEP directors, 84 responded that CS immobilization
skills for ice hockey were not taught in clinical

16
experience. The remaining 45 respondents averaged 1.77 ±
1.06 hours in clinical experience.
Table 9. A One-Way ANOVA for Hours in Clinical Experience
on CS Immobilization Techniques
HRClin
Sum of
df
MS
F
P
Squares
Between
954.795
2
477.397
75.824
.000
Groups
Within
2417.717
384
6.296
Groups
386
Total
3372.512
Table 10. Tukey’s HSD for Comparing Time in Clinical
Experience(1=Football, 2=Men’s Lacrosse, 3=Ice Hockey)
Mean
(I)
(J)
Diff.
Std. Sig.
Lower
Upper
Sport
Sport
(I-J)
Error
Bound
Bound
HRClin 1
2
3.295* .312 .000
2.56
4.03
3
3.368* .312 .000
2.63
4.10
2
1
-3.295* .312 .000
-4.03
-2.56
3
.074
.312 .970
-.66
.81
3
1
-3.368* .312 .000
-4.10
-2.63
2
.074
.312 .970
-.81
.66
*The mean difference is significant at the .05 level.

17
Additional Findings

Findings that were also noteworthy to the study were
which semester athletic training students were being taught
CS immobilization skills (Table 8). The 129 ATEP directors
responded to which multiple semesters athletic training
students were taught CS immobilization skills, which
resulted in N = 334 responses.
Table 11. Semester AT Students Are Taught Cervical Spine
Immobilization Skills
Semester
Frequency
Percentage
27
8.1
1st semester
Freshman
2nd semester
43
12.8
Freshman
77
23.1
1st semester
Sophomore
50
14.9
2nd semester
Sophomore
58
17.3
1st semester
Junior
2nd semester
23
6.8
Junior
36
10.7
1st semester
Senior
15
4.5
2nd semester
Senior
3
.89
1st year
entry master
2
.59
2nd year
entry master

Another important finding involved why the ATEP was
unable to obtain the required equipment to teach CS
immobilization skills for all three equipment intensive

18
sports. Out of the 129 ATEP directors, 80.6% (N = 104)
answered that they do not have all the required equipment.
The ATEP directors marked all answers that were reasons for
not having the required equipment, resulting in N = 180
responses. Table 9 represents reasons why the ATEP were
unable to obtain the equipment.
Table 12. Reasons for Inability to Obtain All Required
Sports Equipment.
Reason
Frequency
Percentage
Budgetary
34
18.8
Reasons
Inability to
25
13.8
Obtain Equipment
Football not a
0
0
high priority
Lacrosse not a
46
25.5
high priority
Hockey not a high
42
23.3
priority
Other*
33
18.3
* Comments can be seen in Appendix C5

The ATEP directors answered a series of Likert Scales
pertaining to how they agreed or disagreed with the
statements. The findings found for questions 19-21
(Appendix C3) were substantial for this study. The
statements phrased how confident they were that the
athletic training students attained CS immobilization
skills for all three contact sports. Out of the 129 study
participants, 99.2% (N = 128) completed the Likert Scales.
Table 10 represents the program directors responses.

Table 13. Program Director’s Opinion on How AT Students Are
Prepared to Immobilize the Cervical Spine for all Three
Equipment Intensive Sports
Sport
Strongly
Disagree
Agree (%)
Strongly
Disagree
(%)
Agree (%)
(%)
Football
4(3.1)
3(2.3)
47(36.4)
74(57.8)
M.Lacrosse 31(24.2)
56(43.7)
34(26.5)
7(5.4)
Hockey
32(25)
60(46.8)
28(21.8)
8(6.2)
The last considerable finding of the study involved
the study participants answering a Likert Scale to whether
or not they agreed with the phrase of educational
competencies appropriately emphasize the need for athletic
training students to have necessary skills to immobilize
athletes in intensive equipment sports other than football.
Out of the 129 study participants, 99.2% (N = 128)
completed the Likert Scales. Table 11 represents the
program directors responses.
Table 14. Program Director’s Opinion on How Educational
Competencies Emphasize Immobilization Skills on All Three
Equipment Intensive Sports
Response
Frequency
Percentage
Strongly Disagree
9
7.1
Disagree
66
51.6
Agree
44
34.4
Strongly Agree
9
7.1

20
DISCUSSION

The following section will include 1) Discussion of
Results, 2) Conclusion and 3) Recommendations.

Discussion of Results

The primary findings of this study were that athletic
training students experienced more hours of lecture, lab,
and clinical experience being taught CS immobilization
skills for an athlete wearing football equipment, compared
to that of an athlete wearing men’s lacrosse and ice hockey
equipment. The results showed that athletic training
education programs were teaching 2-4 hours in lecture, lab,
and clinical experience on football CS immobilization
skills. Time that was devoted to CS immobilization skills
that focused on men’s lacrosse and ice hockey equipment was
considerably less, ranging from 20-30 minutes in lecture,
lab, and clinical experience respectively.
It should be known that out of the 129 program
directors surveyed, 66.6% (N = 86) responded that they do
not teach men’s lacrosse CS immobilization protocols. These
respondents did not answer questions to how many hours were
spent in lecture, lab, and clinical experience and were

21
thus giving zeros for statistical analysis, which could
explain the results of low average hours spent on men’s
lacrosse CS immobilization skills.
The remaining 33.4% (N = 43) of respondents were
separately analyzed to find the mean hours spent in
lecture, lab, and clinical experience. Athletic training
education programs who did teach men’s lacrosse CS
immobilization skills averaged over an hour in lecture, two
hours in lab, and three and half hours in clinical
experience. These 43 respondents were also asked if they
used men’s lacrosse equipment in their clinic and formal
instruction. The results showed that 23 of those programs
did use the equipment, while the rest who do teach CS
immobilization skills for men’s lacrosse did not.
The same can also be said for why averaged hours spent
on ice hockey CS immobilization skills were low. Out of the
129 program directors that responded, 65.1% (N = 84)
reported that they do not teach ice hockey CS
immobilization skills, thus given zeros during statistical
analysis for mean hours spent in lecture, lab, and clinical
experience.
The remaining 34.9% (N = 45) of program directors were
separately analyzed to find the mean hours spent in
lecture, lab, and clinical experience. Athletic training

22
education programs that did teach ice hockey CS
immobilization skills averaged 45 minutes lecture, an hour
and 10 minutes in lab, and an hour in clinical experience.
These 45 respondents were also asked if they used ice
hockey equipment in their clinic and formal instruction.
The results showed that 21 of those programs did use the
equipment, while the rest who do teach CS immobilization
skills for ice hockey did not.
The findings support the hypotheses that athletic
training students will spend more hours in lecture, lab,
and clinical experience on football CS immobilization
skills then for men’s lacrosse and hockey CS immobilization
skills.
The 129 athletic training education programs were a
collection of programs from all ten NATA districts, except
district two. District two participants were involved in
the pilot study. Pilot study results can be seen in
Appendix C7. District four had the most participants,
consisting of 24.1% (N = 31) of the total respondents.
District ten consisted of 2.3% (N = 3) of the total
respondents, but there are only eight ATEP in district 10.
Most of the programs involved with the study were
accredited or re-accredited within the past ten years.
Programs that ranged from one to five years (27.9%) and six

