Are high school girls' lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys' lacrosse players are required to wear?

Head Impact Kinematics and Brain Tissue Strains in High School Lacrosse

Male lacrosse and female lacrosse have differences in history, rules, and equipment. There is current debate regarding the need for enhanced protective headwear in female lacrosse like that worn by male lacrosse players. To inform this discussion, 17 high school lacrosse players (6 female and 11 male) wore the Stanford Instrumented Mouthguard during 26 competitive games over the 2021 season. Time-windowing and video review were used to remove false-positive recordings and verify head acceleration events (HAEs). The HAE rate in high school female lacrosse (0.21 per athlete exposure and 0.24 per player hour) was approximately 35% lower than the HAE rate in high school male lacrosse (0.33 per athlete exposure and 0.36 per player hour). Previously collected kinematics data from the 2019 high school male and female lacrosse season were combined with the newly collected 2021 kinematics data, which were used to drive a finite element head model and simulate 42 HAEs. Peak linear acceleration (PLA), peak angular velocity (PAV), and 95th percentile maximum principal strain (MPS95) of brain tissue were compared between HAEs in high school female and male lacrosse. Median values for peak kinematics and MPS95 of HAEs in high school female lacrosse (PLA, 22.3 g; PAV, 10.4 rad/s; MPS95, 0.05) were lower than for high school male lacrosse (PLA, 24.2 g; PAV, 15.4 rad/s; MPS95, 0.07), but the differences were not statistically significant. Quantifying a lower HAE rate in high school female lacrosse compared to high school male lacrosse, but similar HAE magnitudes, provides insight into the debate regarding helmets in female lacrosse. However, due to the small sample size, additional video-verified data from instrumented mouthguards are required.

Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football

Background

There has been little focus on concussions in youth lacrosse players in the United States.

Purpose

To provide a descriptive analysis of the epidemiology and incidence of concussions in youth lacrosse and compare the results with well-documented analyses of concussions in youth American football.

Study Design

Descriptive epidemiology study.

Methods

Data on concussions in pediatric patients playing lacrosse from 2006 to 2019 were collected using the National Electronic Injury Surveillance System (NEISS). Weighted calculations and combined participation data obtained from membership in USA Lacrosse were used to estimate injury incidence. A comparison dataset was created using the NEISS data on youth football-related concussions. The cause of concussion was categorized into player-to-player, player-to-stick, player-to-ball, or player-to-ground contact.

Results

A total of 37,974 concussion injuries related to lacrosse were identified in players with a mean age of 14.5 ± 3.5 years; 70% of concussions occurred in boys. National participation in lacrosse increased from 2006 to 2011 by a mean of 10.3% annually, followed by a lower annual growth rate of 2.5% from 2012 to 2019. The overall incidence of concussion injuries increased over the study period (r = 0.314), with the incidence rate in boys being greater than that of girls from 2009 to 2013. The most common cause of concussion was player-to-ground contact for boys and player-to-ball or player-to-stick contact for girls. The mean annual concussion incidences in youth lacrosse and youth football were 443 and 355 per 100,000 participants, respectively.

Conclusion

Over the study period, 16% of lacrosse injuries were diagnosed as concussions, a higher mean annual incidence per 100,000 participants than that of youth football (443 vs 355). The cause of concussion was different based on sex, with higher rates of player-to-ball or player-to-stick contact in female players versus player-to-ground contact in male players.

Quantifying head impact exposure, mechanisms and kinematics using instrumented mouthguards in female high school lacrosse

Current debate exists regarding the need for protective headwear in female lacrosse. To inform this issue, the current study quantified head impact exposure, mechanisms and kinematics in female lacrosse using instrumented mouthguards. A female high school varsity lacrosse team of 17 players wore the Stanford Instrumented Mouthguard (MiG) during 14 competitive games. Video footage was reviewed to remove false-positive recordings and verify head impacts, which resulted in a rate of 0.32 head impacts per athlete-exposure. Of the 31 video-confirmed head impacts, 54.8% were identified as stick contacts, 38.7% were player contacts and 6.5% were falls. Stick contacts had the greatest peak head kinematics. The most common impact site was the side of the head (35.5%), followed by the face/jaw (25.8%), forehead (6.5%), and crown (6.5%). Impacts to the face/jaw region of the head had significantly (p < 0.05) greater peak kinematics compared to other regions of the head, which may have resulted from the interaction of the impacting surface, or the lower jaw, and the sensor. The current study provides initial data regarding the frequency, magnitude and site of impacts sustained in female high school lacrosse. A larger sample size of high quality head impact data in female lacrosse is required to confirm these findings.

A Helmet of Her Own?: A Qualitative Study of Key Stakeholder Perspectives on Headgear in Girls' Lacrosse

Introduction

Despite the high incidence rate of concussions in women's lacrosse, there is substantial push back against the use of helmets at the secondary educational and collegiate levels in the U.S. This study examines the social factors influencing the controversy surrounding the use of protective headgear and how the recent development of headgear specific to the women's game has shaped ongoing debates.

