To remove tape, tape cutters (Fig. 20-1) are recommended in lieu of scissors because they have protective tips to avoid cutting the skin and are made to slide easily under the tape’s edge.

Fig. 20-1 Example of tape cutters. (Note the protected tips designed to avoid cutting the skin when removing tape.)

Rigid thermoplastic materials

Rigid thermoplastic materials include plastics, elastomer or rubberlike materials, or a combination of these two. Orthoplast, Multiform (Alimed, Dedham, MA), Aquaplast, Polyfoam (Smith & Nephew), Polyflex, and Ezetoy (Smith & Nephew) are common thermoplastic materials used to make rigid splints.¹⁹ Plastic is more conforming than rubberlike materials and is used for smaller splints (e.g., those used for the finger). Both materials come in conveniently sized solid or perforated sheets.

To make a splint from thermoplastic materials, typically a pattern is first fashioned from paper, which can be easily folded when custom fitting it to the area. Using this pattern, the appropriately shaped piece of thermoplastic material can be cut, softened with heat (typically 150°–180°F)^* either by immersing it in a hydrocollator or by using a heat gun and molded to the body part. The fabricated brace can be securely attached to the athlete by hook-and-loop straps, elastic webbing, or elastic or cloth tape, or it can be incorporated into the pockets of the uniform (Fig. 20-2). Prefabricated splints from these materials are available. When designing protective pads, one must be certain that the material selected for fabrication is permitted by the sport.

Fig. 20-2 Fabricating a custom-fitted orthosis from a thermomoldable material. A, Pattern is sized and cut. B, The pattern is used to fashion the orthosis from a piece of thermoplastic material. C, The orthosis is heat softened and molded to the athlete, taking care to not burn the athlete when applying the heated orthosis. D, The fabricated brace is secured to the athlete.

Governing bodies for sport typically determine the materials that are to be used. Regulations may vary depending on the sport, the age of participants, and the level of competition. The National Federation of High Schools (NFHS, Indianapolis, IN) and the National Collegiate Athletic Association (NCAA, Indianapolis, IN) may have additional rules. Splints and pads should protect the athlete but should not be able to be used as a weapon against the opponent, nor should they provide an unfair advantage to the athlete.

Open-cell and closed-cell foam pads and splints

Semirigid splints can be made from thermoplastic polyethylene closed-cell foams (e.g., Plastazote, Zotefoams, Walton, KY; Nickleplast, Alimed; Aliplast, Alimed) or from ethylene vinyl acetate (EVA) foam. Because these materials are less ridged than heat moldable plastic and rubberlike materials, they are permitted by most sport ruling bodies. Prefabricated splints made from these materials also are available. EVA foam is a softer, more resilient material than polyethylene foams. Polyethylene foams are firmer and more resistant to heat. Both products have a fine uniform closed-cell structure, can absorb high energy, are poor water absorbers yet good thermal insulators, have a broad working temperature, provide good weather and chemical resistance, and have excellent buoyancy characteristics. Both can be molded for pressure distribution and protection and can be laminated with a closed-cell cushion-type material (e.g. Pelite, Durr-Fillauer, Montgomery, AL; Volara, Voltek, LLC., Lawrence, MA).

Open-cell foams, like foam rubber, are lower-density materials. The cells are connected and therefore allow for air passage. These materials can cushion and absorb fluids, but they are not good shock absorbers because they deform quickly with impact.

Silicone elastomer (Smith & Nephew or Dow Corning Corp., Midland, MI) is a liquid-type material that reinforces gauze bandages. When activated by a catalyst, it forms a soft splint material that can be used for casts and splints when more rigid materials such as plastic and rubberlike (elastomer) combinations or polyethylene or EVA foams are not permitted by the sport.^3,⁴ Soft casting tape (e.g., 3M Healthcare) also can be used for this purpose (Fig. 20-3). After the splint is fashioned and allowed to harden, the device is bivalved so that, if needed, it can be replaced with a more rigid cast/splint for everyday uses. The softer splint is taped in place for play, practice, and competition.

Fig. 20-3 Bivalved soft splint. The splint is taped to the athlete for protection during practice and play. It can be used in sports where a splint fashioned from more rigid material is not permitted. The athlete can wear the more rigid splint when not participating in sport.

Pneumatic devices

Air-filled braces and pads have gained in popularity in the last decade, but their use is limited because of problems with deflation and punctures. Pneumatic splints are used following trauma to immobilize injured extremities. Air pockets have been added for support in ankle braces, tennis elbow counterforce devices, and other protective orthosis.

Examples of protective equipment

Shoulder

Pads for protection

Tackling, checking, and violent ground contact leave the shoulder extremely susceptible to injury. Sports such as football, hockey, and lacrosse require the use of shoulder pads to help protect the sternum, clavicle, shoulder, and scapula. Significant improvements in shoulder pads design have been made over the last 25 years. Currently, pads are made of high-impact, plastic outer shells to deflect collision forces and an inner lining composed of open-cell or closed-cell foam or air dispersion pads to absorb force. They are lightweight and flexible to permit adequate range of motion (ROM) of the shoulder and neck, yet they provide sufficient protection of the chest, back, and shoulder girdle.

Football pads provide the player with greater protection than do hockey or lacrosse shoulder pads (Fig. 20-4). Attachments such as rib and back plates, biceps pads, and neck rolls add further levels of protection (Fig. 20-5). To decrease the incidence of injury and improve comfort, manufactures have added ventilation systems (e.g., Temperature Management System, Williams Sports Group, Jacksonville, FL). While on the sidelines, players connect small air hoses to their pads and can circulate cooled air through ventilation channels in the interior of the pads.