23
to ten years (38.7%) had the highest number of respondents,
while programs ranging from 11 years to 25 years (3.1%8.5%) had the least number of respondents. The highest
average number of graduates from ATEP’s was six to ten
students (39.5%), while the lowest average graduation rates
was 25 students or more (3.1%).
The program directors also indicated which of the
three equipment intensive sports their associated
institutes had and the NCAA divisions they are in. What was
found was that the majority of the programs had football (N
= 45 in DI, N = 27 in DII, N = 38 in DIII, N = 1 Club, and
24 did not have football). Very few programs had DI men’s
lacrosse (N = 3) and hockey (N = 9) programs, with the
majority of programs not having men’s lacrosse (N = 94) and
hockey (N = 87) programs. One consideration this study
omitted was to survey institutes affiliated with the
National Association of Intercollegiate Athletics (NAIA).
This study also investigated during which semester the
athletic training students were being taught CS
immobilization skills. The results showed that a majority
of athletic training students obtained and learned CS
immobilization skills during the first semester of their
sophomore year. Programs were found to teach CS
immobilization skills during multiple semesters in an

24
athletic training student’s undergraduate career. Entry
level master’s programs were also teaching in multiple
semesters. The findings demonstrate that athletic training
students are well prepared early in their academic career
to handle emergency situations involving acute head and
neck injuries. Also, they are continually being re-educated
on CS immobilization as they progress through the
professional phase of the ATEP.
Even though athletic training students were taught CS
immobilization skills early and often throughout their time
in undergraduate and entry level master’s program, the time
was spent more on football CS immobilization skills than
that for

men’s lacrosse and ice hockey. Assumptions can be

made that more time was spent on football because programs
have the sporting equipment associated with football. This
study asked program directors what the reasons were if they
did not have all the required equipment for all three
equipment intensive sports. The highest percentage of
responses was men’s lacrosse CS immobilization skills
(25.5%) and ice hockey CS immobilization skills (23.3%)
were not as high of a priority to teach compared to that of
football CS immobilization skills (0.0%). Budgetary reasons
also had a high percentage (18.8%) of the responses for
reasons not having all the required equipment.

25
Additional comments were allowed to be made by program
directors to why they were unable to obtain all of the
required equipment. The majority of programs directors
commented that men’s lacrosse and ice hockey were sports
their students were not exposed to, because those sports
are not at the college/university or surrounding clinical
sites. This reason is not a valid one, just because ATEP’s
do not have these sports on their campus or surrounding
areas does not mean a student that graduates from their
program will not go on to work with men’s lacrosse or ice
hockey in the future. Program directors also stated that
their programs utilize football equipment in formal and
clinical instruction to explain the differences in men’s
lacrosse and ice hockey equipment. There are some that
speculate that all helmets are generally the same and can
utilize the same protocols. However, the helmet and
shoulder pads for these three sports are so different in
their design that different emergency protocols have to be
made to accommodate them. Several program directors
commented that the thought of teaching CS immobilization
skills for different equipment intensive sports didn’t
occur to them, stating they have never seen rules that
require all three to be taught. These program directors
have it right; there are no rules, so the thoughts would

26
not occur to them. All the more reason for CS
immobilization skills to be taught for equipment intensive
sports other than football
The purpose of this study was to determine if there is
a need to specify educational competencies of acute care of
injury, pertaining to CS immobilization skills. Athletic
training education program director’s opinions can assist
in that. The survey instrument devised a Likert Scale with
three questions that stated how well prepared the students
in director’s ATEP are with immobilizing the head and neck
of an athlete wearing football, men’s lacrosse, and ice
hockey equipment. Without much surprise, 57.8% of program
directors strongly agreed and 36.4% agreed that the
students in their programs were well prepared in football
CS immobilization protocols.
Program directors also responded to how well the
students were prepared in men’s lacrosse CS immobilization
protocols, 26.5% of ATEP directors agreed that the students
in their program are well prepared in men’s lacrosse CS
immobilization protocols. However, 43.7% program directors
disagreed and 24.2% strongly disagreed that the students in
their program are well prepared in men’s lacrosse CS
immobilization skills.

27
The results also showed how program directors
responded to how well their students were prepared in ice
hockey CS immobilization protocols, 21.8% of ATEP directors
agreed the students in their program are well prepared in
ice hockey CS immobilization protocols. While 46.8%
disagreed and 25% strongly disagreed that the students in
their program are well prepared ice hockey CS
immobilization skills.
Table 15. Program Director’s Opinion on How AT Students Are
Prepared to Immobilize the Cervical Spine for all Three
Equipment Intensive Sports
Sport
Strongly
Disagree
Agree (%)
Strongly
Disagree
(%)
Agree (%)
(%)
Football
4(3.1)
3(2.3)
47(36.4)
74(57.8)
M.Lacrosse 31(24.2)
56(43.7)
34(26.5)
7(5.4)
Hockey
32(25)
60(46.8)
28(21.8)
8(6.2)

Program directors also expressed their disagreement
that CS immobilization skills were being emphasized for all
three equipment intensive sports by the educational
competencies. Of program directors, 51.6% felt that the
educational competencies do not fully specify protocols for
CS immobilization skills for all three equipment intensive
sports. With over fifty percent of the program directors in
this study disagreeing that the educational competencies of
acute care of injury are adequate, then this study suggests
a just cause for changes to be made.

28
The data demonstrates the need for established
protocols of CS immobilization for athletes wearing men’s
lacrosse and ice hockey equipment to be a mandatory
competency. Athletic training education program directors
are seeing first hand that athletic training students are
not being fully educated on all the possible scenarios
where a cervical spine injury can occur. It can be assumed
that athletic training students, who graduate from a
program where these skills are not being taught, will not
be fully prepared to handle a situation where an athlete of
men’s lacrosse and/or ice hockey suffers a severe head
and/or neck injury.

Conclusions

After reviewing the results of this study, it is
concluded that athletic training students are spending
significantly less time in lecture, lab, and clinical
experience reviewing CS immobilization skills for athletes
wearing men’s lacrosse and ice hockey equipment compared to
the time spent reviewing CS immobilization skills for
football. Athletic training education program directors
feel that educational competencies do not emphasize or
specify CS immobilization skills for all three contact

29
equipment sports. Athletic training education programs
should focus on increasing time spent on teaching their
students CS immobilization skills for all equipment contact
sports. Therefore, athletic training students will have
more knowledge and ability to immobilize a head and neck
for equipment intensive sports other than football.

Recommendations

Further research recommendations for this study
involve indicating if there is a correlation between which
equipment intensive sport each ATEP’s college/university
represents, to if the ATEP’s have the associated sports
equipment to teach CS immobilization skills. This would
support that if the college or university has the sport,
then the ATEP should have the required equipment to teach
the corresponding CS immobilization skill.
Another possible area of research recommendation would
be to indicate if there is a correlation between years an
ATEP has been accredited and if the ATEP teaches CS
immobilization skills for all equipment intensive sports.
One might be able to differentiate that ATEP’s with more
years of accreditation will have more experience teaching,

30
thus branch out to teach CS immobilization skills for all
contact equipment sports.
The greatest suggested recommendation, resulting from
this study is for the athletic training competencies of
acute care of injury to emphasize which types of contact
sporting equipment to use. Athletic training students can
then be proficient in performing CS immobilization for all
contact equipment sports. This study’s recommendation is
that athletic training students be taught CS immobilization
skills for the three equipment intensive sports at their
ATEP, because in football, men’s lacrosse, and ice hockey
head injuries have one of the highest rates of occurrences
per athlete-exposures.

