After an educational intervention, athletes demonstrated an improvement in their knowledge on concussions.

Background:The perception high school athletes have regarding concussions may influence their injury-reporting behavior, and if their perceptions are based on incorrect or incomplete information, they may be at risk for subsequent head injuries.Purpose:To determine whether the recent influx of concussion information has had a positive impact on high school athletes’ knowledge of concussions, to determine their perceptions regarding the severity of a concussion injury, and to determine whether receiving correct information will potentially alter their future reporting behavior.Study Design:Cross-sectional study; Level of evidence, 4.Methods:A total of 454 high school athletes (212 females, 242 males; mean age, 15.7 ± 1.15 years) from 6 different schools participated in an anonymous survey. The researchers met with teams individually at their high schools to collect data and provide an educational intervention regarding sports-related concussions. The survey questions assessed the athletes’ personal injury histories and perceptions and knowledge of the severity of concussion injuries.Results:There was a difference in the number of athletes who reported having their “bell rung” (n = 297) versus the number of athletes reporting at least 1 concussion (n = 172) (t (453) = −11.60, P = .000, d = −0.54). There was also a difference in the number of athletes who reported a history of at least 1 concussion at the beginning of the study session (n = 172) versus the number of athletes who reported at least 1 concussion at the end of the session (n = 292) (t (453) = −12.018, P = .000, d = 0.732). Fifty percent of athletes also stated that the importance of a game/event should dictate when they return to play.Conclusion:High school athletes continue to fail to realize when they have sustained a concussion. Additionally, athletes lack understanding regarding the severity and seriousness of a concussion. A better effort at formalized education must be made if the culture of sports is to change.Clinical Relevance:Allied health care professionals need to continue to put forth a great effort in educating all student athletes on what a concussion is and the dangers of a concussion injury. Preseason meetings should be used as an opportunity to provide formalized education to all student athletes.

Background:An athlete’s lack of concussion knowledge could lead to significant underreporting and injury mismanagement. To provide more effective management strategies of concussions in adolescent athletes, further examination of reporting behaviors is of critical importance.Hypothesis:The hypotheses for this study were as follows: (1) Girls are more likely to report concussion, (2) girls are more likely to report future concussions after an educational intervention, and (3) a difference in rationale for not reporting concussion will be found between sexes.Study Design:Cross-sectional, cohort design.Level of Evidence:Level 3.Methods:Survey answers were collected on 454 high school athletes (212 girls, 242 boys; mean age, 15.7 ± 1.15 years). Individual team meetings lasting approximately 30 minutes were held to collect data and provide an educational lecture. Participants were randomly provided an iClicker to submit a response to questions asked.Results:Girls were more likely to report a concussion (χ2 = 8.32, df = 3, N = 454, P = 0.040) and more likely to report future concussions after educational intervention (χ2 = 8.54, df = 2, N = 454, P = 0.014). There were no differences between sexes regarding rationale for not reporting a concussion (χ2 = 6.42, df = 4, N = 454, P = 0.170).Conclusion:There is concern these athletes still fail to understand the severity and potential sequelae of concussion injury. Both sexes cited that concussion is not a serious enough injury to warrant reporting to a medical professional.Clinical Relevance:High school athletes recover more slowly from concussions compared with college athletes; therefore, educating this population and promoting the importance of being knowledgeable regarding concussion recognition may increase reporting prevalence.

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External load has become a common metric for coaches to track the activity profiles of athletes during training and competition.  The advent of wearable technology has made external load monitoring accessible for more coaches.  The purpose of this study was to compare positional (attack, midfield, and defense) and game (first half to second) external loads.  An NCAA Division I women’s lacrosse team was recruited to wear triaxal accelerometers and GPS units during five non-conference games during the 2020 regular season.  The external load metrics evaluated for this study included total distance, sprint distance (> 19 km∙hr-1), number of power plays (> 3 m·s-2), top speed, and PlayerLoad.  Significance was set at p < 0.05.  No significant differences among positions were observed for full game measures (p > 0.05).  A significant main effect for time was observed for sprint distance (midfield; p < 0.001 ) and power plays (midfield; p < 0.001 and defense; p = 0.004).  While no significant differences occurred for activity profiles among positions, high-intensity efforts (sprint distance and power plays) were significantly less in the second half, likely due to fatigue.  Coaches and sports scientists can use this information to manage in-game fatigue through tactics such as strategic substitutions and time-outs, thus preserving the intensity of the activity profiles late in the game.

