Position Statement:  The importance of mandating protective headgear (helmets) in the sport of  girls’/women’s lacrosse.

After much extensive information gathering and review of current available literature, AMSSNY recommends the following with regard to the use of helmets in the sport of girls’/women’s lacrosse:

1. Regulation approved protective headgear should be a mandated piece of equipment for all players in the sport of girls’/women’s lacrosse on the youth, high school, collegiate and post collegiate level.

2. Until conclusive impact studies and acceleration studies provide pertinent data resulting in the production of headgear designed specifically to address the mechanisms of injury in the sport of girls’/women’s lacrosse, all players should be mandated to wear the NOCSAE (National Operating Committee on Standards for Athletic Equipment) approved hard helmets currently used in the sport of boys’/men’s lacrosse.

3. Coaches, officials, athletic trainers, players and parents, must be adequately educated as to the current, “rules of the game” with regard to girls’/women’s lacrosse, to ensure the safety and integrity of the sport. Education must occur in both officially sanctioned programs, as well as recreational programs, to afford a safe playing field for all girls/women participating in the sport.

4. As the sport of girls’/women’s lacrosse is deemed a different version of the sport of lacrosse than that of boys’/men’s lacrosse, it is paramount that all coaches, officials, athletic trainers, and players recognize the differences and stringently adhere to the current “rules of the game” as set forth by US Lacrosse and other governing bodies.

5. In addition to ensuring safe play by enforcing strict penalties for dangerous and overly aggressive play, all coaches, athletic trainers, officials, parents and players need to be properly educated as to the magnitude of concussive injuries in the sport; realizing that head injuries can occur on the practice field as well as during sanctioned play.

6.  It is imperative that all head injuries as well as other types of sport related injuries, be identified and reported as such, by coaches and athletic trainers, to the appropriate, authoritative recording bodies.

Background:

It is estimated that 35 million children in the US, participate in organized sports programs (“Youth Sports Statistics”, 2013).  According to the Centers for Disease Control and Prevention (CDC), in 2009 more than 7,100 children aged 0-19 were treated daily in hospital ER’s for sports or recreational related injuries, totaling approximately, 2.6 million children/year.  In 2003, sports and recreational injuries resulted in a cost of more than 11 million dollars in healthcare spending (CDC, 2013).  To minimize injuries in sports such as lacrosse, primary preventative strategies must include the use of approved protective equipment.

Participation in any given sport can bring the risk of injury.  Simply outfitting players with protective gear does not guarantee that an injury will not occur.  Protective equipment however, has a role in affording the player an added layer of protection against injury.

Recent media attention on concussive injuries in the NFL has caused many to begin examining the scope of this issue in various organized sports. Both short term, as well as long term deleterious effects,have been noted from repeated head trauma.  Many athletic organizations however have been slow to respond, even though scientific data has shown that repeated head trauma can have long term sequela for athletes of all ages. There are those who argue that the addition of helmets to a sport will result in changing the nature of the game,thus resulting in dangerous aggressive play, which may lead to an increased potential for head trauma (Cantu & Hyman, 2012, p. 149 – 152). Mandating protective headgear in the sport of girls’/women’slacrosse however, does not have to impact the integrity of the sport.  As athletes become more defined, and the level of play increases, regulatory bodies are called upon to modify the rules of the game to ensure the safety of all athletes.

At present, there are three organizations which write the rules for the sport of Lacrosse in the United States.  US Lacrosse is the governing body which develops the rules of play for boys’ and girls’ youth lacrosse, high school girls’ lacrosse, non-varsity collegiate women’s and post collegiate men’s andwomen’slacrosse. The rules set forth by US Lacrosse are endorsed by the National Federation of State High School Associations (NFHS) which sets the rules for high school boys’ lacrosse as well as the NCAA which sets the varsity collegiate rules for men’s and women’slacrosse.  The rules of play for both girls’ and women’slacrosse are published annually by US Lacrosse and include all required equipment for players and goal keepers; as well as optional allowed equipment.  At the present time, the rules prohibit the use of hard helmets in the girls’/women’s sport, with the exception of the goal keepers.  In 2004 US Lacrosse amended the rules to require NOCSAE certified helmets, like those worn in boys’ lacrosse, to be mandatory equipment for all goal keepers in girls’/women’slacrosse.  In 2005, goggles and mouth gear became mandatory equipment in the sport of girls’ lacrosse. Currently, US Lacrosse allows soft headgear to be worn by players of girls’/women’slacrosse, but there is no official mandate requiring any type of head gear for all players (U.S. Lacrosse, 2013).  Mandatory head gear should be no more a catalyst in changing the nature of the game than the addition of approved protective eye gear and mouth guards have been.