2-4

31
REFERENCES
1. Vaccaro AR, Harrop JS, Daffner SD, Berta SC. Acute
Cervical Spine Injuries in the Athlete: Diagnosis,
Management, and Return-to-Play. International SportMed
Journal. 2003; 4(1):1-9
2. Dick R. Ferrara MS. Agel J. et al. Descriptive
Epidemiology of Collegiate Men’s Football Injuries:
National Collegiate Athletic Association Injury
Surveillance System, 1988-1989 Through 2003-2004. Journal
of Athletic Training. 2007; 42(2):221-233
3. Dick R. Romani WR. Agel J. Case JG. Marshall SW.
Descriptive Epidemiology of Collegiate Men’s Lacrosse
Injuries: National Collegiate Athletic Association Injury
Surveillance System, 1988-1989 Through 2003-2004. Journal
of Athletic Training. 2007; 42(2):255-261
4. Agel J. Dompier TP. Dick R. Marshall SW. Descriptive
Epidemiology of Collegiate Men’s Hockey Injuries:
National Collegiate Athletic Association Injury
Surveillance System, 1988-1989 Through 2003-2004. Journal
of Athletic Training. 2007; 42(2):241-248
5. Waninger KN, Management of the Helmeted Athlete With
Suspected Cervical Spine Injury. American Journal of
Sports Medicine. 2004; 32(5):1331-1350
6. Segan RD, Cassidy C, Bentkowski J. A Discussion of the
Issue of Football Helmet Removal in Suspected Cervical
Spine Injuries. Journal of Athletic Training.
1993;28(4):294-305
7. Sherbondy PS, Hertel JN, Sebastianelli WJ. The Effect of
Protective Equipment on Cervical Spine Alignment in
Collegiate Lacrosse Players. American Journal of Sports
Medicine. 2006; 34:1675-1679
8. LaPrade RF, Schnetzler KA, Broxterman RJ, Wentorf F,
Wendland E, Gilber TJ. Cervical Spine Alignment in the
Immobilized Ice Hockey Player: A Computed Tomographic
Analysis of the Effects of Helmet Removal. American
Journal Sports Medicine. 2000; 28(6): 800-803
9. Acute Care of Injuries and Illness. 4th Edition Athletic
Training Competencies. 3; c.

APPENDICES

APPENDIX A
Review of Literature

34
REVIEW OF LITERATURE

Spinal injuries are a major concern in any sporting
event due to major life consequences they can have on the
athlete. According to studies looking at the NCAA Injury
Surveillance System done during 1988-1989 through 20032004, head and neck injuries are one of the most prevalent
injuries in football, men’s lacrosse, and men’s hockey.
Dick et al. reported that, during fall games of football,
6.8% of all injuries that occur are to the head and our
concussion related.1 Dick et al. also reported in another
study that, during games of men’s lacrosse, 8.4% of all
injuries that occur are to the head and our concussion
related.2 Hockey injuries were also looked at. Agel et al.
reported that, during games of men’s hockey, 9.0% of all
injuries that occur are to the head and our concussion
related.3

The need for proper management is vital for the

safety and well being of the injured athlete. The use of
protocols in the assessment and management of spinal
injuries can be helpful in decisive decision making,
especially in sports involving protective equipment that
might have to be removed.
Protocols have been well established and documented in
the management and acute care of football athletes with

35
cervical spinal injuries, but not for other such sports as
lacrosse and ice hockey. Protocols for injured lacrosse
athletes, once developed need to be taught in the entry
level setting, so future certified athletic trainers can
provide the appropriate care for the injured athlete. The
purpose of this literature review is to discuss the issues
related to how immobilization skills are taught in ATEP.
The sections that will be discussed include: (1) Spinal
Injuries in Athletics, (2) Mechanisms of Injury, (3)
Management of Spinal Injuries, and (4) Face Mask Removal.

Spinal Injuries in Athletics

Spinal injuries in collision sports can happen and it
is the responsibility of the certified athletic trainer to
be well prepared in cervical spine immobilization
techniques to maximize the safety of the athlete.
According to Vaccaro et al. only 10% of all the annual
cervical spine injuries in the United States occur in
athletics.4 Although serious traumatic spine injuries are
rare, all cervical spine injuries should be managed the
same way, with the worst case scenario in mind.

When a

cervical spine injury occurs, the authors explain that
symptoms that resolve quickly are typically found in less
severe injuries like brachial plexus stretches or

36
“stingers”.

Longer, more prolonged, symptoms are signs of

something more serious and need to be examined immediately.
Since there is no universally accepted return to play
criteria, only a physician has final word on whether or not
an athlete is ready for participation.5
Various spinal injuries can occur, and Walling6
discusses goes over three different serious conditions that
can be the result of sports-related injuries to the
cervical spine.

The three injuries are; (1) cervical cord

neurapraxia, (2) spinal stenosis, and (3) “stingers”.
Cervical cord neurapraxia and spinal stenosis is caused by
hyperflexion or hyperextension of the neck and results in
compression of the spinal cord. Once a football player has
had one of these injuries, a second occurrence is 56% more
likely to happen. A “stinger” is essentially an injury to
the brachial plexus that causes paresthesia in the
corresponding upper extremity, occurring as high as 65% of
the time during a player’s career.

Walling concludes by

saying that since it is difficult to predict neurapraxia
and the nature of the cervical spine injury, frequently the
final decision on returning to play is made by the athlete.7
Langer, Fadale, and Palumbo8 explain catastrophic neck
injuries as a structural alteration of the cervical spine
associated with damage to the spinal cord. Rare as this is,

37
this type of traumatic injury can lead to more severe
neurologic conditions for a collision sport athlete, such
as paralysis. During treatment, the helmet and shoulder
pads worn by the athlete can cause a problem, but the
authors explain how proper equipment protocols can avoid
this. The authors conclude by saying that complete
understanding of the anatomy, evaluation, and the protocols
for on-site management is necessary for the best outcome.9
Related to the occurrence of spinal injuries, several
articles performed multiple year studies in specific
sports. Randall et al. review 16 years of NCAA injury
surveillance data for men’s football and identified
potential areas of injury prevention weaknesses.
Epidemiological data helps certified athletic trainers
design injury prevention protocols and then test their
effects.10 The results of the data showed injury rates are
always changing, so testing the effects of protective
equipment need to be performed to determine their
effectiveness.

The data will also help designing new

injury prevention techniques.
Diamond and Gale performed a study to examine lacrosse
related injuries in the different genders and different
ages.

Data was assessed through the National Electronic

Injury Surveillance System over a 10-year period.

