‘I’m in pain wherever I am’: the troubling rise of concussion in girls’ lacrosse

The Guardian

February 24, 2022

Becca Losch wore goggles and a mouthguard. She did exercises to strengthen her knee ligaments. Yet the prospect of a head injury barely crossed her mind.

In 2012, while a student at a New Jersey high school, she was hit in the back of the head by a lacrosse ball during a warm-up drill before a game. She does not remember falling to the ground, being helped up by teammates and carrying on.

The next six months were a blur of pain, confusion and frustration. Before her concussion, Losch was an energetic honour student who played lacrosse, basketball and soccer. Her health deteriorated so gravely that she struggled to read, write, walk up stairs and brush her teeth. She became too unwell to attend school, enduring migraines, eye pain, photosensitivity, insomnia, nausea, exhaustion, dizziness, tinnitus and an inability to focus.

That autumn she was referred to the concussion programme at the University of Pittsburgh Medical Center and slowly improved under treatment plans which included retraining her brain to improve her balance and vision problems.

After a year of homeschooling – cycles of 10 minutes of verbal tuition, then five minutes’ rest – Losch was able to return for her senior year, dictating essays into an app, graduating on time with honours and going on to attend college.

Now she wears headgear every day: a $30 ice pack bought from Amazon that she wraps around her head to soothe her migraines. Losch is convinced that her devastating injury would have been far less serious if she had worn a hard helmet, which was forbidden by the rules. “My doctors are pretty confident, especially where I was hit, on the back of my head, that it would have significantly decreased or I wouldn’t have had the injury at all,” she says.

The firm, dense rubber ball can travel at speeds far greater than 60mph but hard-shell helmets and face masks are obligatory in US boys’ lacrosse while flexible headgear is optional for girls (goalies aside). Among other important differences, some forms of body checking are allowed for boys over 12. The rules divergence can be traced to sexism as the sport grew in the 1930s, when contact sports were viewed as inappropriate for women.

Yet a 2015 study of concussions in college and high school football, soccer, lacrosse and ice hockey found that women’s lacrosse had the second-highest incidence rate after football. That year, Florida became the first state to mandate headgear in girls’ high school lacrosse, a decision that met with widespread resistance within the sport. No other states have followed so far, even as evidence mounts of the potential value of headgear.

A 2020 study led by Dawn Comstock of the Colorado School of Public Health examined high school lacrosse head injuries from 2008-09 to 2018-19 and estimated that 44.7% of girls’ concussions could have been prevented had they worn the same helmet as the boys.

“For boys, athlete-athlete contact was the most common mechanism of concussion accounting for 66.4% of all concussions, while stick or ball contact accounted for 23.5%,” the authors wrote. “For girls, stick or ball contact accounted for 72.7% of all concussions, while athlete-athlete contact accounted for 19.8%.”

A major study of 357,225 games and practices published in 2021 by University of Florida Health also indicates that headgear can have a significant protective effect in female high school lacrosse. Researchers found that states without headgear mandates had a 59% higher concussion rate compared to Florida. The disparity rose to 74% during competitions, since games are more dangerous than training sessions.

Knowing little about the sport, Rob Stolker had no initial objection when his two youngest daughters asked him in 2014 if they could play lacrosse. He asked the coaches why the girls did not have helmets and shoulder pads like the boys on the adjacent field. “They said, ‘girls don’t wear helmets’, just matter-of-factly. I didn’t understand it then, I still don’t understand it now.”

He researched the issue and decided not to let his daughters play. After discovering there were no approved headgear options he founded Hummingbird Sports, one of only two women’s lacrosse headgear manufacturers whose equipment meets certification requirements implemented in 2017 by the governing body, USA Lacrosse, after years of research and development. Stolker is a member of the Brain Safety Alliance, a headgear advocacy group.

Defenders of the status quo often question the effectiveness of headgear in preventing body-to-body concussions and cite dubious fears that improved protective equipment will inspire a “gladiator effect”, an attitude shift that induces the kind of rough contact more often seen in the male game. “It is complete bunk. To people outside it doesn’t make any sense,” Stolker says.

Losch’s injury resulted from an accident, not deliberate aggression. Strict enforcement of the rules by officials and coaches ought to discourage recklessness, and helmets are likely to be most effective against the stick and ball injuries that the 2020 analysis suggests are most common in the female game. The Florida study findings cast doubt on the “gladiator effect” theory.

Stolker believes that by continuing to treat male and female players differently the sport is placing tradition over safety: “That is the way it is, 100% that’s the issue here,” he said. “There’s a feeling [among parents] that organisational leaders are looking out for the safety of their girls and that’s what clearly doesn’t happen.”

Ann Kitt Carpenetti, vice-president of lacrosse operations at USA Lacrosse, disagrees. “If we had just done nothing that would be fair,” she says. “We have invested dollars and been thoughtful about our approach. We haven’t ever said that we are closed off to policy change.” She points out that USA Lacrosse mandated eyewear in the female game in 2004-05 and contributed funding for the Florida analysis.

“It’s the first study of its kind on a novel piece of headgear. It has had some benefit,” Carpenetti says, but “is it conclusive enough to make everybody have to wear it? I think there is a lot of support within the research community as well as in the game community to continue to ask questions… We’re proponents of making evidence-based decisions and that’s what we’re going to continue to do.”

As coaches, officials and local and state associations digest the Florida report, the topic is likely to spark debate in the summer, the time of year when rule changes are proposed and agreed ahead of the next season.

Losch now lives in New York and works in pharmaceutical advertising. She takes Botox injections every three months to help with her daily migraines. “That has significantly improved my quality of life. Prior to that, every time the weather changed or if I had to be on the computer for an hour I would get a migraine to the point where I was vomiting,” she says. “I try not to let it hold me back, still kind of have a life. I’ll be in pain whether I’m home or if I’m out, so I just kind of keep going.”

She is optimistic that headgear will eventually be mandated in girls’ lacrosse. “That would be lovely,” she says. “I don’t want anyone else to have to go through this.”

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