Shielding a Bruise: How to Make a Simple Protective Pad
William O. Roberts, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 11 - NOVEMBER 98
A knee to the quad, a kick in the shin, or a slash to the wrist can produce a contusion that may take an athlete out of a game. If an injured athlete does continue without adequate protection, he or she is vulnerable to repeated muscle trauma that may increase the risk of myositis ossificans traumatica.
Using a custom-made pad to protect a soft-tissue injury may allow an athlete to return to participation safely and quickly, or at least more comfortably. A pad may boost the confidence of athletes, especially those in collision or contact sports, by decreasing their risk of reinjury. Constructing such a pad in the office is simple and quick with the right materials. The device is good for protecting surgical scars or deep abrasions as well as bruises.
Materials. A firm, custom-fitted, protective pad can be made with the ready-to-use fiberglass splinting materials found in most offices. These splints usually consist of five to seven layers of water-activated fiberglass-resin-impregnated material in a protective cover that is backed with foam padding. We stock the 3M Scotchcast One-Step (3M, St Paul) in a variety of sizes, but the 3 x 12-in. and 4 x 15-in. splints are probably adequate for most protective pads. A heavy scissors, an elastic bandage, and synthetic stockinette are also needed.
Size. First, identify and measure the site to be protected and choose a splint package of the appropriate size. Cover the site with synthetic stockinette, remove the splint from the package, and cut it to an appropriate length—about 2 to 4 in. above and below the injury—with the heavy-duty scissors or shears. Shift the fiberglass material within the protective cover so that each end has a padded edge.
Fitting the pad. The material is dipped in water and placed on the area to be protected as shown in figure 1. To ensure a good fit, wrap the activated material with an elastic bandage (figure 1) to keep it in place while the fiberglass hardens. The splinting material hardens quickly—about 5 to 10 min—and can be used immediately, although it takes 2 hours to completely cure.
If the injury site is sensitive to pressure, the pad can be modified during fabrication by putting a roll of gauze or cast padding or a doughnut pad under it to lift it off the injured area before the material becomes firm. The space created minimizes direct pressure on the injury when the splint is later worn without the roll or doughnut pad. This technique is most useful to protect a contusion on the tibia or a painful acromioclavicular joint.
Securing the Pad
Each time the pad is worn, the injury site may first be sprayed with Tuf-Skin (Cramer Products Inc, Gardner, Kansas) or a similar product to minimize pad migration. The site should then be covered with stockinette to absorb and wick away sweat (the athlete should be sent home with two or three lengths of stockinette). After the pad is placed over the site, the extra stockinette should be folded over each end of the pad as shown in figure 2.
The elastic wrap used to form the pad can also be used to secure it in place (figure 2); usually it works best to use extra wrap above and below the pad. Coban Action Wrap (3M, St Paul) may be used instead of elastic wrap but must be used with caution because it can compromise circulation if applied too snugly.
To further minimize pad movement, athletes who have thigh injuries can wear compression shorts over the pad, and those who have lower-leg injuries can wear a compression or soccer sock over the pad. Athletes who wear such rigid material in competition may need the approval of game officials or may need to add extra, dense padding.
Dr Roberts is a family physician at MinnHealth SportsCare in White Bear Lake, Minnesota, and medical director of the Twin Cities Marathon. He is a fellow of the American College of Sports Medicine, a charter member of the American Medical Society for Sports Medicine, and an editorial board member of The Physician and Sportsmedicine.
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