The

38
results showed that males accounted for 80.5% of the
injuries that occurred, due to the nature of the sport.
The head and face were more commonly injured, but were more
prevalent among females. Women lacrosse players are at more
of a risk to injury to the head and face than are men. It
was the authors’ recommendation that protective face gear
be worn for women’s lacrosse players.11
Tator, Carson, and Edmonds presented the ever growing
increase of spinal injuries in hockey. In 1981, Canadian
officials established the Committee on Prevention of Spinal
Injuries in Hockey. Now called SportSmart, there job is to
document the epidemiology of spinal injuries.12 The first
ever recorded spinal injury was 1966, and then from 1987 to
1991 there has been 182 cases reported. A total of 241
cases have been recorded from 1966-1993.13 With this
alarming rate of injuries, the authors believe there is
need for more research to be done to relinquish these
numbers.

Mechanisms of Injury

To better understand spinal injuries, the athletic
trainer needs to better understand the mechanisms of
injury. With that knowledge, the athletic trainer can help

39
decrease the risk of injury. Heck et al. presented
guidelines to decrease the risk of cervical spine fractures
and dislocations in football players.

The authors explain

how axial loading of the cervical spine is the primary
cause in spinal injuries.14 In football, tackling with the
head up and with hitting with the shoulder or chest, the
athlete decreases these chances. Their recommendations are
to educate players, coaches, officials about how
catastrophic these injuries can be when “spearing”.

Also,

advise coaches on correcting this behavior with their
players.
Pre-participating physical examinations can help the
athletic trainer discover if any of the athletes are more
susceptible to cervical spine injuries. Decoster et al.
designed a study to observe injury patterns between
generalized joint hypermobility and nonhypermobile NCAA
athletes.

The researchers screened 310 athletes from 17

lacrosse teams for joint hypermobility before the season
and recorded injury rates throughout the season.

The

injuries were then compared between hypermobile to
nonhypermobile athletes.

The results showed that twenty of

the 147 men and 54 of 163 women were hypermobile.
Throughout the season 100 athletes suffered 134 injuries.

40
However there were no significant differences in overall
injury rate between the two mobility groups.15
Swartz, Floyd, and Cendoma’s article provided
knowledge about functional anatomy, kinematic response, and
mechanisms involved in axial-compression cervical spine
injuries, as they relate to sport injuries. The cervical
vertebrae have 80-90 degrees of flexion, 70 degrees of
extension, 20-45 degrees of lateral flexion, and 90 degrees
of rotation on both sides. The first (C1) and second (C2)
cervical vertebrae form to create the atlanto-axial joint.
C1 is responsible for flexion and extension of the head,
while C2 is responsible rotation of the head. The rest of
the cervical column allows for flexion and extension, with
limited lateral flexion. The most common mechanism of
injury of the cervical spine is axial loading. Axial
loading occurs when the head and neck is flexed to 30
degrees, like a head first tackle. When this happens the
natural shock absorbing component disappears, potentially
causing serious injury.

The authors conclude that by

understanding the mechanisms of cervical spine injuries,
the likelihood of occurrence will reduce.16
Lacrosse helmets differ in design from football, but
axial loading with lacrosse helmets can still cause
significant damage to the spine. Caswell and Deivert

41
examined the effects of repetitive impact forces on
lacrosse helmets and to increase awareness of helmet
safety. Four helmets were studied, 2 traditional helmets
and 2 contemporary helmets. The helmets were raised to 152
cm and released 10 times onto an anvil, padded with a small
rubber modular elastomer programmer.

A triaxial

accelerometer was placed within a head form, inside the
helmet to measure impact force.

The results show that the

repetitive drops increased results on the elastomer
programmer, indicating a greater chance of cerebral injury.
The researchers concluded that contemporary helmets faired
better, but both helmets should be reconditioned or
replaced every season.17

Management of Spinal Injuries

Management of spinal injuries is the most vital aspect
when insuring safety for the injured athlete. The purpose
of Banerjee et al. article is to describe the best way to
manage an emergency catastrophic cervical injury in
football and hockey athletes.

The authors express the

importance of pre-event planning and preparation.

The

importance of emergency responsiveness of cervical spine
injuries is vital for on-field care and proper transport to

42
the emergency room.18 They also review the protocols for the
quick removal for protective gear.

They concluded that the

sports medical team should be highly qualified in all of
these areas for proper care of the athlete.
The Inter-association Task Force for appropriate care
of the spine developed guidelines for care. These
guidelines were created for pre-hospital management of an
athlete with a suspected spinal injury. They emphasize
never moving an athlete with suspected with spinal injury
and always be conscious of the athlete’s ABC’s,
neurological status, and consciousness.

The guidelines

also recommend that the facemask should be removed prior to
transportation, no matter what the current status is of the
athlete’s breathing.

The guidelines conclude by saying

that all skills should be all but second nature to the
athletic trainer before they really needed in an emergency
situation.
Bailes et al. point out that even though catastrophic
spine injury in sport has been decreasing over the years,
cervical spine injuries are still of high importance and
requires constant attention by the athletic trainer. The
magnitude of the injury is life altering and the importance
of on-field management is vital.

This article provides

recommendations for management and treatment of this

43
injury.

The authors conducted a literature review to find

the most relevant sources between 1970 and 2005.

By using

MEDLINE and search terms such as ‘spinal cord injury’ and
‘cervical spine injury’, the authors found that there are a
variety of injuries due to spinal trauma and the athletic
trainer should be ready to follow the Inter-Association
Task Force for the Appropriate Care of the Spine Injured
Athlete.19
More pre-hospital guidelines were developed by Kleiner
et al. The purpose of this text is to provide the certified
athletic trainer with prehospital guidelines to manage a
suspected spinal injury. The proper care of suspected
spinal injuries can decrease the possibility of a secondary
injury occurring.

This text uses the Inter-Association

Task Force for Appropriate Care of the Spine-Injured
Athlete as their primary guidelines.

Planning, practicing,

and educating are what the authors conclude are the best
ways to be prepared for treating a suspected head or spine
injury.20
Waninger examined published articles on cervical
management of a helmeted athlete with a suspected spinal
injury.

The author reviews on-field management with the

emergency department. This author also exemplifies the
importance of not removing the helmet or shoulder pads

44
unless absolutely necessary.

Waninger points out that

radiographs through the equipment may be inadequate and
computed tomography and magnetic resonance imaging needs to
be studied further.21 The article concludes that planning
ahead and being comfortable with the skills is important
and should be practiced regularly.
Management begins on the field of the play. Tierney et
al. had the objective to assess the effect of head position
and football equipment on the cervical spine when an
athlete is lying supine on a spine board.

The design was

set up with measuring occiput elevations at 0cm, 2cm, and
4cm with and without equipment.

Depending on those

elevations, sagittal space available for the cord, sagittal
spinal-cord diameter, and cervical thoracic angle, were
determined by MRI.

Twelve men were used as subjects.

The

results showed that there was more sagittal space for the
cord with 0cm of occiput elevation compared to 2cm and 4cm
of elevation.22 The equipment condition also showed similar
results. The authors concluded that helmet and shoulder
pads should be left on during spine-board immobilization of
an injured football player.

0cm of occiput elevation

should be maintained.
Segan et al. looked at why helmet removal in a spinal
injury situation is potentially dangerous and the authors

45
give reasons for not removing a helmet. The authors tackle
the myths of helmet immobilization such as how it
interferes with immobilization, interfere with visual
assessing, cause hyperflexion of the neck, and prevent
proper airway management.

