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EFFECTIVENESS OF HIGH SCHOOL GIRLS LACROSSE HEADGEAR MANDATE IN THE REDUCTION OF HEAD AND FACE INJURIES

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Shayla Veasley
Shayla Veasley
Shayla Veasley
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Samuel L. Baron
Samuel L. Baron
Samuel L. Baron
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Michael Nguyen
Michael Nguyen
Michael Nguyen
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Utkarsh Anil at New York University
Utkarsh Anil
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Abstract

Due to a large number of eye injuries in girls’ lacrosse, US Lacrosse instituted a rule making protective eye-wear mandatory starting in the 2004-2005 season. Although the eye-wear was shown to significantly reduce injuries to the eyes, injuries to the head and face are still commonly reported despite body checks and stick checks to the body being illegal. In 2016, US lacrosse ruled that headgear could be used by its teams as long as it meets ASTM standard F3137*. There has been continued controversy over whether or not headgear in women’s lacrosse could make players more aggressive and/or lead to fewer dangerous call penalties by the officials, thus increasing the head and face injury rate. In 2017, the Public Schools Athletic League, which governs most scholastic sports in New York City, became the first high school organization in the country to mandate ASTM standard F3137 headgear for all women’s lacrosse players. The purpose of this study is to investigate the effect of ASTM standard F3137 approved headgear on the rate of head and face injuries in high school girls’ lacrosse.
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EFFECTIVENESS OF HIGH SCHOOL GIRLS LACROSSE HEADGEAR MANDATE IN THE
REDUCTION OF HEAD AND FACE INJURIES
Shayla Veasley, BA1, Samuel L. Baron, BS2, Michael Nguyen, BA3, Utkarsh Anil, BA4,
Michael Alaia, MD5, Dennis Cardone, DO6, Noel Testa, MD7
1NYU Langone Health, USA, 2NYU Langone Health, New York, NY, USA, 3NYU Langone Health,
USA, 4NYU Langone Health, USA, 5NYU Langone Health, USA, 6NYU Langone Health, USA,
7NYU Langone Health, USA
INTRODUCTION: Due to a large number of eye injuries in girls’ lacrosse, US Lacrosse instituted a
rule making protective eye-wear mandatory starting in the 2004-2005 season. Although the eye-
wear was shown to significantly reduce injuries to the eyes, injuries to the head and face are still
commonly reported despite body checks and stick checks to the body being illegal. In 2016, US
lacrosse ruled that headgear could be used by its teams as long as it meets ASTM standard
F3137*. There has been continued controversy over whether or not headgear in women’s lacrosse
could make players more aggressive and/or lead to fewer dangerous call penalties by the officials,
thus increasing the head and face injury rate. In 2017, the Public Schools Athletic League, which
governs most scholastic sports in New York City, became the first high school organization in the
country to mandate ASTM standard F3137 headgear for all women’s lacrosse players. The
purpose of this study is to investigate the effect of ASTM standard F3137 approved headgear on
the rate of head and face injuries in high school girls’ lacrosse.
METHODS: This was a prospective cohort study. The study group included three JV and five
varsity girls’ lacrosse teams, as well as their game opponents, who were mandated to wear
headgear for all practice and game events over the course of the 2016-2017 and 2017-2018
lacrosse seasons. Certified athletic trainers assessed and documented all injuries that occurred as
a result of participation on the lacrosse teams and athlete exposures were estimated based on the
number of team practice and game events. Injury rates were compared with those from the High
School RIO (Reporting Information Online) injury data reports from the 2008-2009 to 2015-2016
lacrosse seasons as well as an external publication based on RIO data that provided concussion
injury rates.
RESULTS: Over the study period, 17 total injuries were reported during 22397 athlete exposures
(AEs), for an injury rate of 0.76 injuries per 1000 AEs. Two total head/face injuries (2 concussions)
were reported during the study for both a head/face and concussion rate of 0.09 per 1000 AEs.
There was a significant decrease in injury rates for total injuries (RR 0.4927; 95% Confidence
Interval [CI], 0.3037-0.7995; P-value 0.004) and head/face injuries (RR 0.2232; 95% CI, 0.2232-
0.055; p-value 0.016) when comparing this data to the HS RIO study reports. When compared to
the concussion data provided by the external RIO publication, there was a lower injury rate that
was not found to be significant (RR 0.26; 95% CI, 0.0630-1.033; p-value: 0.03879).
DISCUSSION AND CONCLUSION: Headgear use did not increase the injury rate for the
head/face when compared to data before the optional headgear use rule. This may help to dispel
fears over an injury rate that would increase due to more aggressive play or less cautious
officiating.
The Orthopaedic Journal of Sports Medicine, 7(3)(suppl 1)
DOI: 10.1177/2325967119S00026
©The Author(s) 2019
... 34,35 Proponents of headgear mandates propose that required use will decrease the severity of impacts and decrease the risk of injury. 36 Those in opposition cited the Peltzman and the Gladiator effect, which hypothesizes that with increased safety measures, at least some of their benefits will be offset by increased risky behavior. 18,37 The state of Florida now mandates helmet use in girls lacrosse. ...
