Here is an article from the Summer 2002 edition of the Pole Standard. Here M.D.'s Spencer Chang and Wilson SooHoo discuss many of the issues involved with the use of helmet while pole vaulting.   A Medical Position on the Topic of Headgear in Pole Vaulting Spencer Chang, M.D. and Wilson SooHoo, M.D. The topic of helmets is one that should be very carefully considered. We feel that the first thing that should be investigated is whether a helmet will make pole vaulting a safer and better event, not a less safe and more dangerous one. Our concerns from a medical standpoint are described below. The stakes to the sport of pole vaulting are enormous. There are rumors of states either considering dropping the pole vault from high school competition or not allowing pole vault competition for girls. Part of the reason is cost, but the other reason, and probably the excuse that will be used, is perceived danger to athletes. If a helmet standard is adopted in haste, it turns out to be the wrong standard and athlete gets killed because of it, then officials could claim that the pole vault is unsafe both with and without headgear and would have an easier time canceling competition in our sport. Issues pole vault helmet research should take into account: 1) The benefits of preventing a few athletes from suffering major acute injuries must be balanced against the potential for chronic injuries to a large number of athletes. It should be remembered that only a very few athletes miss the pit and strike their heads, and that even for these individuals, such an occurrence is uncommon. In contrast, the vast majority of the vaulters land safely on the pit up to thirty times per workout. During every one of these safe landings the back of the head strikes a soft pit. A helmet can magnify this impact, and the cumulative effects of these landings must be taken into account. Back in the mid-nineties, when Jan Johnson was talking about helmets, Wilson was one of the early adopters and started wearing a helmet (a ProTec skateboard model) while vaulting. This lasted only for one session because he did not like the feeling that his brain was rattling within his cranium. A helmet potentially could result in increased jarring of the brain and low-grade trauma, even when a vault goes perfectly. Therefore, the potential cumulative effects, over years, of helmets on the head and brain during routine safe landings should be considered and the forces involved should be compared to those involved in boxing. 2) The possibility of cervical hyperflexion injuries must be considered. Landing on one's neck is far more common occurrence than missing a pit and striking one's head. This can occur in the following circumstances: a) overeating backwards after clearing (or not clearing) a crossbar; b) landing in a pit while still rotating backward after breaking a pole; and c) landing in a pit while still rotating backward after losing grip of the pole shortly after takeoff. It is possible that the added padding posterior to the occiput could result in a forced hyperflexion injury of the neck should the vaulter land high up on his/her shoulders and neck/head after over-rotating on a vault. Two neck injuries noted in a current study of catastrophic vaulting injuries were the result of such hyperflexion injuries. In another study, a collegiate female landed high up on her shoulders and neck/head, causing a hyperflexion injury of the neck resulting in transient paresthesias to all of her limbs for 30 minutes. This situation may have been exacerbated by the added flexion caused by a helmet. Further studies regarding the efficacy of helmets or potential for further injury need to be conducted. These should include biomechanical studies with simulated impact scenarios from typical improper landings, and radiographic studies to determine the effect that a helmet might cause on increasing neck flexion with an over-rotation type landing. Spencer is attempting to procure materials and funding for such a study. Spencer's preliminary study done with lateral cervical radiographs demonstrated that a typical skateboard helmet added 10¡ of added flexion from the C2-C5 levels. The increase in flexion was primarily at the C3-C4 levels. This increase in flexion was the same in both a flat supine position and a rotated backwards position. This study needs to be done on more volunteers to determine if this pattern holds true. If so, the helmet has a potential to dramatically increase the flexion of the neck with an over-rotated landing. The concern is that since the added flexion is relatively high in the cervical spine the potential injuries would be very severe. A C4 quadriplegic would most likely be ventilator-dependent and not have the function of his or her deltoids. In a study of cervical spine injuries in children aged 1 to 17, the mortality rates were 4.3% for the C3 level, and 3.7% for the C4 level. Dr. Robert Cantu, a famous neurosurgeon and one of the leading specialists in sports related head and neck injuries, also has expressed his concerns about the helmet in the pole vault. He believes that the helmet increases the risk of hyperflexion neck injuries and therefore is against its use (2002, personal communication). 3) The helmet could catch on loose fabric of the pit when a pole breaks. This should not be a major obstacle, especially if the helmet were made thin, but should be accounted for. In the accidents mentioned above resulting from a pole breaking (2b) or an athlete losing grip and landing in a pit on his/her neck (2c), the athlete will still have horizontal velocity when striking the pit. If the lower posterior lip of the helmet were to catch on the fabric lining on the top of the pit, which is often loose on aging pits, it could result in traction of the cervical area. This could markedly exacerbate any potential hyperflexion injury and increase the chances of a true anterior cervical dislocation. 4) Athletes landing on the edge of a pit and then falling out will still have horizontal velocity, so any biomechanical or impact studies should take into account this added energy and not just the acceleration/velocity due to gravity. 5) A new set facilities standards is being proposed, which includes the padding of hard surfaces around the vault area and around the planting box in addition to enlargement of the primary landing area. The proposal is for at least two inches of padding, which is thicker than any helmet should be and can be made thicker if a safety task force so decides. ---------------------------------------------------------------------------- The Authors Dr. Spencer Chang is currently a Chief Resident in orthopaedic surgery at the University of Hawaii. He will graduate on June 15, 2002. Future training includes a sports medicine fellowship with Dr. John Uribe of the University of Miami, and a foot and ankle fellowship with Dr. Roger Mann in Oakland. Spencer is a graduate of the University of Hawaii John A. Burns School of medicine and is a member of the Alpha Omega Alpha honor society awarded to the top medical students of his class. He graduated from the University of Washington where he lettered as a pole vaulter. He has coached at Iolani High School from 1992-2000, and the University of Hawaii from 2000-2002. Spencer is also the author of the instructional pole vault video "Vault 2000." He is currently on staff as medical counsel for the North American Pole Vault Association. He was a guest speaker at the 2002 Reno Summit on the topic "Reducing Injuries through Proper Instruction and Technique." Previous research includes "Water sports related cervical spine injuries" which won 1st place local and regional awards. His current study on pole vault injuries won 2nd place at the 2002 Hawaii Orthopaedic Association meeting. Dr. Wilson SooHoo has been involved in pole vaulting for over 30 years and graduated from medical school in 1983. His medical schooling included rotations in kinesiology, sports medicine and physical medicine and rehabilitation, where he became acquainted with the care of spinal injury patients. His residency training was in both general surgery and pathology. During his surgery residency, which was at the country's busiest trauma center, he cared for and helped operate on a variety of trauma patients, including those with closed and penetrating head injuries and spinal cord injuries. During his pathology training he did autopsies on patients with both acute brain injuries during his forensics rotation and on patients with more chronic brain insults during his hospital pathology training. He has 10 scientific publications to his credit, either as author or co-author. In addition, he has received training in complementary health fields to augment his coaching knowledge, most notably applied kinesiology and applied motor control. His pole vaulting achievements, although they pale in comparison to others dealing with this subject, include: a stint competing for and coaching the vaulters of the Republic of China national team; a stint coaching vaulters at UC Davis as a graduate assistant; two national age group national indoor championships; and being a member of an NCAA Division II national championship team. Although usually too busy to coach, he occasionally coaches individuals. All of his high school girls have jumped 11'6" or higher and his current one recently jumped 11'9".