The authors designed this

article for EMT’s, because they might confuse protocols for
motorcycle helmet removal for football helmet removal.

The

authors explain facts for each myth and explain protocols
for face mask removal when CPR is necessary.

The authors

recommend communication with local EMS so that the best
care for the athlete is provided.23
Lacrosse equipment is much different than that of
football. The helmets are not designed the same and the
shoulder pads are not as thick. Studies have been done to
examine how to manage lacrosse athletes with possible
cervical spine injuries. Sherbondy, Hertel, and
Sebastianelli’s article determined that the lacrosse helmet
and shoulder pads effect the alignment of the spine.

The

subjects for these trials were 16 uninjured male collegiate
lacrosse players.

Cervical spine angular alignment was

evaluated by using computed tomography.

The patients were

immobilized in the supine position with the helmet and
shoulder pads on, and with the helmet removed and shoulder
pads on. The results showed that when the helmet and

46
shoulder pads were left on, there was an increase of
cervical extension compared to no equipment.

With just the

helmet removed, there was an increase in cervical flexion
compared to equipment in place.

The authors concluded that

the lacrosse helmet and shoulder pads should be left in
place until they can be removed in a controlled fashion.

They also concluded that the effect the equipment has on
the neck is different for lacrosse helmets then football or
ice hockey helmets. Lacrosse helmets tend to have a
curvature that extends the athletes neck. When comparing
shoulder pads, lacrosse shoulder pads are thinner and less
padded then football and hockey shoulder pads.
Ice hockey may be slightly less of a contact sport
than football; however, hockey players can generate more
force by building up speed on the ice. With that increase
in force, it also creates an increase of potential
catastrophic injuries, especially of the head and neck. The
athletic trainer needs to be prepared for any such injury
to occur. LaPrade et al. researched to determine if
removing a hockey helmet causes any increase in lordosis of
the cervical spine in ice hockey players.

The trials

consisted of radiographically assessing 10 male hockey
players in three different scenarios. The subjects wore the
helmet and shoulder pads, the shoulder pads and without the

47
helmet, and with no equipment at all.

The results show

that there is a significant increase in lordosis of the
cervical spine with the helmet removed.

The authors

recommend that the hockey player’s helmet should remain on
and not be removed, except for rare exceptions.25
With lacrosse growing as a sport, more spinal injuries
are occurring. With that in mind, some colleges with elite
lacrosse programs have developed their own protocols for
the acute care of a cervical spine injured lacrosse
athlete. At the University of Maryland, the athletic
trainers created guidelines and emergency action plans for
lacrosse cervical spinal injuries.

They also lay out

specific lacrosse helmet removal techniques.

They are very

similar to that of a regular football helmet removal, but
the lacrosse helmet has no cheek pads. They also recommend
applying a cervical collar to keep the head from lying in
extension. The guidelines did not mention shoulder pad
removal. The authors recommend training every calendar
year.26
Immobilization is the next task that needs to be
second nature to an athletic trainer. The purpose of
Wagninger et al’s study was to compare the amount of
cervical spine and head movement in football, lacrosse, and
ice hockey helmets during immobilization procedures.

The

48
subjects consisted of 12 ice hockey, 9 football, and 9
lacrosse NCAA DI athletes.

The athletes were immobilized

on backboards and three motion analysis cameras followed
retroreflective markers placed on the helmets.

The results

showed football players having the least amount of motion,
while lacrosse players had the most amount of motion, but
the results were not significantly different.

With this

information the authors concluded that the same prehospital care that is done with football helmets can be
done with the lacrosse and ice hockey helmets.27

Face Mask Removal

The US lacrosse association’s sport science and safety
division has published a set of protocols to help the
certified athletic trainer in the process of removing the
face mask. They also recommend that the helmet and shoulder
pads should remain on to keep the cervical spine aligned.
The positive aspect about this published work is that it
goes over face mask removal protocols for all the different
styles of helmets.28
As immobilization is accomplished, face mask removal
should be done so the athletic trainer can assess the
athlete thoroughly and provide CPR if necessary. Studies

49
examining the removal of the lacrosse facemask have not
been performed. Swartz et al. investigated the affects of
different football helmet designs on the performance of
face-mask removal.

The authors hypothesized that the

cordless screw driver will perform with better efficiency
than cutting tools.

In this study, 19 certified athletic

trainers were randomly assigned to two groups.

One group

was given a cordless screwdriver and a FM Extractor, while
the other group was given a cordless screwdriver and a
trainer’s angel.

They were asked to perform face-mask

removals under six different conditions comprising of 3
different helmets, 3 types of face-masks, and 5 styles of
loop straps.

The results showed that the cordless screw

driver was more efficient in creating less movement of the
head, faster time to complete, and less difficulty in
exertion.

The conclusion is that for multiple helmet

conditions, a cordless screwdriver is better for each
situation.29
In an emergency situation, removing the face mask
quickly is essential for delivering appropriate care for
the athlete. Gale, Decoster, and Swartz investigated the
effectiveness and speed of using combined tools to remove a
face-mask during an emergency situation on the field
throughout the course of the season. Eighty-four members of

50
a NCAA DII football team were used as subjects.
four were available for trials.

Seventy-

A battery-operated

screwdriver was used for face mask removal, along with
other cutting tools if need be.

The results showed that

98.6% of the trials were successful in face-mask removal
and were completed in an average time of 40.09 seconds.30
The authors also found that there was no difference in
effectiveness or time throughout the season.

They

concluded that combining the cordless screwdriver with a
cutting tool provides a fast and reliable way for face mask
removal.

They recommended that since one face-mask was

failed to be removed, athletic trainers should be prepared
for helmet removal.
When speed is a factor, head movement must be kept at
a minimal. Swartz et al. evaluated the performance of
different facemask removal tools during a football helmet
face mask removal. Four different tools were used
including: the anvil pruner, polyvinyl chloride pipe
cutters, Face Mask Extractor, and Trainer’s Angle. Each
tool was then used to retract a face mask.

Eleven

different athletic trainers were used as subjects. A 3dimensional video was used to determine movement of the
head while the tools were used to remove the face mask.
The video was then analyzed for head movement and the time

51
it took for the face mask to be retracted.

The results

showed that the anvil pruner was quickest, while the Face
Mask Extractor had the least amount of head movement.

The

authors concluded that the anvil pruner and the Face Mask
Extractor had nearly identical scores.31
When time is an issue and rescue breathing only needs
to be delivered, Richard et al. studied and compared 2
pocket-mask insertion techniques with a face-mask rotation
technique to find which was the quickest to deliver rescue
breathing with the least amount of cervical motion.

Three

airway techniques were tested: the chin-insertion technique
(the pocket mask is inserted under the face mask onto the
mouth and nose), eye-hole-insertion technique (the pocket
mask is inserted through the eye hole onto the mouth and
nose), and the screwdriver technique (which allows the
valve to be placed through the facemask and attach to the
mask). One athletic training team tested the techniques on
12 NCAA DIII football players.

The results showed that

both pocket-mask techniques allowed for quicker delivery of
rescue breathing. The chin technique had greater
displacement from the original spine placement than the
eye-hole technique.

