February 2017

Out on a limb: Her head’s in the game

By Jordana Bieze Foster, Editor

It’s more difficult to assess the effects of head impacts in female lacrosse players than in their male counter­parts. But it’s no less important, particularly with regard to lower extremity injury prevention.

Head impacts in male lacrosse players can be quantified with the use of instrumented helmets, as Sacred Heart University researchers did in a recent study examining associations between subconcussive impacts and balance (see “Subconcussive subtleties: Lacrosse study links balance, impacts,” page 13).

Female lacrosse players typically don’t wear helmets, which have been deemed unnecessary since the rules of the women’s game prohibit contact between players. And yet, despite the official emphasis on noncontact play for women, multiple studies have found that concussion risk is similar for both genders, at both the high school and college levels. And, in a 2014 University of Virginia study in which head impacts were assessed using mastoid-patch accelerometers, the number of head impacts was similar for men’s and women’s college lacrosse players.

That’s why, although the Sacred Heart study included only male players, its findings are likely relevant for female players as well. The study found higher levels of subconcussive impacts accumu­lated during the course of a lacrosse season were associated with greater deterioration in scores on the foam-surface aspects of the Balance Error Scoring System test between the pre- and postseason.

It’s unclear whether the subconcussive impacts directly caused the balance deficits, but that certainly makes intuitive sense, since postconcussion balance impairment is common and can persist long after most concussion symptoms have resolved (see “Concussion repercussions: Studies explore lower extremity effects,” June 2016, page 13).

Studies of head impacts in male lacrosse players also have lower extremity injury implications for their female counterparts.

Although researchers are only beginning to explore the injury implications of subconcussive impacts, multiple studies have suggested impaired balance alone can increase the risk of lower extremity injury in athletes—including ankle sprains and anterior cruciate ligament injuries, which account for up to 30% of injuries in female lacrosse players.

And there’s at least some evidence to suggest the relationship between balance and lower extremity injury may be more pronounced in female athletes than in male athletes. In a 2006 study of high school basketball players, a composite reach distance of less than 94% of limb length on the Star Excursion Balance Test performance was associated with a 6.5 times greater risk of lower extremity injury in girls—but no similar association was seen in boys.

It seems clear that if lower extremity practitioners who work with female lacrosse players aren’t monitoring those athletes’ balance during the course of a season and implementing balance training protocols as needed, they should be.

But it also seems that efforts to reduce subconcussive head impacts in female lacrosse players could help reduce lower extremity injury rates even further. That starts with better enforcement of those rules stipulating noncontact play in the women’s game. Because the helmets worn by male lacrosse players do facilitate the study of head impacts, but no helmet has yet been proven to neutralize the effects of those head impacts in athletes of either gender.

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