Tag Archives: Lacrosse Injuries

Concussions In Lacrosse: “Lacrosse Magazine” Presents “In-Depth Q&A” With US Lacrosse Sports Science & Safety Experts On The “Biology, Risks, And Long-Term Implications Of Concussions”

Dr. Margot Putukian and Dr. Ruben Echemendia of the US Lacrosse Sports Science and Safety Committee were among presenters at the International Consensus Conference on Concussions in Zurich, Switzerland.

Dr. Margot Putukian and Dr. Ruben Echemendia of the US Lacrosse Sports Science and Safety Committee were among presenters at the International Consensus Conference on Concussions in Zurich, Switzerland

What is the biology of a concussion? What actually happens to the brain?

RE: A concussion creates changes in the chemistry of the brain that produces a “neuro-metabolic cascade” that renders cells temporarily inoperative and vulnerable to further injury. This metabolic cascade is accompanied by a disruption of the blood supply to the brain, thereby reducing the amount of glucose (fuel) available to the brain for healing. These changes affect the entire brain, not just one region.

What are the risks of playing with a concussion? What is second-impact syndrome?

MP: It is difficult to know the exact risks of continuing to play while concussed, but in the younger athlete, there has been a concern that a second insult can occur while the athlete is still recovering from a first injury, and that a dysregulation in the blood flow to the brain can then result, causing a significant increase in the pressure in the brain. Though considered controversial by some researchers, second-impact syndrome has been reported in youth athletes and associated with significant complications, including death.

RE: Continuing to play while having symptoms places the vulnerable brain at risk for additional injury that may lead to more severe, prolonged or even life-long problems with cognitive and psychological functioning. Second-impact syndrome is rare and thought to occur when an individual sustains a blow to the brain during a time when the brain has not fully recovered from a previous concussion. The blow can often be a relatively mild one.

Are there long-term health implications from concussions?

MP: The majority of concussions resolve in 10-14 days without any known long-term consequences. However, in a very small percentage, there are persistent symptoms and ongoing difficulties with cognitive function or balance.

RE: Some studies suggest there can be long-term changes in neurocognitive functioning; others do not. There is no consensus among experts in the field. The key appears to be appropriate evaluation and management of the injury.

What impact, if any, does age play in concussions?

MP: Younger athletes appear to take longer to recover and therefore should be treated with caution. Other modifiers that are associated with a prolonged recovery include an increased number and duration of symptoms and a history of prior concussion. Other modifiers that may play a role in prolonged recovery include a history of migraine headaches, attention deficit hyperactivity disorder (or other learning disorders) and history of depression, anxiety or other mental health disorders.

Besides rest (physical and mental), what else can help recovery?

MP: An initial period of rest is important, and avoiding cognitive activity, such as texting, video games and extended computer work, also is important. After a few days, light exercise can be initiated assuming it doesn’t worsen symptoms. It’s unclear if other interventions are helpful in assisting recovery, but alcohol, aspirin, narcotics and other medications that impair cognitive function or increase bleeding are typically avoided in the first few days.

RE: It is very important that athletes with concussions remain well hydrated, maintain good nutritional habits and get plenty of sleep. Keep in mind that physical and cognitive rest does not mean placing the child in a cocoon. Typical activities of daily living, including school, should be added as soon as they are tolerated without producing an increase in symptoms.

What misperceptions about concussions do you encounter?

MP: One myth is that helmets prevent concussion. Though they are effective in preventing skull fracture and bleeds, and may lessen impact forces, they do not prevent concussion. Sometimes the assumption is that putting a helmet on an athlete will protect them, when it might not. In fact, if they have a false sense of security, they may play more aggressively and therefore be at a greater risk for injury. Another myth is that the greater the impact force, the more likely that a concussion will occur or the more severe the concussion. There is not enough research to support this, and what limited data we have actually suggests that concussive injury can occur with different levels of impact.

RE: Some people still believe that you need to lose consciousness or have serious memory impairment to have a concussion. Neither is true. Some believe that a concussion is a bruise to the brain; it is not. Many believe that you have to be hit hard or be hit on the head to have a concussion. Neither is true.

Can you comment on the effectiveness of neurocognitive (baseline) testing?