Although the sports of boys’ and girls’ lacrosse are identified as two distinctly different games, based upon the rules of play and the required equipment, both sports include the use of a small hard ball weighing 5 to 5.25 ounces, and wooden sticks. In girls’ varsity lacrosse, the shot velocity of the ball has been shown to reach speeds of 60 mph. Although the rules of play in girls’ lacrosse prohibit body checking, and aggressive play, body and stick contact still occur. A study conducted by The Center for Injury Research and Policy, Columbus Ohio, showed that 37.1% of girls’ lacrosse injuries were either concussive or facial injuries as compared with boys’ 19.2% (Rock & Haynes, 2011).  According to the National Federation of State High School Associations, girls’ lacrosse ranked 5^th for head and face injuries, and 3^rd for concussive injuries when compared to other high school sports (Goldman, 2013).  A recent study by George Madison University, in 2012, used video analysis to examine common injury mechanisms which result in head trauma in high school girls’ lacrosse.  The study concluded that most head injuries on the varsity level resulted from stick to head contact near the goal, and that most stick contact was unintentional in nature (Caswell, 2012).

In 2010, The New York State Public High School Athletic Association was poised to pass a mandate requiring hard helmets, like those worn in boys’ lacrosse, for all NY state public high school girls playing the sport.  The mandate however was voted down with a recommendation to allow US Lacrosse, as the governing body of the sport, to determine the appropriate protective headgear needed for the girls’ sport (Goldman, 2013). US Lacrosse has been working with independent researchers over the past few years to study impact and shot velocity, in an effort to develop the most effective protective head gear for girls’ lacrosse.  Four years have elapsed since the mandate was voted down in NY, and at present there remains no resolution to this pressing issue.  Girls across the country are once again taking to the lacrosse fields without mandated head protection.

As in any sport, protective equipment is only one aspect to increase the safety of those on the playing field; education with regard to the acceptable rules of play is also of paramount importance.  All coaches, athletic trainers, officials and athletes should be well aware of the approved rules of play and the penalties for deviating from those rules.  Officiating individuals must be accountable for enforcing penalties, to ensure that play remains at a safe and acceptable level.  In addition, all those involved in a sport must be educated on the importance of identifying head trauma when it occurs on the field of play. The CDC, in cooperation with U.S. Lacrosse as well as other officiating sports organizations, has developed the “Heads up Initiative”.  The “Heads up Initiative” is designed to educate coaches, athletic trainers, parents, athletes and medical professionals, on the signs and symptoms of head trauma and the acceptable rules for return to play (National Center for Injury Prevention and Control, 2008).

With a primary strategy focusing on mandating protective head equipment for all players, and a secondary strategy focusing on increased education and a heightened awareness to recognize and respond appropriately to head trauma, the playing field will be a safer place for all athletes.

References

Cantu, Robert and Hyman, Mark.  (2012). Concussions and our Kids.  Boston: Houghton Mifflin Harcourt.

Caswell, Shane. (2012). New study examines head injuries in girls’ lacrosse using video analysis.
newsdesk.gmu.edu.
Retrieved from http://newsdesk.gmu.edu/2012/02/new-study-examines-head-injuries-in-girls-lacrosse-using-video-analysis/

Centers for Disease Control and Prevention. (2013, July 2).  A national action plan for child injury prevention.
Retrieved from http://www.cdc.gov/safechild/NAP/overviews/sports.html

Goldman, Dan. (2013, August 19).  Game changer?  The helmet debate in girls’ lacrosse. MPNnow.com.
Retrieved from http://www.mpnnow.com/article/20130818/news/30818995/

National Center for Injury Prevention and Control. Heads Up: Concussion in Youth Sports, Activity Report (2007-2008). Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention: 2008.4

Rock, Tom and Haynes, Stephen. (2011, June 4). Need for helmets in girls’ lacrosse debated.  Newsday.
Retrieved from http://www.newsday.com/sports/high-school/girls-lacrosse/need-for-helmets-in-girls-lacrosse-debated-1.23930910

U.S. Lacrosse. (2013).
Retrieved from http://www.uslacrosse.org/rules.aspx

“Youth Sports Statistics”. (2013).
Retrieved from http://www.statisticbrain.com/youth-sports-statistics.