The screw driver technique caused too

much lateral spine translation. The authors concluded that

52
the eye-hole insertion was the better choice than the other
two techniques.32
When the athlete has been received at the emergency
department, there have been questions to whether or not
imaging can be done with helmet still on. Veenema et al.
tried to determine if the cervical spine can be visualized
with the helmet and shoulder pads on while a lateral film
is taken by an Emergency Department x-ray machine.

One

male subject was used and was fully immobilized under three
different conditions: 1) no equipment, 2) football helmet
and shoulder pads, and 3) hockey helmet and shoulder pads.
A single lateral film was taken of the subject’s cervical
spine in all three scenarios. Results showed that the
football helmet and shoulder pads could not be visually
seen through. While the hockey helmet and shoulder pads
could be visually seen through.

The authors conclude that

the hockey equipment can remain on, but the football
equipment should be removed prior to imaging.33 The authors
admit that their primary limitation is a single subject
that is uninjured.

53
Summary

Protocols have been well established and documented in
the management and acute care of football athletes with
cervical spinal injuries. Hockey also has protocols for
injured athletes; maybe not as well know to every athletic
trainer. However, very few protocols exist for men’s
lacrosse. Teaching the protocols for cervical spine injured
athletes in these three contact sports needs to be taught
in the undergraduate setting, so the future certified
athletic trainer can provide appropriate care. With a full
understanding of spinal injuries, mechanisms of injury, and
management of spinal injuries; the future certified
athletic trainer should be able to care for the injured
athletes in all contact sports.

APPENDIX B
The Problem

55
THE PROBLEM

Statement of the Problem
The athletic trainer in today’s sporting world needs
to be always aware and alert. An emergency situation where
a equipment intensive sport athlete suffers a cervical
spine injury requires the athletic trainer to act quickly
and decisively, using everything that he or she has
previously learned. The appropriate care in the field can
have great impact on the injury outcome. Most athletic
training education programs teach their students how to
immobilize and remove a facemask by using football
equipment. Few programs take the time to teach there
students protocols for ice hockey and men’s lacrosse.
The purpose of this study was to examine the need for
specifying the educational content that athletic training
students are taught acute care of injuries, pertaining to
CS immobilization of athletes wearing protective equipment,
in the athletic training competencies.

Definition of Terms
The following definitions of terms will be defined for
this study:

56
1)

Axial Load- a compressive force usually
associated with the spinal column.

Athletic Training Competencies- a set of required
teaching guidelines an ATEP has to follow.

Athletic Training Education Program (ATEP) - an
education setting where students a taught the
practice of athletic training.

Cervical Spine (CS) - seven vertebrae bones
ranging from the base of the skull to the
beginning of thoracic spine

Immobilization- technique used in stabilizing the
head and neck of a person suspected of a spinal
injury.

Commission on Accreditation of Athletic
Athletic Training Education (CAATE) - Governing
body that accredits athletic training programs at
universities and colleges.

NATA Educational Council- Governing body that
decides what content athletic training students
are to be taught and tested.

57
Basic Assumptions
The following are basic assumptions the research will
use in this study:
1)

The subjects will answer honestly and to the best
of their knowledge.

Subjects will not receive outside help any other
individual or outside source on any question.

The sample is a representation of the population
of CAATE program directors nationally.

Limitations of the Study
The following examples are possible limitations of the
study:
1)

The response rate of the survey could be low due
to busy schedules of the program directors.

As with any anonymous survey, answers might not
be answered honestly by the subjects.

Significance of the Study
Athletic trainers should possess all the available CS
immobilization techniques when working with equipment
intensive sports. Each sport has different equipment, which
requires different methods of immobilization and face mask
removal in order to provide the safest acute care for the

58
athlete.

Athletic training education programs that teach

only one method or use one style of equipment to teach
their students are not providing their students with a full
knowledge of CS immobilization skills.
This study examined how athletic training education
programs teach their students how to immobilize an athlete
wearing contact sport equipment. The survey asked athletic
training education programs their teaching methods, sport
specific immobilization techniques, and suggestions to
specifying educational content in the athletic training
competencies.
This study is important for athletic trainers and
athletic training educators. An understanding of the
different methods for CS immobilization for the various
equipment intensive sports will make for a better athletic
trainer. The athletic trainer educator, with a better
understanding, will be able to teach the athletic training
student to be more aware of the different and possible
emergency situations they might find themselves in. This
increase in awareness may help ensure the safety of an
injured athlete.

APPENDIX C
Additional Methods

APPENDIX C1
Panel of Experts Letter

61
Hello,
My name is Eric Gelinas.
I am a graduate student at
California University of Pennsylvania conducting a survey
for my thesis. My thesis chair is Dr. Linda Meyer and she
suggested you to serve on my panel of experts and review my
survey. Therefore, I am asking if you have the time and
are willing to review my survey and give me critical
feedback. My target audience is the CAATE program
directors and I am researching how their faculty teaches
their students the immobilization skills for cervical spine
injured athletes wearing different types of sports
equipment, specifically, football, ice hockey and/or men’s
lacrosse helmets and shoulder pads.
I’m investigating to
see if equipment other than football is being used when
teaching cervical spine immobilization techniques.
I am
also investigating if the educational content found in the
NATA competencies should be specified to include what type
of equipment needs to be taught during c-spine
immobilization skills.
I hypothesize that AT students spend more hours in lecture,
lab, and clinical experience on football cervical spine
immobilization skills. If that is the case, then students
in the program are not being fully educated on all the
contact sports that could potentially have an athlete
suffer a cervical spine injury. I hope to change that.
Please let me know if you are NOT able to assist me with
this survey. If you are able to assist, I kindly ask if
you would please reply no later than Monday, November 17,
2008.
Either way, thank you for your time; I greatly appreciate
it.
Sincerely,
Eric Gelinas

APPENDIX C2
Cover Letter

63
March 13, 2009
Dear Program Director,
My name is Eric Gelinas and I am a graduate student at
California University of Pennsylvania. As part of my
graduation requirement, I am to construct a thesis.
Although it is a requirement, my committee chair Linda
Meyer and I hope to add to the body of knowledge for the
profession of athletic training. My CalU IRB approved
thesis topic is “Examining the Need for Specifying
Educational Content for Cervical Spine Immobilization
Skills in Athletic Training Education Programs”.
I am writing to ask for your assistance to complete this
survey. First, this is strictly voluntary and is not
mandatory to complete. There is no risk involved in taking
this survey. Second, this is strictly anonymous and all
answers will be confidential and viewed by myself only. If
you decide to complete and return the survey, then I will
assume that it is an indication of consent to use the data.
If you are willing to take the survey please click on the
link below:
http://www.surveymonkey.com/s.aspx?sm=t6hbCT5TUr7OVyxB_2fWa5_2fg_3d_3d

Please, if you could, respond back by April 3, 2009.
I deeply appreciate your time and assistance. If you have
any questions or concerns, feel free to email me at
gel2319@cup.edu or by phone 603-345-0719.