Brain Health Considerations in the Modern Lacrosse Athlete
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Full-text available
  • Sep 2022
Introduction The annual incidence of sport related concussion ranges from 1.6 to 3.8 million concussions per year representing a common injury in sports. Lacrosse is a rapidly growing sport for both men and women and these athletes are at risk for concussion. The mechanism of injury for concussion in the men's and women's game are different as are the rules and equipment requirements. Objectives To report the epidemiology, pathophysiology, presentation, management of sport related concussion and to highlight recent rule changes for men's and woman's lacrosse in regards to concussion prevention. Methods PubMed and Scopus databases were searched. All levels of evidence (I-IV) pertaining to concussions in men's and women's lacrosse players were analyzed and presented in this narrative review. Results For all high school boys’ sports, lacrosse ranks number 3 for sports with the highest prevalence of concussions. Concussions most frequently result from athlete-to-athlete contact which represents 66.4% of the recorded concussions. For all high school girls’ sports, lacrosse ranks number 2 for sports with the highest prevalence of concussions. In women's lacrosse, stick or ball contact with the athlete's head is the most common mechanism of concussion, accounting for 72.7% of the recorded concussions. Conclusion Both men's and women's lacrosse players are at risk for concussion, even though there are different mechanisms for this injury between the two games. Sports medicine providers should be knowledgeable on diagnosis, management and prevention when caring for lacrosse players. Protective equipment and rule changes are potential means to continue to protect these athletes and still need further investigation.
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... Ten studies appeared to meet all inclusion criteria but used an exposure estimate and thus were excluded. [21][22][23][24][25][26][27][28][29][30] Characteristics of studies Of the included studies, SRC incidence data were available for eight sports; nine for soccer, [31][32][33][34][35][36][37][38][39][40] five for basketball, 33-35 40 41 three for rugby union, 31 42 43 four for lacrosse, 34 35 44 45 two for camogie, 31 46 two for Gaelic football, 31 47 three for field hockey 34 35 48 and two for ice hockey. 35 49 These athletes competed at collegiate, 31 36 41 43 45-49 Studies were predominantly from the USA, 32-41 44 45 48 49 with the remainder from the UK, 42 New Zealand 43 and Ireland. ...
Epidemiology of sport-related concussion rates in female contact/ collision sport: a systematic review
Article
Full-text available
  • Sep 2022
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).
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... Within this study, there were six quidditch players, which presents a limitation as this cannot be considered a significant representation of the quidditch community as a whole. Tran et al. (7) noted that of the players with head injuries, only 39% (11,12). ...
Incidence of concussions and injuries among quidditch players
Article
Full-text available
  • Jan 2021
Purpose: To evaluate the rates of concussion and injury in quidditch, a high-contact sport growing in worldwide participation. Methods: A systematic review of the MEDLINE database was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for all studies reporting on concussion and/or injury rates in quidditch epidemiology. Results: Five studies were identified that had been published in the last 15 years on the concussion and injury rates among quidditch players worldwide. Each of these five studies included a concussion analysis and two included overall epidemiological rates. Conclusions: Injury rates seen in the two studies were found to be lower than those seen in other high-contact sports. There is a need to further study concussion symptoms among this understudied population.
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... 24,28,31 Advocates propose that headgear use will decrease the severity of impacts and reduce the risk of injury. 32 Opponents allude to the Peltzman effect, 23 first coined in automobile safety research, which argues that when increased safety measures are implemented, at least some of their benefits will be offset by increased risky behavior. Similarly, headgear opponents predict that any benefits of headgear will be counteracted by more aggressive game-play and risk-compensation behaviors by players. ...
The Effects of Headgear in High School Girls' Lacrosse
Article
Full-text available
  • Dec 2020
Background Girls’ lacrosse headgear that met the ASTM International performance standard (ASTM F3137) became available in 2017. However, the effects of headgear use on impact forces during game play are unknown. Purpose To evaluate potential differences in rates, magnitudes, and game-play characteristics associated with verified impacts among players with and without headgear during competition. Study Design Cohort study; Level of evidence, 3. Methods A total of 49 female high school participants (mean age, 16.2 ± 1.2 years; mean height, 1.66 ± 0.05 m; mean weight, 61.2 ± 6.4 kg) volunteered for this study, which took place during the 2016 (no headgear; 18 games) and 2017 (headgear; 15 games) seasons. Wearable sensors synchronized with video verification were used. Descriptive statistics, impact rates, and chi-square analyses described impacts and game-play characteristics among players with and without headgear. Differences in mean peak linear acceleration (PLA) and peak rotational velocity (PRV) between the no headgear and headgear conditions were evaluated using a linear generalized estimating equation regression model to control for repeated within-player measurements. Results Overall, 649 sensor-instrumented player-games were recorded. A total of 204 impacts ≥20 g recorded by the wearable sensors were verified with video analysis (102 no headgear; 102 headgear). Most impacts were imparted to the player’s body (n = 152; 74.5%) rather than to the player’s head (n = 52; 25.5%). Impact rates per player-game did not vary between the no headgear and headgear conditions (0.30 vs 0.34, respectively; impact rate ratio, 0.88 [95% CI, 0.37-2.08]). There was no association between impact frequency by mechanism or penalties administered between the no headgear and headgear conditions for overall or direct head impacts. The generalized estimating equation model estimated a significant reduction in mean impact magnitudes overall (PLA: –7.9 g [95% CI, –13.3 to –2.5]; PRV: –212 deg/s [95% CI, –359 to –64]) with headgear relative to no headgear. No game-related concussions were reported during this study. Conclusion Lacrosse headgear use was associated with a reduction in the magnitude of overall impacts but not a significant change in the rate of impacts, how they occur, or how penalties were administered for impacts sustained during competition. Further research is needed with a larger sample and different levels of play to evaluate the consequences of headgear use in girls’ lacrosse.
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Headgear safety attitudes among women's lacrosse stakeholders: Qualitative results
Article
  • Oct 2022
  • J AM COLL HEALTH
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.
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