A Comparison of High School Boys' and Girls' Lacrosse Injuries: Academic Years 2008–2009 Through 2015–2016

Abstract

Context The sex-based differences in the structure and rules of boys' and girls' lacrosse result in very different styles of play, which may have significant implications for the rates and patterns of injuries. Objective To compare the epidemiology of injuries sustained by boys' and girls' lacrosse players. Design Descriptive epidemiology study. Setting Web-based online surveillance system. Patients or Other Participants The High School Reporting Information Online database was used to analyze injuries reported by certified athletic trainers from 2008–2009 through 2015–2016. Main Outcome Measure(s) Practice and competition injury rates, body site, diagnosis, and mechanism. Results Boys had a higher injury rate than girls (20.9 versus 15.7 per 10 000 athlete-exposures, respectively; rate ratio = 1.3, 95% confidence interval = 1.2, 1.4). The most commonly injured body sites for boys and girls, respectively, were the lower extremities (38.0%, 56.4%) and the head/neck (28.3%, 29.8%). More specifically, the most frequently diagnosed injuries for both boys and girls, respectively, in competitions were concussions (23.1%, 25.6%), ankle ligament sprains (7.8%, 15.3%), upper leg strains (4.8%, 6.7%), and knee ligament sprains (4.2%, 6.7%). The most cited mechanism of injury overall was contact with another player (22.0%); among boys, it was contact with a stick (14.8%) and among girls, the most frequent mechanisms were overuse (25.0%) and contact with a stick (14.7%). Conclusions Injury rates and mechanisms of injuries differed between high school boys' and girls' lacrosse players. Boys had a higher rate of injury, with the most common mechanism of injury being contact with another player compared with overuse in girls. However, similarities were seen between sexes for the most frequently injured body sites and injury diagnoses. Future authors should continue to compare differences in injury rates, equipment upgrades, and rule changes in boys' and girls' lacrosse.

Are high school girls’ lacrosse players at increased risk of concussion because they are not allowed to wear the same helmet boys’ lacrosse players are required to wear?

“…Concussion risk in girls' and boys' high school lacrosse are multifactorial and mechanisms of concussion differ across genders (Lincoln et al 2007;Xiang et al 2014;Warner et al 2018;Pierpoint et al 2019aPierpoint et al , 2019b). Thus we calculated the attributable risk and AR% to assess only those concussion resulting from stick or ball impacts associated with the different gendered helmet rules.…”

“…For nearly three decades whether the helmets required in men's/boys' LAX should also be required in women's/ girls' LAX has been debated in the lay media , 2008, -09 Through 2018. Other includes all other mechanism including contact with playing surface, contact with out of bounds object, unknown, etc (Pennington 2016;Miele 2017), by policy makers (Bull and Cavanaugh 2016;NFHS 2019b), and in discussion sections of peer-review publications (Lapidus et al 1992;Harmer 1993;Diamond and Gale 2001;Otago et al 2007;Dick et al 2007;Lincoln et al 2007;Xiang et al 2014;Warner et al 2018;Pierpoint et al 2019aPierpoint et al , 2019b. This ongoing debate motivated Acabchuk and Johnson to publish a manuscript which included a table titled "Relevant evidence to counter each argument against the use of helmets in women's lacrosse" which described several arguments against helmets and, for each, provided "Evidence and/or arguments against rationale" (Acabchuk and Johnson 2017).…”

“…A study comparing concussion rates across 20 high school sports found that among boys' sports, LAX had the third highest concussion rate following football and ice hockey, while among girls' sports, LAX had the highest concussion rate just above soccer (Marar et al 2012). A more recent study found that although concussion rates were slightly higher in boys' vs. girls' LAX (4.8 per 10,000 vs 4.0, RR = 1.2, 95% CI 1.0-1.4), concussions represented a nominally greater percentage of all injuries in girls' LAX (23.1 vs. 25.6%) (Warner et al 2018). This similarity across genders is surprising given several rule differences that should protect girls' LAX players from concussion.…”

“…As expected, given the differences in LAX rules and protective equipment, mechanisms of concussion differ across genders. Several studies have reported the most common mechanism of concussion in boys' LAX is athlete-athlete contact, while the most common mechanism among girls' LAX is stick or ball contact (Lincoln et al 2007;Xiang et al 2014;Warner et al 2018;Pierpoint et al 2019aPierpoint et al , 2019b. Ball contact has been found to be associated with the highest head impacts in girls' LAX (Caswell et al 2017).…”

“…The hard shell helmets mandated in boys' LAX have been demonstrated to be effective at reducing head injuries from potential ball strikes (Rodowicz et al 2015). Yet, for nearly three decades whether the helmets required in men's/boys' LAX should also be required in women's/girls' LAX has been debated (Lapidus et al 1992;Harmer 1993;Diamond and Gale 2001;Otago et al 2007;Dick et al 2007;Lincoln et al 2007;Xiang et al 2014;Warner et al 2018;Pierpoint et al 2019aPierpoint et al , 2019b.…”