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Background: Girls’ high school lacrosse players have higher rates of head and facial injuries than boys. Research indicates that these injuries are caused by stick, player, and ball contacts. Yet, no studies have characterized head impacts in girls’ high school lacrosse. Purpose: To characterize girls’ high school lacrosse game-related impacts by frequency, magnitude, mechanism, player position, and game situation. Study Design: Descriptive epidemiology study. Methods: Thirty-five female participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered during 28 games in the 2014 and 2015 lacrosse seasons. Participants wore impact sensors affixed to the right mastoid process before each game. All game-related impacts recorded by the sensors were verified using game video. Data were summarized for all verified impacts in terms of frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Descriptive statistics and impact rates were calculated. Results: Fifty-eight verified game-related impacts ≥20g were recorded (median PLA, 33.8g; median PRA, 6151.1 rad/s2) during 467 player-games. The impact rate for all game-related verified impacts was 0.12 per athlete-exposure (AE) (95% CI, 0.09-0.16), equivalent to 2.1 impacts per team game, indicating that each athlete suffered fewer than 2 head impacts per season ≥20g. Of these impacts, 28 (48.3%) were confirmed to directly strike the head, corresponding with an impact rate of 0.05 per AE (95% CI, 0.00-0.10). Overall, midfielders (n = 28, 48.3%) sustained the most impacts, followed by defenders (n = 12, 20.7%), attackers (n = 11, 19.0%), and goalies (n = 7, 12.1%). Goalies demonstrated the highest median PLA and PRA (38.8g and 8535.0 rad/s2, respectively). The most common impact mechanisms were contact with a stick (n = 25, 43.1%) and a player (n = 17, 29.3%), followed by the ball (n = 7, 12.1%) and the ground (n = 7, 12.1%). One hundred percent of ball impacts occurred to goalies. Most impacts occurred to field players within the attack area of the field (n = 32, 55.2%) or the midfield (n = 18, 31.0%). Most (95%) impacts did not result in a penalty. Conclusion: The incidence of verified head impacts in girls’ high school lacrosse was quite low. Ball to head impacts were associated with the highest impact magnitudes. While stick and body contacts are illegal in girls’ high school lacrosse, rarely did such impacts to the head result in a penalty. The verification of impact mechanisms using video review is critical to collect impact sensor data. [ABSTRACT FROM AUTHOR]

Background: Women’s field lacrosse is described as a noncontact game relying primarily on rules to decrease the risk of head injuries. Despite not allowing head contact, however, concussions continue to be reported in women’s field lacrosse. Purpose: To assess the ability of men’s lacrosse helmets to decrease linear and angular acceleration for different striking techniques in women’s field lacrosse. Study Design: Controlled laboratory study. Methods: A helmeted and unhelmeted Hybrid III 50th Percentile headform was attached to a Hybrid III neckform and were subjected to impacts by 8 striking techniques. Eleven athletic females completed 5 slashing techniques, while physical reconstruction equipment was used to simulate falls and shoulder and ball impacts to the head. Three trials were conducted for each condition, and peak resultant linear and angular accelerations of the headform were measured. Results: Falls produced the highest linear and angular acceleration, followed by ball and high-velocity stick impacts. Low-velocity stick impacts were found to produce the lowest linear and angular accelerations. Men’s lacrosse helmets significantly decreased linear and angular accelerations in all conditions, while unhelmeted impacts were associated with high accelerations. Conclusion: If women’s field lacrosse is played within the rules, only falls were found to produce high linear and angular acceleration. However, ball and high-velocity stick impacts were found to produce high linear and angular accelerations. These linear and angular accelerations were found to be within the ranges reported for concussion. When the game is not played within the rules, men’s lacrosse helmets provide an effective method of reducing linear and angular accelerations. Thus, women’s field lacrosse may be able to reduce the occurrence of high linear and angular acceleration impacts by having governing bodies improving rules, implementing the use of helmets, or both. Clinical Relevance: Identifying striking techniques that produce high linear and angular acceleration specific to women’s lacrosse and measuring the capacity of a men’s lacrosse helmet to reduce linear and angular acceleration. [ABSTRACT FROM AUTHOR]