Suggested Reading

CBS New York. (2013, May 13).  Athletes and administrators butt heads over helmet requirements in girls’ lacrosse.
Retrieved from http://newyork.cbslocal.com/2013/05/13/athletes-and-administrators-butt-heads-over-helmet-requirements-in-girls-lacrosse

Gilchrist J., Thomas KE., McGuire LC, Coronado V., Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged < 19 years.  MMWR 2011; 60 (39); 1337-1342.

Johnson, Kelly. (2013, August 4).  Princeton schools to become the first in the state to require headgear soccer, lacrosse, and field hockey. The Times of Trenton.
Retrieved from http://www.nj.com/mercer/index.ssf/2013/08/princeton_schools_become_the_first_in_the_state_to_require_headgear_for_soccer_lacrosse_and_field_ho.html

Lincoln AE, Hinton RY, Alquist JL, Lager SL, Dick RW. Head face and eye injuries in scholastic and collegiate lacrosse: a 4 year prospective study. AJSM. 2007. 35 (2) 207-215.

WBALTV 11(2012, May23).  WBALtv.com. The great debate: Why no helmets for women’s lacrosse?
Retrieved from http://www.wbaltv.com/news/maryland/i-team/The-great-debate-Why-no-helmets-for-women-s-lacrosse

Approved by:

The Alliance with the Medical Society of the State of New York, April 11, 2014

Addendum I:(2015)

Since the approval of this position statement, additional information has become available  which further suggests a need for protective head gear in the sport of girl’s lacrosse. Multiple articles on this topic have been published in the American Journal of Sports Medicine. (see additional links below). This information has been shared with the members of the Medical Society of the State of of NY (MSSNY), the members of the NY State Medical Alliance, as well as representatives from the PA Medical Alliance, Maryland Medical Alliance, and Massachusetts Medical Alliance. The MSSNY and the AMA (American Medical Association) House of Delegates have also reviewed the information relevant to the issue of mandating protective head gear in the sport of girls’ lacrosse, and in 2015 passed the following resolutions:

The Medical Society of the State of NY (MSSNY) House of Delegates, April 2015

            MSSNY Resolution 157, in favor of protective headgear in the sport of girls’/women’s  lacrosse

The American Medical Association House of Delegates,June 2015

            AMA H-470.955 previously Res 423, in favor of protective head gear in the sport of girls’ lacrosse

 Additional Links:

http://ajs.sagepub.com/content/early/2012/02/09/0363546512436647
http://ajs.sagepub.com/content/44/11/2947.abstract
http://ajs.sagepub.com/content/44/4/1047.abstract
http://ajs.sagepub.com/content/early/2014/07/17/0363546514539914.abstract?sid=91e6f570-bec0-4130-830e-e7dedd83dbea
http://www.nationwidechildrens.org/news-room-articles/new-study-finds-high-school-lacrosse-players-at-risk-for-concussions-other-injuries?contentid=129470
http://www.healthnewscolorado.org/2014/07/23/as-lacrosse-popularity-surges-helmets-could-check-girls-concussions/
https://www.ncbi.nlm.nih.gov/pubmed/25053695
https://injepijournal.springeropen.com/articles/10.1186/s40621-015-0045-4

Addendum II: (2017)

Beginning in the 2017 season, US Lacrosse has adopted ASTM Standard, F3137, as a performance standard for all headgear to be worn in the sport of girls’/women’s lacrosse.  ASTM Standard F3137 ensures that the helmet meets the following 3 test requirements:

1. A drop impact test that simulates a 45mph stick swing
2. A 60mph ball impact test
3. A deformation test to ensure level of flexibility

 At this time, the use of headgear remains optional for field players. Acceptable headgear must provide full coverage of the head and must be worn with / or incorporate into the product the required ASTM Standard for women’s lacrosse eyewear. The ASTM Standard, F3137, is the first ever performance standard for girls’/women’s lacrosse headgear developed to help reduce impact forces associated with stick and ball contact. As of March 2017, there are two companies which have developed headgear for the sport of girls’ /women’s lacrosse which meet the ASTM standards and thus are deemed acceptable to be used by players of the sport on the field. The Hummingbird Women’s Lacrosse Helmet by Hummingbird Sports and the Cascade LX by Cascade Sports. (See links below)

As of January 1, 2018, protective headgear for the sport of girl’s/women’s lacrosse is not mandated or recommended by the governing body of US Lacrosse and remains “optional”.

https://www.hummingbirdsports.com/
http://www.cascadelacrosse.com/lx/index.php

Respectfully submitted by Cheryl Stier RN MSN Co-chair Health Promotions, AMSSNY

March 2018