Methods

Purposeful sampling was used to recruit interviewees with research knowledge or firsthand experience with injury and protective headgear in girls' lacrosse. Semistructured interviews were conducted and subsequently coded using qualitative research software to identify key themes and patterns.

Results

Sixteen respondents participated in this study; 4 players, 4 coaches, 3 researchers, and 5 administrators were represented in this sample. Overarching themes identified across these interviews included playing through pain, health consequences of concussions, concussion prevention strategies and the potential role of headgear, symbolism of headgear, gender dynamics, autonomy, and decision making.

Conclusions

This qualitative study shows the importance of attention to the unique history of girls' lacrosse and current narratives surrounding headgear in the sport. There is a need for greater collaboration and consensus between all relevant groups to ensure that headgear best addresses the concerns of the people who will ultimately be using it. Future qualitative research should build on this preliminary study with a larger and more diverse sample to follow up on key themes and ultimately inform effective safety measures to protect athletes.

Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis

OBJECTIVES

To evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.

DESIGN

This systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Eight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review.

ELIGIBILITY CRITERIA

Study inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.

RESULTS

In total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high ('++') or acceptable ('+') quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies.

CONCLUSIONS

Policy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC.

PROSPERO REGISTRATION NUMBER

CRD42019152982.

Headgear safety attitudes among women's lacrosse stakeholders: Qualitative results

OBJECTIVE

To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse.

PARTICIPANTS

189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32).

METHODS

Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning.

RESULTS

Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not.

CONCLUSION

Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.

Epidemiology of sport-related concussion rates in female contact/collision sport: a systematic review

Objectives

To determine sport-related concussion (SRC) incidence rates in female contact/collision sport.

Design

Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Data sources

Four databases (PubMed, SportsDiscus, Web of Science, CINAHL) were searched for data from 2012 to 2021.

Eligibility criteria

Studies reporting SRC incidence rates or the number of concussions and athletic exposures (AEs) per 1000 participating events or hours in healthy female contact and collision sport athletes of any age were included.

Results

The search yielded 8438 non-duplicate articles. Following screening, 19 were included in the analysis (median quality score=70%), with 8 reporting match or training incidence rates. Studies were primarily from US high school and collegiate populations; data are reported for eight sports. Rugby union reported the highest match SRC rates (8.2-16.11 per 1000 AE hours), followed by Gaelic football (5.21 per 1000 AE hours) and soccer (2.08-4.04 per 1000 AE events). Where available, match SRC rates were substantially higher than training and overall SRC rates.

Conclusion

Female sports such as rugby union, Gaelic football and soccer present the highest risk for SRCs within the available data. Previous research indicates a potentially greater injury burden for female athletes experiencing SRCs than their male counterparts. Thus, future research should analyse concussion knowledge and return-to-play protocols in these sports. Future research should also prioritise exploration of the gap in SRC rates within amateur sports, and data should be presented specifically in the context of athletic exposures (match vs training).

Trial registration number

CRD42021281569.

Competitive trait anxiety and general self-esteem of athletes according to the sport type and gender

Traditionally, anxiety has been interpreted as a negative emotional state characterized by nervousness, worry, fret, uncertainty and vague fear which could have an adverse effect on sports achievement. On the other hand, sport type and its specific nature and demands, may also be connected with the level of state and trait anxiety. This study aimed to investigate potential differences in the competitive trait anxiety level and general self-esteem according to gender in sports of different contact level. The sample consisted of 1024 (590 males and 434 females) young athletes. Independent variables were sport contact level (non-contact, contact and collision sports) and gender. Dependent variables were measured by the adjusted versions of Sport Competition Anxiety Test and Rosenberg Self-Esteem Scale. Basic descriptive statistics was calculated for all the groups, and the differences between them were established using χ² test and MANOVA. The results suggest significant differences in trait competitive anxiety per sport type, gender and their interaction, and no differences in the general self-esteem level. The current study reveals that not only the intensity but also the intergroup relationship of a sport contact level (non-contact, contact and collision sports) is gender determined. These findings are important in psycho-diagnostic procedure and choosing appropriate coping strategies for athletes.

Epidemiology of Injuries in National Collegiate Athletic Association Women's Lacrosse: 2014-2015 Through 2018-2019

CONTEXT

Lacrosse is an increasingly popular sport; the number of teams participating in collegiate women's lacrosse has increased by 21.4% in the past 5 years.

BACKGROUND

The growth of National Collegiate Athletic Association women's lacrosse, coupled with the ongoing discussions surrounding protective equipment, necessitates further epidemiologic studies in this population.

METHODS

Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program during 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios with 95% CIs were used to examine differential injury rates.

RESULTS

The overall injury rate was 4.99 per 1000 athlete exposures. Less than 30% of injuries were time-loss injuries; injuries were most commonly attributed to noncontact (26.6%) and overuse (25.2%) mechanisms. The most commonly reported specific injuries were lateral ligament complex tears (ankle sprains; 9.1%), concussions (7.2%), and hamstring tears (3.8%).

SUMMARY

Findings from this study were consistent with the existing epidemiologic evidence in previous studies. Injury incidence in practices, in preseason, and as a result of player contact warrant further attention in this population.