US Lacrosse, Sports Science & Safety Committee
Citation: Lincoln AE, Hinton RY, Almquist JL, Lager SL, Dick RW. Head, face, and eye injuries in scholastic and collegiate lacrosse: a 4-year prospective study. Am J Sports Med. 2007 Feb;35(2):207-15.
Until recently, there were little prospectively gathered injury surveillance data for scholastic-age lacrosse. The few epidemiologic studies in the literature were limited by low response rates, nonstandardized injury definitions, and insufficient exposure assessments. A 3-year prospective epidemiologic study of high school girls' and boys' lacrosse injuries concluded that the majority of lacrosse injuries in this age group involved strains, sprains, contusions, and abrasions. These investigators found that head, face, and eye (HFE) injuries were gender dependent. For boys, the primary head/face injury was concussion, which most frequently resulted from body-to-body contact. For girls, the primary head/face injury was contusion, which most commonly resulted from incidental stick or ball impact.
Injury data from collegiate play indicate that men's lacrosse generally has a 30% to 40% higher game injury rate and similar practice injury rates as compared with the women's collegiate game although HFE injuries constitute a substantially larger percentage of injuries in women's games than in men's games. Most of the women's HFE injuries are minor in terms of days lost from play, but there is a real potential for significant damage to the unprotected face with a hard ball being thrown at eye level at speeds up to 60 mph. Incidents of sight-impairing injuries and orbital fractures have been noted. These initial findings, combined with concern by the sport's national governing bodies (US Lacrosse, NCAA), have led to the current study of lacrosse injuries specific to HFE.
The aims of this study were to:
- Document primary mechanisms of HFE injury
- Demonstrate differences in injury risk between the men's and women's game
- Identify differences in injury risk between high school and collegiate levels of participation
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.
Study Population & Data Sources
Data were prospectively gathered for each of the 23 high schools in the Fairfax County (Virginia) Public School System. Each high school participates in both girls' and boys' lacrosse, has 2 certified athletic trainers, and is part of a computerized injury surveillance system. As an official part of their job duties, the certified athletic trainers entered injury and illness data on a daily basis. A system-wide program supervisor monitored the program to enhance compliance and data quality. A certified athletic trainer was available daily and was on the field for all games.
At the college level, data were collected through the NCAA Injury Surveillance System (ISS). The ISS annually collected data from a voluntary representative sample of schools sponsoring lacrosse via athletic trainers. The target sample was 10% of the schools from each of the 3 divisions that sponsored lacrosse. Data were prospectively collected from an annual mean of 34 men's lacrosse programs (range, 26-41 programs; 17% of sponsoring schools) and an annual mean of 64 women's lacrosse programs (range, 49-83 programs; 27% of sponsoring schools) during the 2000 to 2003 seasons.
Injuries were analyzed in terms of (1) session type (practice or game), (2) nature of injury, (3) anatomical area injured, (4) mechanism of injury, (5) player activity at time of injury, and (6) most common scenarios for concussions, eye injuries, and face injuries. Results were reported in terms of the proportion of injuries for boys versus girls and men versus women and incidence density (number of injuries per 1000 athletic exposures). Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated to examine differences by gender, with girls and women as the reference groups.
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 significant 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.