A within-person randomised trial to investigate the effects of a rigid cervical collar on three-dimensional angular movement and angular acceleration during emergency spinal immobilisation and extrication procedures in elite football (soccer) players: The RESTRICT study

Abstract

ABSTRACT Objective To determine the effects of rigid collars on cervical movement and acceleration during triple spinal immobilisation and extrication. Methods Procedures were performed on 15 non-injured volunteers in random order of collar and no-collar. Primary outcomes were angular movements and angular accelerations of the head relative to the thorax. Secondary outcome was the total procedure time. Results Between collar and no-collar, small but significant differences were found for mean angular movements during 15 ° tilt tasks for lateral flexion (3.4 ° : 95%CI: 1.4 ° , 5.4 ° ), flexion-extension (2.4 ° 95%CI: 0.4 ° , 4.4 ° ), rotation (–3.7 ° : 95%CI: –7.2 ° , –0.2 ° ) and total rotation (6 ° : 95%CI; 2.9 ° , 9.1 ° ). For the lift and lower task there was a significant difference in total lateral flexion of only 0.3 ° (95%CI: 0.1 ° , 0.5 ° ). Total movement during the procedure was significantly more for rotation without the collar (6.6 ° : 95% CI: 1.9 ° , 11.3 ° ). Small but significant differences were found for angular acceleration only during the lift and lower task for maximum lateral flexion (–6.5 rads/s 2 , 95%CI: –12, –1 rads/s 2 ), maximum rotation (–2.8 rads/s 2 , 95% CI: –5.2, –0.4 rads/s 2 ) and minimum rotation (–3.5 rads/s 2 , 95%CI: –5.9, –0.1 rads/s 2 ). The procedure was significantly longer with the collar (257.5s [95%CI: 245.3, 269.7s} versus 230.9s [95%CI: 215, 246.8s]. Conclusion There were statistically significant but clinically negligible differences between a rigid cervical collar and no-collar in some parameters for the triple immobilisation and extrication procedure in the sporting context. These novel results provide highlight important clinical considerations when immobilising and extricating players after a head or cervical injury.

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