RE: Baseline testing can be very useful in establishing the pre-injury functioning of the athlete. If available, athletes should take advantage of baseline testing. However, baseline testing sometimes creates significant complexity in the evaluation of an athlete’s cognitive functioning. Because of this complexity, a qualified neuropsychologist should interpret any neuropsychological testing.

MP: The utility of baseline computerized neuropsychological testing has recently been questioned. Although it appears to promising, there are several factors to consider in NP testing including the effects of fatigue, injury and motivation.

What are your opinions on the return-to-play laws that have been passed in 49 states and D.C.?

MP: The Zack Lystedt Law passed in Washington State was the first of many that have raised the awareness of the importance of this injury as well as the importance of removing athletes from play when signs and symptoms of concussion are present.

RE: These laws are a good first step towards raising awareness and providing basic guidelines for the management of concussion. The laws are not uniform across states, and hence some are better than others.

US Lacrosse contends there yet no scientific evidence to suggest helmets prevent concussions. Do you adhere to this position?

RE: Yes, this is accurate. Helmets are designed to prevent catastrophic head injury, and they are very good at doing that. They just were not designed to, and do not, prevent concussion.

MP: We need to explore the effects of various headgear options and continue to investigate the mechanisms of injury in lacrosse for both the men’s and women’s game, and evaluate interventions that can decrease injury — including rule changes, rule enforcement, coaches and player education. Whether future equipment modifications can prevent or lessen the severity of injury remains unanswered at this time.

Do you have other recommendations from the conference in Zurich?

MP: There has been a lot of research regarding the assessment and management of concussion that has led to a more cautious approach to this important injury. There are advanced neuroimaging techniques which show promise in demonstrating functional and structural injury with concussion. There also has been a significant amount of information regarding the acceleration forces that occur in different sports that quantify the number, extent and location of forces to the head with sport.

RE: Thus far we have focused a great deal of attention, effort and money on baseline testing but have not focused much on the post-injury evaluation, which is in many ways far more crucial. It is imperative that any athlete with a concussion be evaluated by a qualified medical professional who is specifically trained in the evaluation and management of this injury. The use of a multidisciplinary team of professionals — physicians, neuropsychologists and athletic trainers — is ideal.

For more:  http://laxmagazine.com/genrel/100713_what_is_a_concussion_q_and_a_with_us_lacrosse_experts

Lacrosse Injury Prevention: US Lacrosse Releases “How To Make Proper Contact In Men’s & Boys Lacrosse” Online Instructional Course (Video)

US Lacrosse BannerThe US Lacrosse new online instructional course, How to Make Proper Contact in Men’s & Boys’ Lacrosse, is available free of charge to all of its members at uslacrossecourses.org.

After several years of development and collaboration with professionals in martial arts, gymnastics and other contact sports, US Lacrosse has developed the course to help reduce the number of injuries resulting from illegal and hard hits by teaching proper technique to deliver and receive contact in men’s and boys’ lacrosse.

The course, featuring host Sam Bradman (LXM Pro Tour), is a valuable resource for coaches, players, parents and officials. It navigates the user through nine units of written and video instruction, graphs, drills and other US Lacrosse resources for members to use and refer to as often as needed. The units cover a range of topics including: what is making contact in lacrosse, age-appropriate contact, injuries and contact, receiving contact, making contact, and more.

Find out more at USLacrosse.org.

Lacrosse ACL Knee Injuries: “Champion Magazine” Features “Obstacle Course: After Reconstructive Surgery, Student-Athletes Face A Grueling Path To Emotional And Physical Recovery”

Obstacle Course Article On Knee Reconstruction Surgery Champions Magazine

Every year, more than 2,000 NCAA student-athletes across 15 high-risk sports will feel that bomb detonate inside their knee, hear the menacing echo reverberate through their body, endure a few minutes of misery in their final moments on the playing surface and eight or more of the most trying months of their lives off it. Next season isn’t assured.


“No matter how strong you are, you’re still at risk,” says Dr. Leland Winston, head physician for Rice athletics. “When the ACL tears, your muscles don’t have time to react quickly enough to protect it.”

Student-athletes crumple into a heap on a court or a field, clutching vainly at a knee. Slow-motion replays show the joint contorting, buckling, twisting. Questionable return, the announcers say. Torn ACL, the newspapers read. We’ll see him next season, fans think. Bring in the next player.

