CONCUSSION AND HEAD PROTECTION IN LACROSSE Taking Care of America s Fastest Growing Sport
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1 CONCUSSION AND HEAD PROTECTION IN LACROSSE Taking Care of America s Fastest Growing Sport Richard Hinton, MD, MPH (410) , richard.hinton@medstar.net Medical Director / Fellowship Director, MedStar Sports Medicine Executive Member, US Lacrosse Sports Science and Safety Committee Baltimore, Maryland
2 DISCLOSURES Financial disclosures I have no financial disclosures pertinent to this talk Membership disclosures Member, US Lacrosse Sports Science and Safety Committee
3 LACROSSE Oldest and fastest growing team sport in America Unique men s, women s and youth games Played by all age groups Combination of speed, stick, ball, and contact make for a unique set of injury mechanisms, types, and preventive efforts
4 MEDSTAR: LACROSSE SPORTS MEDICINE
5 LACROSSE SPORTS MEDICINE: PARTNERSHIP US LACROSSE: The national governing body for men s, women s, and youth lacrosse Full Circle of Activity Public Health Approach to Health and Safety
6 US LACROSSE: SPORTING SUCCESS Positive Games Experience Honoring the Game Focus on Youth and Recreational Health and Safety a Priority Can this Model Succeed?
7 SPORTING SUCCESS IN AMERICA The Entertainment Sports Complex Overused Entertainers and Overweight Spectators Focus on the Top Professional Model Club vs. Scholastic Play Multiple Secondary Gain Issues The It Factor College Admission and Scholarships Club vs. Scholastic Play Learning Life s Lessons and having Fun? Posse / Drop Off Mentality Increased Injury Exposure Club
8 US LACROSSE Health and Safety Priorities National standards for gender and age specific rules, coaching, and officiating One sport: two games Concussion and head, face, eye injuries for women s, men s, and youth lacrosse ACL tears and other lower extremity injuries Sudden cardiac death Youth specific rules Specific conditions: hand fractures and testicular injuries
9 Games share ONE SPORT: TWO GAMES Differences in Men s and Women s Lacrosse Full field, free flowing play Speed, quick change of direction Passing, shooting, stick work Men s game Purposeful collision sport Women s game Incidental contact Game specific Equipment Requirements Injury Prevention Strategies Culture and History Women playing Men s Lacrosse
10 CONCUSSION AND HEAD PROTECTION IN LACROSSE The MedStar Advanced Model for Sports Medicine Research Step 1 Step 2 Injury & Disease Surveillance Problem Identification Establish Extent of Injury Problem (Data Collection) Risk Factor Identificaton Establish Etiology and Mechanisms of Sports Injury Step 5 Implementation, Feedback and Assessment Full Scale Implementation & Effectiveness Step 4 Assess Effectiveness in controlled environment Step 3 Develop Intervention/ Potential Solutions Develop, Introduce & Revise Preventive Measures Feedback
11 Sports Injury Surveillance Systems System Administrator Pros Cons Example study NCAA Injury Surveillance System (ISS) Datalys Center Web-based High capture rate National sample Variability in data coding(?) Limited # of participating colleges Validity of Soccer Injury Data in NCAA (2011) Injury Treatment & Tracking System (ITTS) Fairfax County (VA) Public Schools Daily electronic capture of 25 high schools & 27 sports Includes time-loss and no time loss injuries Representative of a single geographic area/school district Trends in concussion incidence in high school sports (2011) Reporting Information Online (RIO) Nationwide Children s Hospital Web-based 100 participating high schools with AT National sample of 12 sports Variability in data coding(?) Sex Differences in Concussion Symptoms of High School Athletes (2011) National Center for Catastrophic Sport Injury Research University of North Carolina at Chapel Hill Death and permanent disability sports injury data that involve brain and/ or spinal cord injuries Based on reports of catastrophic/ fatal injuries Catastrophic Football Injuries Annual Report (2011) 11
12 OVERALL INJURY RATES FOR NCAA SPORTS February 18,
13 NCAA CONCUSSION RATES
14 American Journal of Sports Medicine, 2005
15 COMMON INJURIES Scholastic Boys Lacrosse
16 June 1, 2013 COMMON INJURIES Girls Scholastic Lacrosse
17
18 LACROSSE CONCUSSION RATES Scholastic Boys and Girls
19 American Journal of Sports Medicine, 2012
20 American Journal of Sports Medicine, 2013
21 CONCUSSION MECHANISM Scholastic Boys and Girls Lacrosse Table 1. Boys Girls Level of play Varsity 22 (65%) 14 (100%) Junior varsity 12 (35%) 0 Concussion mechanism Body check 32 (94%) 1 (7%) Stick (unintentional) 0 5 (36%) Stick (intentional) 0 3 (21%) Collision (unintentional) 2 (6%) 3 (21%) Ball 0 1 (7%) Undetermined 0 1 (7%) Penalty called Yes 8 (24%) 2 (14%) No 25 (73%) 10 (71%) Unknown 1 (3%) 21 2 (14%)
22 February 18,
23 23
24 Why are hard helmets and mounted face masks not required in women s lacrosse?
25 Hard helmets / facemasks have not been required or deemed necessary in women s lacrosse because: The nature of women s lacrosse is an incidental contact sport The risk of head/face injury is on par with other sports Administrative controls (rules) and educational programs have been created for players, coaches, and officials to teach the nature of the game and reduce exposures Unique history and culture of the women s game
26 ASTM STANDARDS FOR GAME SPECIFIC WOMEN S LACROSSE HEAD PROTECTION ASTM Consensus Based Standards Setting Includes NGB, Manufacturers, Consumers, Interested Parties On ballot for 2014 Testing to include Drop test ( duplicate stick checking ) Cannon ball test Flexibility ( safety for other players ) testing Relatively soft head protection ( game specific ) Two piece Single piece with goggles mounted
27 HELMET SENSOR DATA IN MEN S Kindshi et al: MedStar Sports Medicine and Towson University Sports Medicine: Head impact exposure in men s collegiate lacrosse players Unpublished LACROSSE G Force Tracker Linear Acceleration and Rotational Velocity 9 games, 39 practices 17 Div I Male Lacrosse Players Total Impacts, Threshold Impacts Video Pairing
28 HELMET SENSOR DATA Avg. # Impacts 23 games 8.7 per practice Vast majority low impact g 3% >70 g ~ 80 % related to body to body contact > 70 g impacts are in loose ball situations > left side hits for right handed players Position specific
29 HEAD IMPACTS IN MEN S LACROSSE
30 HEAD IMPACTS IN MEN S LACROSSE
31 HEAD IMPACTS IN MEN S LACROSSE
32 SUMMARY Concussion, head, face, and eye injuries are priority issues for men s, women s, and youth lacrosse Injury mechanisms, types, and rates are age and gender specific Injury prevention strategies, including head protective devices must be game specific to be effective Women s and men s lacrosse are two different sports and have unique health and safety issues US Lacrosse has been exceptionally proactive in lacrosse health and safety
33 THANK YOU MedStar Sports Medicine US Lacrosse
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