Background: Risks and mechanisms of head, face, and eye injuries in high school and college lacrosse are not well documented. Purpose: To identify (1) primary mechanisms of head, face, and eye injuries in lacrosse and (2) differences in injury risk between the men's and women's game and between high school and collegiate levels. Study Design: Descriptive epidemiological study. Methods: The authors gathered data on 507 000 girls' and boys' high school and 649 573 women's and men's college lacrosse athletic exposures using sport-specific injury surveillance systems over 4 seasons. They identified the most common scenarios for head, face, and eye injuries. Results: The high school girls' head, face, and eye injury rate (0.54 per 1000 athletic exposures) was significantly higher (incident rate ratio, 1.42; 95% confidence interval, 1.09-1.86) than that for boys (0.38 per 1000 athletic exposures); college women (0.77 per 1000 athletic exposures) sustained a higher rate of injuries (incident rate ratio, 1.76; 95% confidence interval, 1.42-2.19) than did men (0.44 per 1000 athletic exposures). Concussions constituted a higher percentage of injuries among boys (73%) and men (85%) than among girls (40%) and women (41%). Men sustained few facial injuries, whereas a substantial proportion of women's injuries involved the face and orbital area. Conclusion: Although permitting only incidental contact, women's lacrosse had higher rates of head, face, and eye injuries at both the high school and collegiate levels. Concussion was the most common injury. For men, the primary injury mechanism was player-to-player contact; women's injuries primarily resulted from stick or ball contact. High school injury rates were lower than were college rates, but the nature of injuries, body parts affected, and mechanisms were similar. [ABSTRACT FROM AUTHOR]

Background: Contact sports place athletes at risk for cervical spine injury. Protective helmets and shoulder pads worn by football and ice hockey athletes alter cervical spine alignment. The effect of helmet and shoulder pads on neck alignment in lacrosse athletes is not known. Hypothesis: Helmets and shoulder pads worn by lacrosse athletes alter cervical spine alignment. Study Design: Controlled laboratory study. Methods: Sagittal plane cervical spine alignment was evaluated in 16 uninjured male collegiate lacrosse players using computed tomography. Patients were immobilized in the supine position on a standard spine board. Testing was performed without equipment, with both helmet and shoulder pads in place, and with the helmet removed. Angular measurements of the cervical spine were made and analyzed. Results: The presence of both the helmet and shoulder pads caused an increase in overall cervical extension (mean, 6°) compared with the absence of both pieces of equipment (P = .002). Helmet removal alone resulted in a mean increase in cervical flexion of 4.7° in the upper cervical spine compared with the presence of both pieces of equipment (P = .011). Compared with the absence of equipment, shoulder pads caused increased cervical flexion in the lower cervical spine (mean, 4.4°; P = .036). Conclusion: Protective equipment worn by lacrosse athletes causes statistically significant increases in cervical extension, and its removal causes statistically significant increases in cervical flexion. This alteration is different from that previously reported for protective equipment in football and ice hockey. Clinical Relevance: The authors' recommendation is that both lacrosse helmets and shoulder pads be left in place until they can be completely removed in a controlled fashion. The effect of external equipment on neck position is different for lacrosse compared with football and ice hockey. [ABSTRACT FROM AUTHOR]

Background: Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts. Hypotheses: Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick. Study Design: Cohort study (Prevalence); Level of evidence, 2. Methods: Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men's and women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years. Results: Anterior cruciate ligament injury rates in women's basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men's basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men's soccer over the study period. The rate of anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men's basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women's basketball and soccer. Conclusion: There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men's lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men's and women's lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk. [ABSTRACT FROM AUTHOR]