Then they turn the page.

ACL InjuriesBut what is an ACL? Why does it matter? Why does it so frequently interject itself into discussions of college athletics? After all, it’s merely one of four major ligaments that stabilize the knee. But it runs vertically through the middle of the joint, serving as its backbone, keeping the femur and tibia in place as players cut, jump and accelerate through practice and competition. Though student-athletes are faster and stronger than they’ve ever been, a study of NCAA injury data revealed that ACL tears rose by 1.3 percent annually over a recent 16-year period.

But advances in surgical and rehab techniques have shifted the odds dramatically in their favor. Orthopedic surgeons note that roughly 90 percent of athletes recover from ACL tears, most of whom reach pre-injury levels of athleticism. The snap of a ligament and gasps of concerned fans are no longer the requiem for an athletics career.

After they’re stitched – sometimes stapled – together, student-athletes will spend many waking hours in forgotten training rooms where torment and tedium collide. As the graft and the screws settle into tunnels burrowed inside bone, they’ll rehabilitate shriveled muscles, performing endless repetitions of exercises that evoke a startling, unfamiliar brand of pain. They’ll watch the teammates they’ve sweated and bled with go to battle without them. They’ll miss classes in the mostly bedridden week that follows surgery. They’ll tackle homework with minds smothered by pain medication.

And when they’re cleared to play again? Most endure a yearlong battle with themselves, learning once again to trust the joint that’s caused so much strife.

“This is harder than anything you’ll do on the court,” says Oklahoma State basketball athletic trainer Jason Miller. “This is the hardest thing to get through. It’s painful. It hurts. It’s time consuming.”

Champion Magazine

By Brian Burnsed

And student-athletes will navigate the other parts of their lives, the parts not devoted to or defined by basketball or soccer or football, on crutches. Tasks once taken for granted – sleeping comfortably, getting off a toilet, opening a door, maneuvering into a car or comically small college desk, getting a meal in a cafeteria, or carrying a textbook-laden backpack across campus – become monumental obstacles. And stairs sap time and energy, evoking dread and sweat. They’re to be avoided. Except, in college, they seem to be unavoidable; Olukemi lives on the third floor.

“Stairs were the hardest part after surgery,” Olukemi says, more than three weeks into rehab. “They still are.”

– See more at: http://www.ncaa.org/wps/wcm/connect/public/ncaa/Champion+Features/obstacle+course#sthash.G9jm7nPW.V37R3uhA.dpuf

Injuries In Lacrosse: “Should Helmets Be Required In Women’s Lacrosse”, A Chicago Tribune Video Interview Of An Illinois High School Girls Lacrosse Player Who Suffered Four Concussions

Chicago Tribune reporter John Keilman interviews Sara Letmanski, a Glenbard West senior who has suffered four concussions as a result of playing lacrosse.

Lacrosse Injuries: Lake Brantley Girls Lacrosse Team (FL) Reports That Fifteen Players Suffered Concussions During 2013 Season (Video)

Male athletes and concussions, especially on the football field, have been the focus of significant research, but local experts said female athletes are now suffering more and more concussions.

Concussions In Lacrosse: “Impact Indicator” Microsensor Technology Imbedded In Helmet Chinstrap Monitors “Force And Duration” Of Hits To Determine Likelihood Of Head Injuries (Video)

The Impact Indicator is microsensor technology and intelligent software embedded in a chinstrap. The Indicator measures the force and duration of a hit, and instantly signals a level of any hit over 240 HIC’s (Head Injury Criterion) by illuminating a red LED light on the front of the Indicator, easily visible by coaches, trainers, officials, and other players. The Head Injury Criterion (HIC) is a measure of the likelihood of head injury arising from an impact. It is the same criterion used in Automobile Safety Testing and by the U.S. Military. The Head Injury Criterion was established by the Bioengineering Center at Wayne State University in Detroit, Michigan, the same bioengineering program behind ESPN’s Sports Science.

