Tucker WS‡, Chester TE†, Decoster LC†, Swartz EE*, Endres BD†: †New Hampshire Musculoskeletal Institute, Manchester, New Hampshire, *University of New Hampshire, Durham, New Hampshire, ‡ University of Central Arkansas, Conway, Arkansas

Context: With potential cervical spine injury, immobilization and removal of barriers to the airway, such as a facemask (FM), are essential. Helmet removal may be indicated in certain situations. It is unknown if removing the FM prior to helmet removal is beneficial.

Objective: To compare head acceleration, time and difficulty during helmet removal with and without facemask removal.

Design: Quasi-experimental.

Setting: Controlled laboratory.

Patients or Other Participants: Twenty-eight certified athletic trainers free of physical ailments participated in this study (12 males: age=30.8±8.5 yrs, height=179.0±6.4 cm, mass=83.7±15.8 kg, athletic training experience=7.5±8.3 yrs; 16 females: age=28.6±6.0 yrs, height=161.9±6.4 cm, mass=69.0±13.6 cm, athletic training experience=5.3±5.5 yrs).

Main Outcome Measures: Dependent variables were peak acceleration in three planes (sagittal, frontal and transverse), trial time and difficulty. For each dependent variable, a 2x2 factorial RMANOVA was performed with Bonferroni adjusted Pairwise post-hoc comparisons. (Alpha level = p<0.05).

Results: Main effects were detected in sagittal plane acceleration for helmet (F1,13=18.015, p=0.001) and technique (F1,13=18.534, p=0.001). The 360 (5.19±1.6m/s/s) was greater (p=0.001) than the VSR4 (3.1±0.67m/s/s) and FM-on (4.76±1.1m/s/s) was greater than FM-off (3.52±0.80m/s/s). There was a main effect in the transverse plane for helmet (F1,13=17.009, p=0.001) and technique (F1,13=10.075, p=0.007). The 360 (4.87±1.6m/s/s) was greater than the VSR4 (2.8±0.78m/s/s) and FM-on (4.33±1.1m/s/s) was greater than FM-off (3.34±0.93m/s/s). A main effect (F1,13=5.801, p=0.032) in frontal plane acceleration was detected. The 360 (2.71±1.6m/s/s) was greater than the VSR4 (1.94±0.67m/s/s). For time, there was a main effect for helmet (F1,13=49.165, p<0.001) and technique (F1,13=21.956, p<0.001). The VSR4 (91.2±18.8s) took longer than the 360 (50.2±11.1s) and FM-off (82.5±13.8s) took longer than FM-on (59.0±15.0s). For difficulty, there was a main effect for helmet (F1,13=5.746, p<0.032). The VSR4 was more difficult (2.67±0.83) than the 360 (2.31±0.73). An interaction (F1,13=6.471, p<0.024) revealed the VSR4 as being more difficult with FM-off, but the 360 more difficult with FM-on.

Conclusions: While removal of a facemask limited acceleration at the head, the removal process increased the time for the task for both helmets and increased difficulty with the VSR4. Future research analyzing induced motion is warranted.