Sincerely,
Eric Gelinas, ATC
California University of Pennsylvania
250 University Ave.
California, PA 15419
Gel2319@cup.edu

APPENDIX C3
ATEP Directors Survey

65
ATEP Director Survey
1.

Cumulatively, how many years has the ATEP at your
institution been accredited by NATA, CAAHEP and/or
CAATE?
___________

On average, how many students graduate from your
program annually?
___________

In which NATA district is your college/university
located?
___________

What division do each of the university/college sport
teams participate?
Div I
Div II Div III Club
None
Football
□
□
□
□
□
Men’s Lacrosse
□
□
□
□
□
Ice Hockey
□
□
□
□
□

In what semesters are your AT students taught (theory
and practice) cervical spine immobilization techniques?
(Mark all that apply)
□
□
□
□
□

1st
1st
1st
1st
1st

semester Freshmen
semester Sophomore
semester Junior
semester Senior
year entry master

□
□
□
□
□

2nd
2nd
2nd
2nd
2nd

semester Freshmen
semester Sophomore
semester Junior
semester Senior
year entry master

In which of the following settings are the athletic
training students taught how to immobilize a c-spine
injured athlete wearing a FOOTBALL HELMENT AND SHOULDER
PADS: (Mark all that apply)
□
□
□
□

In a lecture setting
In a lab setting
Clinical experiences
Not at all

If ATEP directors answer, Not at all, skip to question #10.

Do the AT students use football helmets and shoulder
pads to practice with during the educational sessions?
□ Yes

□ No

Approximately how many total hours do the athletic
training students spend on theory and hands on
experience for immobilization skills for c-spine injured
football players? (Please Complete the Blanks)
___hours in lecture
___hours in lab
___hours in clinical experience

When practicing the immobilization techniques, do the
athletic training students practice on the actual
playing surface or a similar playing surface for
football?
□ Yes

□ No

10. In which of the following settings are the athletic
training students taught how to immobilize a c-spine
injured athlete wearing a MEN’S LACROSSE HELMET AND
SHOULDER PADS: (Mark all that apply)
□
□
□
□

In a lecture setting
In a lab setting
Clinical experiences
Not at all

If ATEP directors answer, Not at all, skip to question #14.

11. Do the AT students use men’s lacrosse helmets and
shoulder pads to practice with during the education
sessions?
□ Yes

□ No

12. Approximately, how many total hours do the athletic
training students spend on theory and hands on
experience for immobilization skills for c-spine injured
men’s lacrosse players? (Please Complete the Blanks)
___hours in lecture
___hours in lab
___hours in clinical experience
13. When practicing the immobilization techniques, do the
athletic training students practice on the actual
playing surface or a similar playing surface for
lacrosse?
□ Yes

□ No

14. In which of the following settings are the athletic
training students taught how to immobilize a c-spine
injured athlete wearing an ICE HOCKEY HELMET AND
SHOULDER PADS: (Mark all that apply)
□
□
□
□

In a lecture setting
In a lab setting
Clinical experiences
Not at all

If ATEP directors answer, Not at all, skip to question #19.
15. Do the AT students use ice hockey helmets and shoulder
pads to practice during the educational sessions?
□ Yes

□ No

16. Approximately how many total hours do the athletic
training students spend on theory and hands on
experience for immobilization skills for c-spine injured
ice hockey players? (Please Complete the Blanks)
___hours in lecture
___hours in lab
___hours in clinical experience

17. When practicing the immobilization techniques, do the
athletic training students practice on the actual ICE
playing surface or a similar playing surface for ice
hockey?
□ Yes

□ No

18. Of the following, which of the learning styles are used
to teach your athletic training students immobilization
skills for c-spine injured athletes wearing contact
equipment?
□
□
□
□

Live presentation
Video
Handouts
Other: (Please Specify) __________________________

19. Do you have the required specific sport equipment to
teach c-spine immobilization skills for all three
contact sports?
□ Yes

□ No

If ATEP directors answer, Yes, skip to question # 21

20. If you don’t have all the required equipment to teach
c-spine immobilization skills for all three contact
sports, why not? (Mark all that apply)
□
□
□
□
□
□

Budgetary reasons
Inability to obtain required equipment
Hockey techniques are not as high priority
Football techniques are not as high priority
Lacrosse techniques are not as high priority
Other: (Please Specify) __________________________

21. How are the athletic training students tested/evaluated
on their immobilization skills?
□ Written Exam
□ Proficiency Exam
□ Other: (Please Specify) __________________________

22. How are the athletic training students evaluated on
their immobilization skills?
□
□
□
□

Check off system with multiple criteria
Letter grade system
Point scale system
Other: (Please Specify) __________________________

23. Are the athletic students who failed an immobilization
exam allowed to retake it?
□ Yes

□ No

Please rate how you would answer the following statements
by choosing one of the following
1. Strongly Disagree
2. Disagree
3. Agree
4. Strongly Agree
24. Our athletic training students are properly trained and
prepared to immobilize FOOTBALL athletes wearing both a
helmet and shoulder pads.
□ Strongly Disagree □ Disagree

□ Agree □ Strongly Agree

25. Our athletic training students are properly trained and
prepared to immobilize MEN’S LACROSSE athletes wearing
both a helmet and shoulder pads.
□ Strongly Disagree □ Disagree

□ Agree □ Strongly Agree

26. Our athletic training students are properly trained and
prepared to immobilize ICE HOCKEY athletes wearing both
a helmet and shoulder pads.
□ Strongly Disagree □ Disagree

□ Agree □ Strongly Agree

27. The educational competencies appropriately emphasizes
the need for athletic training students to have the
necessary skills to immobilize athletes in intensive
equipment sports other than football.
□ Strongly Disagree □ Disagree

□ Agree □ Strongly Agree

APPENDIX C4
Institutional Review Board

APPENDIX C5
ATEP Directors Comments to Why They Are Unable to Obtain
Required Equipment

77
ATEP Directors Responses to Why They are Unable to Obtain
all the Required Equipment to Teach CI Immobilization
Skills for all Equipment Contact Sports.
•
•

•
•
•
•

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Lacrosse and hockey are not conference sports.
We teach the concepts and related them to the
equipment we do practice on. We try to instill in our
students that there is always more to learn and they
need to learn "on the job" for each setting in which
they are employed.
Do not have these sports.
We don't provide coverage for lacrosse and don't have
ice hockey as a sport in our conference.
We are in the process of ordering.
Theory of helmet removal techniques are very similar,
plus we do not have hockey or lacrosse at our
institution.
Haven't really thought about it much before.
Do not have hockey.
We don't have either sport in New Mexico!
We do not have hockey or hockey in area.
I have not seen a rule that all three sets of
equipment are required by the NATA-EC.
No hockey team and Lacrosse is not sanctioned-only a
club.
Have never even considered Lacrosse or Hockey when
discussing c-spine injuries.
Affiliated sites maintain hockey and football
equipment.
We don't work with hockey or lacrosse within our
clinical settings.
Don't have lacrosse or hockey.
Time requirements and therefore priorities.
We do not have any other contact sport except
football.
Can't justify purchasing if we don't have the sport.
Not sure.
Hockey and lacrosse are not clinical experiences for
our students.
Ice hockey and lacrosse are uncommon here.
We don't have Lax or IH teams in this part of the
country and just have not thought to include these
sports in our practice sessions.

