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Balance between game integrity and injury risk

There is no greater challenge than to appropriately balance a sport’s integrity with injury risk.  And there is also no greater responsibility for a sport’s national governing body.  Since the formation of US Lacrosse in 1998, the investigation of injuries in men’s and women’s lacrosse has been a focus of the doctors and researchers who comprise its Sports Science & Safety Committee.

The prevention of injuries that involve the head, face and eyes has been an ongoing priority for US Lacrosse.  Early in the organization’s history, US Lacrosse mandated eyewear in women’s lacrosse to prevent the rare injury caused by a ball impact to the eye.  Although some players and coaches actually boycotted the organization over the decision, recent US Lacrosse-funded research concluded that eyewear represented a modest equipment intervention that, combined with rule changes and greater education, actually decreased the incidence of head and face injuries while virtually eliminating serious eye injuries.

Most agree that sports participation carries a risk of serious injury, but few agree on what constitutes acceptable risk in sport…and a people’s opinions can understandably change quickly when a child is injured.  When serious injury occurs, passionate pleas for significant interventions focused on eliminating the risk of injury can understandably follow.  But knee-jerk reactions based on emotion rarely result in sound decisions.  For instance, some parents and administrators have recently called for men’s lacrosse helmets to be required in the women’s game even though research has indicated that the rates of concussion in boys’ high school lacrosse are considerably higher than in girls’ high school lacrosse, which is similar in concussion rate to girls’ high school soccer.  Of growing concern are parents who seek to “concussion-proof” their children, many of whom may bring a history of concussion from other sports or activities to the lacrosse field, sometimes in a misguided attempt to return them to play before a brain injury is fully healed.

The organization is now focused on leading efforts to develop a women’s lacrosse-specific headgear standard in collaboration with the American Society of Testing and Materials (ASTM).  Women’s lacrosse rules have long allowed soft headgear.  But the rule predates the deeper understanding of concussion injury that has emerged in recent years, as well as any research on injury mechanism in women’s lacrosse.  While no headgear in any sport can eliminate the risk of concussion, active US Lacrosse-funded research is focused on measuring the impact force of lacrosse stick checks and shot follow-throughs, which will be important to the development of a headgear standard specific to the risks and culture of the women’s game. 

Consideration of additional equipment is certainly one consideration to reduce injury risk, but the evolution of rules and the establishment of mandatory educational qualifications for coaches and officials are equally important.  US Lacrosse has introduced significant changes to the rules of both men’s and women’s lacrosse in recent years based on a better understanding of how injuries to the head and face occur in each game, and has invested millions of dollars into the development of standardized education qualifications for coaches and officials .  In men’s lacrosse, the organization championed recent rule changes at the college and high school levels that prohibit any contact to an opponent’s head, and introduced a progressive introduction of body contact at younger age levels based on the physical and cognitive development stages of children.  And in women’s lacrosse, US Lacrosse has led more than a dozen rules changes, including the elimination of sticks checks at younger age levels and increased severity of penalties for dangerous checks at older age levels, have been recent priorities.

Continued investment in research, along with ongoing guidance from experts in the field of sports medicine, are constants that will enable US Lacrosse to better educate players and parents of the unique risks associated with each version of the sport, and responsibly introduce interventions focused on maintaining an appropriate balance between game integrity and injury risk.

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