The Impact Indicator is…

• Sophisticated microsensor and intelligent software technology
• Tested to the highest standards in leading sports laboratories
• Calculated to the industry’s most accepted standard of impact
• A reliable way to monitor every hit in every game and every practice
• Invaluable in a day of shrinking trainer and coaching staffs
• Comfortable to wear and easy to use

The Impact Indicator is not…

• A monitor for anything but possible head injuries
• A medical device that diagnoses concussions
• A substitute for qualified medical evaluation
• Protection against the possibility of concussion

For more information on The Impact Indicator, please visit http://www.battlesportsscience.com

Lacrosse Injuries: Concussions Can Be “Reduced, Not Eliminated” By Improvements In Helmet Technology According To Recent Studies

“..Since a perfect helmet has not been designed, tested or manufactured, Mihalik said helmets should be judged by the following criteria: They should fit properly. They should weigh as little as possible. And they should be small, comfortable, economical as well as “look good,..”

“behavior modification” such as discouraging players from “leading with the head” when tackling in football could do as much as improved helmet design to avert concussions…”

Improved helmet design has helped reduce concussions in impact sports such as football and hockey, but it may be impossible to design a helmet that completely eliminates them, according to a panel of sports science professors outlining the latest findings.

Helmets “certainly help to mitigate forces that are distributed by impact to the skull and the intracranial cavity and the brain,” said Kevin Guskiewicz, a professor of sports science at North Carolina and an expert on football helmets. “But the brain is still going to move inside that cranial cavity regardless of whether there’s a helmet on or not.”

With improved soft materials inside its hard outer shell, a modern helmet can lessen the effect of a straight-ahead, “linear” impact, but can’t do much to prevent the effects of the head rotating from the impact, Guskiewicz said Monday at the National Athletic Trainers’ Association convention.

 For more: http://www.forbes.com/feeds/ap/2011/06/21/business-financial-impact-concussions-trainers_8527014.html

Sports Safety Legislation: National Athletic Trainers Association (NATA) Reports That Only Five States Have Enacted “Youth Sports Injuries” Laws As States Face Budget Issues

Despite widespread awareness of an upward trend in catastrophic and sometimes fatal injuries to young athletes, legislative action has been slow to follow.

“What makes this even more concerning is that state budgets are in crisis, so legislators are cutting programs that keep kids safe. In many cases athletic trainer positions are at risk of being terminated — eliminating the very people who protect and provide medical services to physically active children.”

This according to the National Athletic Trainers’ Association, which points out that although at least 75 bills in 32 states and the District of Columbia related to youth sports injuries have been introduced this year, only five have been signed into law.

“It is disappointing that so much legislation been introduced, yet so little has been passed,” NATA president Marjorie J. Albohm, MS said in a recent press release urging legislators to take action.

Citing sudden cardiac arrest, heat illness and concussions as three of the most pressing and dangerous types of injuries sustained, NATA cites data showing that 50 injuries proved fatal to young athletes last year, while four deaths have already been reported in 2011. According to the Centers for Disease Control and Prevention, high school athletes account for 2 million injuries, 500,000 doctor visits, and 30,000 hospitalizations each year.

“With young athletes participating in year-round play both at school and on youth league and travel teams, it is critical for coaches, parents, athletic trainers, administrators, and others to ensure the safety of student athletes, yet only 42 percent of high schools have access to athletic training services,” said Albohm. “The continued enactment of legislation will help keep our young athletes safe.”

A review of the 75 youth sports safety bills that have been introduced to state legislatures this year shows that the overwhelming majority (53) are addressing concussions or brain injury. Sudden cardiac arrest and mandatory AEDs represent the second and third most popular subjects of legislation, respectively, followed by bills that would mandate schools having access to athletic trainers. Individual state legislatures are also addressing bills related to cheerleading (Mass.) and steroids (N.Y.). Of the five bills that have been enacted, four are related to concussion awareness, prevention and treatment (South Dakota, Utah, Wyoming and Colorado), while Resolution 75 in New Jersey encourages school districts to improve staff and student preparedness for incidents of sudden cardiac arrest.

While a small handful of bills have either been voted down or withdrawn, most of them are now in the hands of legislative subcommittees, where NATA — with a vested interest in promoting the athletic training profession — fears they will languish, especially as most legislative sessions have already expired or are soon to.