Background:Investigation into the effect of cumulative subconcussive head impacts has yielded various results in the literature, with many supporting a link to neurological deficits. Little research has been conducted on men’s lacrosse and associated balance deficits from head impacts.Hypotheses:(1) Athletes will commit more errors on the postseason Balance Error Scoring System (BESS) test. (2) There will be a positive correlation to change in BESS scores and head impact exposure data.Study Design:Prospective longitudinal study.Level of Evidence:Level 3.Methods:Thirty-four Division I men’s lacrosse players (age, 19.59 ± 1.42 years) wore helmets instrumented with a sensor to collect head impact exposure data over the course of a competitive season. Players completed a BESS test at the start and end of the competitive season.Results:The number of errors from pre- to postseason increased during the double-leg stance on foam (P < 0.001), tandem stance on foam (P = 0.009), total number of errors on a firm surface (P = 0.042), and total number of errors on a foam surface (P = 0.007). There were significant correlations only between the total errors on a foam surface and linear acceleration (P = 0.038, r = 0.36), head injury criteria (P = 0.024, r = 0.39), and Gadd Severity Index scores (P = 0.031, r = 0.37).Conclusion:Changes in the total number of errors on a foam surface may be considered a sensitive measure to detect balance deficits associated with cumulative subconcussive head impacts sustained over the course of 1 lacrosse season, as measured by average linear acceleration, head injury criteria, and Gadd Severity Index scores. If there is microtrauma to the vestibular system due to repetitive subconcussive impacts, only an assessment that highly stresses the vestibular system may be able to detect these changes.Clinical Relevance:Cumulative subconcussive impacts may result in neurocognitive dysfunction, including balance deficits, which are associated with an increased risk for injury. The development of a strategy to reduce total number of head impacts may curb the associated sequelae. Incorporation of a modified BESS test, firm surface only, may not be recommended as it may not detect changes due to repetitive impacts over the course of a competitive season.

Background:Gaining a better understanding of head impact exposures may lead to better comprehension of the possible effects of repeated impact exposures not associated with clinical concussion.Purpose:To assess the correlation between head impacts and any differences associated with cognitive testing measurements pre- and postseason.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 34 National Collegiate Athletic Association Division I men’s lacrosse players wore lacrosse helmets instrumented with an accelerometer during the 2014 competitive season and were tested pre- and postseason with the Sport Concussion Assessment Tool (SCAT 3) and Concussion Vital Signs (CVS) computer-based neurocognitive tests. The number of head impacts >20g and results from the 2 cognitive tests were analyzed for differences and correlation.Results:There was no significant difference between pre- and postseason SCAT 3 scores, although a significant correlation between pre- and postseason cognitive scores on the SCAT 3 and total number of impacts sustained was noted (r = –0.362, P = .035). Statistically significant improvements on half of the CVS testing components included visual reaction time (P = .037, d = 0.37), reaction time (P = .001, d = 0.65), and simple reaction time (P = .043, d = 0.37), but no correlation with head impacts was noted.Conclusion:This study did not find declines in SCAT 3 or CVS scores over the course of a season among athletes who sustained multiple head impacts but no clinical concussion. Thus, it could not be determined whether there was no cognitive decline among these athletes or whether there may have been subtle declines that could not be measured by the SCAT 3 or CVS.

Head impacts resulting in a concussion negatively affect the vestibular system, but little is known about the effect of subconcussive impacts on this system. This study's objective was to determine if subconcussive head impacts sustained over one competitive lacrosse season, effect sway velocity. Healthy Division I male lacrosse players (n = 33; aged 19.52 ± 1.20 years) wore instrumented helmets to track head impact exposures. At the beginning and end of the season the players completed an instrumented Balance Error Scoring System assessment to assess sway velocity. Score differentials were correlated to the head impact exposure data collected via instrumented helmets when averaged within participant. Paired samples t-tests revealed a post-season increase in sway velocity on the double leg stance, firm surface (p = 0.002, d = 0.59); tandem stance, firm surface (p = 0.033, d = 0.39) and double leg, foam surface (p = 0.014, d = 0.45) A significant correlation was found between change in tandem stance, firm surface sway velocities and linear acceleration (p < 0.001, r = 0.65). It appears subconcussive impacts may result in tandem stance balance deficits. Repetitive head impacts may negatively affect sway velocity, even in the absence of a diagnosed concussion injury.