Lincoln AE, Caswell SV, Almquist JL, Dunn RE, Hinton RY. Am J Sports Med. 2013 Feb 14. [Epub ahead of print]
Take Home Message: Video analysis of high school boy’s lacrosse indicated that most concussions are related to the intentional use of helmets in impacts and that the injured player is often not expecting a hit. Results from this type of research have already had direct implications on rule changes in lacrosse.
In lacrosse, one of the fasting growing sports in the United States, concussion is a significant concern. Understanding the mechanisms of head injury in boy’s lacrosse could help us develop new injury prevention strategies but unfortunately most of the previous research has depended on eyewitness- or self-reported details. To improve our understanding of game situations and injury mechanisms that contributes to concussions Lincoln et al. systematically examined injury mechanisms of concussion in high school boy’s lacrosse using video analysis. The authors hired professional videographers to record home matches (varsity and junior varsity) from 25 schools over 2 years (518 games in 2008 and 2009). If an injury took place, the athletic trainer communicated this to the videographer so they could record the approximate time. Then, the researchers went back and reviewed each video with time before and after each concussion. They evaluated over 64 characteristics; for example, the position of the player, whether they had possession of the ball, or if they were attempting to reach the ball. The authors analyzed 34 (50.7%) of the game-related concussions, which mostly involved the varsity level athletes (65%) as well as midfielders (53%) and defenders (27%). The majority of athletes with a concussion (59%) did not have possession of the ball at the time of injury and many (56%) were said to be ‘defenseless’. In 79% of the impacts the opposing player’s head hit the injured athlete. Interestingly, none of the concussions occurred because of hits from the ball or stick. The officials only called a penalty after 9 (26%) impacts.
This study is important because it highlights that many concussions in high school boy’s lacrosse are associated with player-to-player impacts, especially when the injured athlete is not anticipating a hit. Furthermore, it is concerning that many of these impacts are initiated by the opposing player’s head. The authors suggest that the main cause of concussions in high school boy’s lacrosse may be “the intentional use of helmets during player-to-player contact”. The preliminary findings from this study have already had widespread implications. The NCAA, National Federation of State High School Associations, and US Lacrosse used the preliminary data to implement rule changes in 2011 to 2012 that made it illegal to intentionally use helmets during contact. It will be important to monitor lacrosse to determine if the rule changes have benefit, but this is a good example of how research can spark rule changes without compromising the game. In addition, videotape impact analysis may also be able to help with concussion diagnosis in the future if unclear initially. This could be the purpose of future research. How do you think we can further prevent these ‘defenseless’ hits in such sports as lacrosse and football? Do you think clinicians will ever use videotape in their evaluation of concussion, especially in those injuries that are not so straightforward?
Written by: Jill R. Crosson D.O.
Reviewed by: Jeffrey Driban