For more:  http://athleticbusiness.com/editors/blog/default.aspx?id=479

Concussions In Lacrosse: NFL Introduces New “Concussion-Assessment” Protocol Utilizing A Standard Assessment, Neurological Examination And Balance Assessment, All Performed Off The Field

The NFL’s head, neck and spine committee introduced a new concussion-assessment protocol where team medical personnel will have the option to:
  • Use a new standardized assessment that combines a symptom checklist

  • Perforn a limited neurological examination that includes a cognitive evaluation

  • Do a balance assessment.

“This is a guideline and not a mandate,” said Margot Putukian, a doctor and member of the committee and chair of the return-to-play subcommittee.
Teams will be advised to do the assessment in the locker room and not along the sidelines during a game. The committee received input from the NFLPA and the union’s medical advisors.
“I love what we are doing with the league,” Falcons general manager Thomas Dimitroff said. “It’s about the safety of the players. We still have a fantastic product. It continues to be a very aggressive product.”
The league can’t unilaterally impose the guidelines.
“It takes a little bit of the gray area out of it in my mind,” Dimitroff said. “It makes sure that we have some checks and balances. I think it’s positive for both sides.”
The league has recognized the danger of players with concussions returning to action too soon and possibly risking additional brain damage.The NFL’s head, neck and spine committee introduced a new concussion-assessment protocol Friday.
“This is a guideline and not a mandate,” said Margot Putukian, a doctor and member of the committee and chair of the return-to-play subcommittee.
Under the new protocol, team medical personnel will have the option to use a new standardized assessment that combines a symptom checklist, a limited neurological examination that includes a cognitive evaluation, and a balance assessment.
Teams will be advised to do the assessment in the locker room and not along the sidelines during a game. The committee received input from the NFLPA and the union’s medical advisors.
“I love what we are doing with the league,” Falcons general manager Thomas Dimitroff said. “It’s about the safety of the players. We still have a fantastic product. It continues to be a very aggressive product.”
The league can’t unilaterally impose the guidelines.
“It takes a little bit of the gray area out of it in my mind,” Dimitroff said. “It makes sure that we have some checks and balances. I think it’s positive for both sides.”
The league has recognized the danger of players with concussions returning to action too soon and possibly risking additional brain damage.
For more:  http://athleticbusiness.com/articles/lexisnexis.aspx?lnarticleid=1368310672&lntopicid=136030023

Injuries In Lacrosse: Report Finds Concussions In High School Boys And Girls Sports Have Increased Four-Fold In Past Ten Years

Football took the prize as the riskiest sport, with a rate of about six concussions per 10,000. Boys’ lacrosse and soccer came next. For girls, concussions were most common during soccer at three and a half per 10,000, followed by lacrosse and basketball.

“The risk there is second impact syndrome, which essentially means that the brain is still recovering from trauma from the first concussion, and it sustains a second impact,”

In 2008, there were about five concussions for every 10,000 times kids who got on the playing field. This compares to slightly more than one per 10,000 in 1997, researchers write in the American Journal of Sports Medicine.

Exactly what has driven the number up isn’t clear, but it’s likely to be a combination of things, said study author Andrew Lincoln, who heads the Sports Medicine Research Center at Union Memorial Hospital in Baltimore, Maryland.

“Certainly the recognition of signs and symptoms of concussion have increased dramatically among the players, coaches, athletic trainers and physicians,” he told Reuters Health. “Also, there’s the issue of players performing better, getting stronger and getting faster.”

The researchers recorded the number of concussions at 25 public schools from 1997 to 2008, in six different sports each for girls and boys.

Over the entire period, the chance that boys playing any sport would get a concussion was three in 10,000, compared to one in 10,000 for girls.

However, when boys and girls played similar sports, girls were about twice as likely as boys to get a concussion. The same has been found in college athletes, but no one knows for sure why.

“We know that in general, females are more likely to seek medical care than males are,” Lincoln said, which might explain part of the difference. Girls’ bodies may also be less adept at absorbing a hit, but this is very speculative, he told Reuters Health.

Of the 2650 concussions recorded in the new study, most were one-time occurrences. However, about 290 students suffered two concussions, and 26 had three or more.

It’s extremely concerning to see multiple concussions in high school kids, Weibe said.

For more: http://www.reuters.com/article/2011/02/25/us-concussions-high-school-idUSTRE71O6O620110225?pageNumber=1