Helmets in women's lacrosse: what the evidence shows.

US Women’s lacrosse ranks second only to American football in incidence rate of concussions, according to a study that compiled data from over 200 high schools and 26 colleges [1]. Other studies confirm head injury is a significant risk in the sport; the largest, an epidemiological study using over 1 million athletic exposures in high school and college men’s and women’s lacrosse over four seasons, found that although women’s lacrosse has a no-contact rule, women players had a higher rate of head, face and eye injuries than men; 40% of these injuries were concussions [2]. Stick or ball contact is the primary mechanism of injury to the head in women’s lacrosse. In men’s lacrosse, a contact sport, most concussions arise from player collisions. Men’s lacrosse requires a full protective helmet but, until now, the only approved headgear for women’s lacrosse has been eye protection. For the first time this season, women’s lacrosse players have the option to wear approved headgear. Following a concussion, immediate neurological symptoms (i.e., dizziness, confusion, disorientation and blurred vision) generally resolve spontaneously, and no abnormalities are typically found on routine imaging (computed tomography or MRI); however, prolonged symptoms are more likely to occur following a more severe hit or when an athlete has suffered more than one concussion [3]. A growing body of evidence has linked repeated mild traumatic brain injury to debilitating long-term consequences that may silently accumulate; symptoms vary but may include headaches, memory and attention impairment, emotional instability and the progressive neurodegenerative disease chronic traumatic encephalopathy, also known as CTE ([4] and many others). Given the statistics above demonstrating high incident rates of concussion in women’s lacrosse, along with the potential for long-term impairment from repeated or severe brain trauma, it is easy to agree on the importance of reducing the risk of head injury in the sport of women’s lacrosse. Nonetheless, there is a large debate as to whether adding headgear to the women’s game will help solve the problem. This spring season of 2017 marks the arrival of long awaited new headgear designed specifically for the women’s game. The website of US Lacrosse, the sport’s governing body, currently states: “The ASTM standard is the first ever performance standard for women’s lacrosse headgear, developed to help reduce impact forces associated with stick and ball contact in women’s lacrosse.” [5]. ASTM International (originally established under the name American Society Helmets in women’s lacrosse: what the evidence shows