78
•

•
•
•
•
•
•
•
•
•

Most institutions have football, while there are fewer
that have lacrosse and hockey. So it is discussed and
explained in lecture. We do not have the equipment
since the school does not have the program. And, we
have other purchases that need to be made before we by
hockey and lacrosse equipment for our educational
program.
Not a part of our athletic programming.
Didn't really consider it until now.
School does not offer football or lacrosse.
We do not have much hockey and Lacrosse in the
south... football, however is a nation wide sport.
Thought we needed only an equipment intensive sport.
ATS are not clinically exposed to ice hockey/lacrosse
experiences, however, taught in classroom setting.
We do not have Lacrosse or Hockey in the area.
Not sports our students see in our state.
Sports are not that prevalent.

APPENDIX C6
ATEP Directors Comments about Study

80
ATEP Directors Comments about Study
•

Great survey...I'm interested in reading the results
(and very proud of you, by the way). Please stay in
touch and keep me posted.

•

Yes, please send me the results after you have them,
Many thanks in advance

•

I just wanted to send a quick note on your choice of
topic. I get so many requests to fill things out, and
I try to do them all. However, many of them are
terrible. Bad topics of little importance and poor
questions.
You did a nice job with your questionnaire and have a
very important topic. I know it opened my eyes a bit
to the need to stress hockey and Lax stuff.
Good luck with your study.

•

I would like to see the results of the data you
collect for your thesis.
All the best

•

Thanks for putting this survey together. This is
something my colleagues and I have discussed quite a
bit this year. We had actually been discussing
designing a similar study to see exactly what programs
were doing about cervical spine immobilization, spine
boarding and facemask removal.
I would be very interested in seeing your results when
you are finished compiling them.
As an additional line of questioning, it would be
interesting to see how programs allow students to
practice facemask removal (i.e.: what tools are
available and how much practice time is allowed with
the tools). Our program has gone to purchasing
various tools (we have about 6-8 different facemask
removal tools available and we allow the students
plenty of time to practice with each during lab
sessions). In fact, they practice so much, that we
have had to replace two FM Extractor II's, one

81
"Trainer's Angel" and a number of anvil pruners in the
last three years. Although it is tough on the budget,
I am comfortable knowing they have put in the time to
learn the proper techniques and also have determined
which tool works best for them.
Our practice and teaching time is very high due to the
inclusion of two EMT courses and a three-week focus on
emergency care of the spine injured athlete in our
spine evaluation and treatment course. It would be
interesting to see exactly which courses are being
used to teach this content and these psychomotor
skills.
Also, we have begun devoting two hours during the
junior year to spine boarding in the pool. I included
this in our total lab hours of practice time (even
though it did not involve the use of equipment). I
would be curious to see if this is something that
other programs are including as well.
Thanks again for gathering this information. I think
it will prove to be incredibly valuable to educators
and the profession of athletic training.
•

I just completed your survey on c-spine immobilization
and would be very interested in hearing the results of
the surveys. Please pass along that information when
it is available. Thanks and good luck with your
thesis. I think you have a very intriguing project.

Appendix C7
Pilot Study Results

83
Pilot Study Results
Thirty NATA district two ATEP were asked to
participate in the study and complete the ATEP Director’s
Survey. There was a response rate of 53.3% (N = 16). The
results showed that ATEP’s were averaging more hours in
lecture for football CS immobilization skills (3.31 ± 2.52)
than for men’s lacrosse (0.96 ± 1.61) and ice hockey
(0.72 ± 0.86).
The results showed ATEP’s were averaging more hours in
lab for football CS immobilization skills (4.12 ± 4.11)
than for men’s lacrosse (1.26 ± 2.4) and ice hockey
(0.82 ± 1.75).
The results showed ATEP’s were averaging more hours in
clinical experience for CS immobilization skills
(5.18 ± 6.07) than for men’s lacrosse (0.94 ± 1.57) and ice
hockey (0.72 ± 1.57).
Out of the 16 respondents, 31.2% (N = 5) stated that
they do not teach men’s lacrosse CS immobilization skills.
The remaining 68.8% (N = 11) of the respondents were
separately analyzed. The results showed ATEP’s averaged 1.5
± 1.05 hours in lecture, 1.84 ± 2.73 in lab, and 1.36 ±
1.74 in clinical experience.
Out of the 16 respondents, 37.5% (N = 6) stated that
they do not teach ice hockey CS immobilization skills. The

84
remaining 62.5% (N = 10) of the respondents were separately
analyzed. The results showed ATEP’s averaged 1.17 ± 0.78
hours in lecture, 1.68 ± 2.23 in lab, and 1.27 ± 1.95 in
clinical experience.

85
ABSTRACT
Title:

EXAMINING THE NEED FOR SPECIFYING
EDUCATIONAL CONTENT FOR CERVICAL SPINE
IMMOBILIZATION SKILLS IN ATHLETIC TRAINING
EDUCATION PROGRAMS

Researcher:

Eric D. Gelinas, ATC, PES

Adviser:

Dr. Linda Meyer, Ed.D, ATC, PES

Date:

May 2009

Research Type: Master’s Thesis
Context:

Contact equipment intensive sports include
more than just football. Today’s athletic
trainer must be aware of the various
emergency protocols incase a cervical spine
injury occurs anyone of these sports.

Objective:

Study to determine if athletic training
students are being taught various contact
sport immobilization and equipment
management techniques.

Setting:

An email was sent to the program directors
with a link to the survey to be completed on
an internet based program at the program
directors own discretion.

Participants:

320 ATEP directors were asked to volunteer
their time to participate in the survey. 129
ATEP directors responded to the survey.

Interventions: An original survey was created for this
study. The survey was examined by a panel of
experts to determine the validity of the
survey. Then an IRB approved survey was sent
to 30 program directors to test its
reliability. The survey was created on the
web server ‘Survey Monkey’ and sent via
email to the program directors. A cover
letter explaining the study was also
uploaded with the survey.

86
Main Outcome
Measures:

The research hypotheses will be analyzed
using a one-way analysis of variance at an
alpha level of 0.05.

Results:

The mean hours spent in lecture for Football
CS immobilization was 2.68 ± 1.98, M.
Lacrosse was .32 ± .76, and Hockey was .38 ±
.79. The mean hours spent in lab for
Football CS immobilization was 3.88 ± 3.22,
M. Lacrosse was .29 ± 1.05, and Hockey .30 ±
.84. The mean hours spent in clinical for
Football CS immobilization was 3.62 ± 4.02,
M. Lacrosse .32 ± 1.41, and Hockey .25 ±
.72. A significant difference was found
among time spent in lecture (F(2,384) =
136.98, P < .001), time spent in lab
(F(2,384) = 129.296, P < .001), and time
spent in clinical experience (F(2,384)=
75.824, P < .001) for the three contact
equipment sports.

Conclusions:

This study concluded that athletic training
students are spending significantly less
time in lecture, lab, and clinical
experience reviewing CS immobilization
skills for athletes wearing men’s lacrosse
and hockey equipment compared to the time
spent reviewing CS immobilization skills for
football.

Word Count:

394

87
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Dick R. Romani WR. Agel J. Case JG. Marshall SW.
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Agel J. Dompier TP. Dick R. Marshall SW. Descriptive
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