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Updated: Aug 19, 2026
Modified Drop Tower Impact Tests for American Football Helmets
Published on: February 19, 2017
Football protective gear and cervical spine imaging
R M Davidson1, J H Burton, M Snowise
1Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA.
Study Objective:
We sought to assess the effect of football protective gear on the cervical spine radiographic evaluation of adult male subjects.
Methods:
The study used a prospective, randomized, matched-pairs, observational design. Subjects served as their own control subjects, with cross-table lateral and open-mouth odontoid cervical spine radiographs. Radiographs were obtained with protective head and shoulder equipment (pads group) and without protective equipment (no pads group). Two emergency physicians and 2 neuroradiologists reviewed study radiographs. Physicians assessed radiographic views for adequate cervical spine visualization to the C7-T1 level and the odontoid and related structures. Comparison of radiographic readings for the pads and no pads groups used the McNemar exact test. A McNemar test of equality of paired proportions was used to estimate a population of 20 paired individuals to detect a significant outcome difference.
Results:
Zero percent of the pads group's cross-table lateral structures were adequately visualized by all 4 reviewers (reviewer unanimity decision) compared with 25% of the no pads group's cross-table lateral films (between-group difference 25%; 95% confidence interval [CI] 6.0 to 44). When 3 of 4 reviewers noted adequate visualization (reviewer majority decision), 0% of the pads group's cross-table lateral structures were adequately visualized versus 40% of the no pads group's cross-table lateral radiographs (between-group difference 40%; 95% CI 19 to 62). With reviewer unanimity, 25% of the pads group's open-mouth odontoid structures were visualized versus 45% of the no pads group's open-mouth odontoid structures (between-group difference 20%; 95% CI -8.9 to 49). With reviewer majority analysis, 35% of the pads group's odontoid radiographs were adequately visualized versus 75% of the no pads group's open-mouth odontoid radiographs (between-group difference 40%; 95% CI 12 to 68).
Conclusion:
Football head and shoulder protective equipment appears to be an impediment to cervical spine radiographic visualization. Guidelines for players' cervical spine imaging should incorporate procedures for removal of equipment before initial radiographic evaluation.
