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

ABSTRACTObjectiveTo determine the effects of rigid collars on cervical movement and acceleration during triple spinal immobilisation and extrication.MethodsProcedures 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.ResultsBetween 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/s2, 95%CI: –12, –1 rads/s2), maximum rotation (–2.8 rads/s2, 95% CI: –5.2, –0.4 rads/s2) and minimum rotation (–3.5 rads/s2, 95%CI: –5.9, –0.1 rads/s2). The procedure was significantly longer with the collar (257.5s [95%CI: 245.3, 269.7s}versus230.9s [95%CI: 215, 246.8s].ConclusionThere 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.