Head Injury in Girls’ Lacrosse
Plain Language Summary – “Characterizing Verified Head Impacts in High School Girls’ Lacrosse”
Authors
Shane V. Caswell PhD ATC, Andrew E. Lincoln ScD, Hannah Stone MS ATC, Patricia Kelshaw MS ATC, Margot Putukian MD, Lisa Hepburn PhD MPH, Michael Higgins PhD PT ATC, and Nelson Cortes PhD.
Sponsors
NOCSAE and USA Lacrosse
The following study summary helps us understand a counterintuitive fact: although intentional stick and body contacts are illegal in girls’ lacrosse, the numbers of head and facial injuries from stick and body contact are higher in girls’ lacrosse than in the boys’ game. This difference in injury rate is especially noteworthy because contact is legal in boys’ lacrosse, so it is surprising that boys sustain fewer head and facial injuries.
Another difference between the girls’ and boys’ games is that boys are required to wear helmets and other protective gear, but in the girls’ game, with only a few exceptions, only goalies are required to wear helmets. Players in other positions are only required to wear a mouthguard and protective eyewear.
The researchers noted that their findings were consistent with results from previous studies. This is important because we can have more confidence in findings that are verified in multiple studies.
In addition, the researchers recommended consistent enforcement of game rules and additional research on head protection. The potential for a helmet mandate has been a matter of ongoing discussion in the lacrosse community.
Why was this study done?
• High school lacrosse, particularly girls’ lacrosse, is one of the fastest growing sports in terms of number of players.
• Head injuries, especially concussions, are a common injury in girls’ lacrosse and are most often caused by impacts from the stick or another player.
• Boys’ and girls’ lacrosse games are played differently. In girls’ lacrosse you are not allowed to intentionally contact another player using your stick or body. Since physical contact is supposed to be limited, girls only wear a mouthguard and protective eyewear, unlike boys who wear helmets and additional protective equipment.
What was the purpose of this study?
The purpose of this study was to examine the types of head impacts sustained by girls in lacrosse games.
Researchers wanted to know:
- What caused the most frequent and the most severe impacts during a lacrosse game?
- What player position or game activity resulted in the most head impacts during a game.
How was this study done?
Before each of the lacrosse games, one of the research staff attached an impact sensor, called xPatch, behind the right ear. These sensors record the severity of any impact to the girls’ heads.
The research team also videotaped all the lacrosse games. Each one of the head impacts that the sensor recorded was verified on the video recording of the game. From the game video the researchers also noted where the impact happened on the field, what the player was doing, what caused the impact, and if the referee called a penalty.
Where did this study take place?
This study took place in Manassas, VA.
When did this study take place?
It began in the lacrosse pre-season of 2014 and finished in the lacrosse post-season of 2015.
Who participated in this study?
• Thirty-five girls on the varsity lacrosse teams of two Prince William County public high schools participated in the study. All of the positions were included. A total of 35 girls participated from two high schools. All participants were between the ages of 14-19 years old.
How long did the study last?
The study was held for two lacrosse seasons.
What were the results of the study?
Over the two lacrosse seasons the researchers verified 58 head impacts. There were no reported concussions among players during this study.
Which players were impacted the most?
Midfielders received the most head impacts. Defenders had the next highest number of impacts followed by attackers and then goalies. Goalies were hit the least, but their impacts were often higher velocity. Among all players, about half of the impacts were directly to the head. Impacts from the ball carried the highest velocity.
What caused most of the impacts?
Most impacts were from being hit by the stick. Being hit by another player caused the next highest number of impacts, followed by being hit by the ball.
Which game situations resulted in the most impacts?
An evaluation of individual field player activity before an impact showed that in the majority (72.5%) of cases, either midfield or defense players did not have possession of the ball. Usually these players were struck by a stick or another player while defending or chasing a loose ball. In situations where a player had the ball, most impacts occurred to midfield or attack players struck by a stick while ball handling. Most impacts occurred within the offensive or defensive thirds of the field, which suggests that players may be most vulnerable to impacts during settled offensive and defensive game play as compared with unsettled game play or during transitions.
What else did they find?
The work of Caswell’s team echoes the findings of other researchers in the following ways:
- Most impacts to the head (95%) went unpenalized. Previous studies found that the majority of the time penalties were not called after player injuries occurred.
- A large proportion of midfielders were struck by a stick or another player while defending or chasing a loose ball. This observation aligns with previous research reporting that players seem to be placing themselves in dangerous situations to block opponents’ opportunity to possess, pass, or shoot the ball.
- The findings also back up comments of other researchers who questioned collegiate players’ ability to monitor the location of their stick in relation to other players.
Where can I learn more about this study?
Read the full study: “Characterizing Verified Head Impacts in High School Girls’ Lacrosse” – PDF.
Citation: Caswell S, Lincoln A, Stone H. Characterizing verified head impacts in high school girls’ lacrosse. Am J Sports Med. 2017;45(14): 3374-3381. DOI: 10.1177/0363546517724754