Rule Modifications to Reduce Checking-Related Injuries in High School Boys' Lacrosse

Abstract

Context The National Federation of State High School Associations previously implemented 2 lacrosse rule modifications: Rule 5.4 in the 2012–2013 academic year to heighten the penalty for a head or neck hit to the head, face, or neck (HFN) and Rule 5.3.5 in the 2013–2014 academic year to minimize body checking. Objective To determine if the rates of overall injury, HFN injuries, and concussions due to intentional contact (checking) differed for boys' high school lacrosse players after Rule 5.4 and 5.3.5 modifications were enacted. Design Descriptive epidemiology study. Setting Web-based online surveillance system. Patients or Other Participants Boys' high school lacrosse players during the 2008–2009 to 2016–2017 seasons whose teams involved athletic trainers participating in the High School Reporting Information Online sports injury-surveillance system. Intervention(s) Rule 5.4 in the 2012–2013 academic year increased the penalty for any intentional hits to the HFN, and Rule 5.3.5 in the 2013–2014 year eliminated body checking to a player in a defenseless position. Main Outcome Measure(s) Overall, HFN, and concussion injury rate ratios (IRRs) by checking mechanism; overall and checking-related injury ratios by competitions and practices. Results A decrease was shown in checking-related HFN injuries (IRR = 0.29, 95% CI = 0.13, 0.65) and checking-related concussions (IRR = 0.29, 95% CI = 0.12, 0.70) during practices in the seasons after both rule modifications were imposed, but no decreases occurred in any checking-related injuries during competitions. By injury mechanism, no decreases were evident after the Rule 5.4 modification. When both rule modifications (Rules 5.4 and 5.3.5) were enacted together, concussion rates due to delivering body checks (IRR = 0.51, 95% CI = 0.29, 0.91) and overall injury risk due to being body checked (IRR = 0.72, 95% CI = 0.53, 0.97) decreased. Conclusions When both Rule 5.4 and 5.3.5 modifications were in effect, concussion and overall injury risks decreased for the body checker and the player being body checked, respectively.

Concussion Rates in Youth Lacrosse Players and Comparison With Youth American Football

“…These results may be impacted by an overall decline in participation from 2013, or these declines may also be due to rule changes implemented by the NFSHSA to reduce head and neck injuries. 9 Specifically, these revisions were made to rules regarding body checking during game play but also may have helped contribute to the decreased concussion incidence from 2013. Perhaps as more lacrosse rule changes are made for this population of athletes, the concussion rate, in particular, will continue to reduce.…”

Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis

“…77 Rules minimizing intentional contact to the head or neck and the use of bodychecking in adolescent male lacrosse led to lower bodychecking-related concussion rates during practices (IRR=0.29;95%CI:0.12-0.70) and matches (IRR=0.51;95%CI:0.29-0.91). 78 In professional baseball, a rule limiting collisions between the base runner and the catcher at home plate was associated with a significant reduction in catcher concussion rates (RR=0.31;95%CI:0.11-0.85). 79,80 A rule change in rugby limiting the frequency of interchange replacements did not reduce SRC rates (IRR=0.59;95%CI:0.04-9.48).…”

“…Limiting head contacts in soccer, lacrosse, and baseball have led to lower concussion or head impact rates. 75,76,[78][79][80] Policy limiting the number and duration of contact practices in American football has led to reduced SRC and head impact rates in adolescents. [89][90][91][92] Limiting the number of contact practices did not have as much success in terms of reducing SRC risk or head impacts at the collegiate level as teams were noted to run longer duration practices and with more intense contact (supplemental).…”