A randomised cross-over 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.

ObjectiveTo 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{degrees} tilt tasks for lateral flexion (3.4{degrees}: 95%CI: 1.4{degrees}, 5.4{degrees}), flexion-extension (2.4{degrees} 95%CI: 0.4{degrees}, 4.4{degrees}), rotation (-3.7{degrees}: 95%CI: -7.2{degrees}, -0.2{degrees}) and total rotation (6{degrees}: 95%CI; 2.9{degrees}, 9.1{degrees}). For the lift and lower task there was a significant difference in total lateral flexion of only 0.3{degrees} (95%CI: 0.1{degrees}, 0.5{degrees}). Total movement during the procedure was significantly more for rotation without the collar (6.6{degrees}: 95% CI: 1.9{degrees}, 11.3{degrees}). 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} versus 230.9s [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.