July 23, 2020
High school girls’ lacrosse players are at a higher risk of concussion from a stick or ball impact than boys’ lacrosse players. In girls’ lacrosse, players are allowed, but not required, to wear flexible protective headgear. What they aren’t allowed to wear is the type of hard-shell helmet with a full-face mask that the boys’ lacrosse players use.
A new study, published in May 2020 in Injury Epidemiology, finds that if girls’ lacrosse players used the same helmets that are mandated in boys’ lacrosse, the number of concussions suffered by girls could be reduced by 44 percent.
“What we found is that a surprisingly high proportion of the concussions that girls’ high school lacrosse players sustain, specifically by being struck in the head directly by the stick or the ball, could have been prevented if they had been wearing the same helmet as the boys,” says Dawn Comstock, PhD, a professor of epidemiology at the University of Colorado School of Public Health in Denver.
Different Rules for Boys’ and Girls’ Lacrosse Don’t Result in Lower Rates of Concussion
Researchers used lacrosse concussion data from the National High School Sports-Related Injury Surveillance Study, also known as High School RIO, an internet-based data collection tool that allows direct comparison of injury rates across sports.
By looking at the number of concussions, the number of events and practices, as well as the cause of the concussion, researchers estimated the total percentage of girls’ concussions that could have been prevented if the girls wore the same helmet required in boys’ lacrosse.
Investigators found that while the rate of concussion for boys and girls was nearly the same, the causes of the concussions were not. In girls’ lacrosse, stick or ball contact was the most common trigger and accounted for 72.7 percent of all concussions, and athlete-to-athlete contact accounted for 19.8 percent. For boys’ lacrosse, almost two-thirds of concussions were caused by athlete-to-athlete contact and stick or ball contact accounted for 23.5 percent.
The rules for girls’ and boys’ lacrosse are different. The girls’ game is designed to be “softer and safer,” says Dr. Comstock. “Girls are not allowed body contact or bodychecking like boys are, and girls have what they call the ‘sphere’ rule, which dictates that there is a seven-inch imaginary bubble around the head of each girl, and no one is supposed to be allowed to stick check within that imaginary seven-inch bubble,” she says.
“Those two rules are supposed to be preventing head injury in girls’ lacrosse. The problem is our data shows that those rules are not currently protecting them,” says Comstock.
Although there could be a few different solutions for reducing the risk of concussion in girls’ lacrosse, requiring the girls to wear the same helmets as boys seems to be one of the more logical and proven options, says Comstock.
“There’s lots of research out there that shows that helmets are actually very effective at preventing the kind of injuries of the type that occur when you’re struck directly in the head by a stick or a ball. Helmets are not as effective in preventing the concussions that occur from athlete-to-athlete contact though,” she says.
This safety issue seems like low hanging fruit, says Comstock. “We’ve recognized an injury problem in a sport, and we have an available intervention that we know would be effective at reducing that injury risk — why not utilize it?” she says.
Girls’ Lacrosse Protective Headgear ‘Allowed but Not Required’
Although girls aren’t allowed to wear the same hard-shell helmet that boys wear, there is headgear that is optional for girls’ lacrosse. In 2015, U.S. Lacrosse, the governing body of lacrosse in the United States, collaborated with ASTM International, a nonprofit organization that develops and publishes international voluntary consensus standards, to develop a standard protective headgear for women’s lacrosse.
The headgear fully covers the head and is flexible to ensure that players wearing the headgear will not injure players who are not wearing it, according to U.S. Lacrosse. The standard has two options, one with integrated eyewear, the other without, although any headgear used must be worn with the required eyewear.
The differences in head protection are presumably based on the rules, and not any inherent difference between the sexes.
“There isn’t really a biological or clinical reason for requiring different helmets for boys and girls,” says Mark Halstead, MD, an associate professor in orthopedic surgery and pediatrics and the director of the sports concussion program at Washington University School of Medicine in St. Louis.
And, Comstock adds, “It’s not clear if all the girls wore the optional headgear if it would reduce concussions, in part because hardly any girls chose to wear it.”
Would Mandating Hard-Shell Helmets for Girls’ Lacrosse Actually Increase Injury and Concussions?
“Girls’ lacrosse was very resistant to the protective eyewear mandate in 2004. There was a lot of pushback,” says Dr. Halstead. “Eventually it happened, but with a fuss. Certainly, I could see a similar issue if the change in headgear was proposed,” he says.
This unwillingness to change is not unique to lacrosse, says Comstock. “Historically, every time there’s been an effort to introduce protective equipment into different sports there’s been pushback from people, though the arguments are often the same, regardless of the sport,” she says.
Some people argue that the helmets and full-face mask would reduce peripheral vision or somehow impede the vision of the players, therefore putting the athletes at increased risk because they won’t see balls or sticks coming at them and be able to react accordingly, says Comstock. “That sounds logical, but if the boys could wear the helmet without any undue risk, why can’t the girls?” she asks.
Then there’s the “gladiator effect” argument: If you put a piece of protective equipment on the players it will cause them to be much more reckless and aggressive, which could introduce new injuries into the game because of that increased aggressiveness, says Comstock. “The helmets haven’t had that effect on the boys’ game, and there’s no reason to think that it would cause that for girls,” she says.
When Played Safely, Sports Are an Important Part of a Healthy Lifestyle
Playing a sport is associated with numerous health benefits, such as decreased risk of obesity, chronic disease, and depression, along with improved life skills, including time management and goal setting, according to research published in the Open Access Journal of Sports Medicine.
“We know that playing sports is the most important way for young people to incorporate physical activity as part of a healthy lifestyle,” Comstock says, adding that the findings are not intended to discourage girls from participating in high school lacrosse.
The Centers for Disease Control and Prevention (CDC) recommends that athletes avoid the following behaviors to reduce the risk of concussion in sports:
Striking another athlete in the head
Using your head or helmet to contact another athlete
Making illegal contacts or checking, tackling, or colliding with an unprotected opponent
Trying to injure or put another athlete at risk of injury
“I’d love to see more kids play more sports. I just want to keep them as safe as possible while they do so,” Comstock says.