Concussions have long been an unwelcome byproduct of sports.
And while more attention has been paid in recent years to preventing the mild brain injuries among professional and school-age players, much of the focus, as well as the studies, have been limited to the high-profile and prime-offending game of football.
Officials at US Lacrosse, the sport's governing body, said they also need to step up efforts to learn how players get hurt and how to minimize risks. One recently released study has helped the group understand the frequency of injury and differences between males and females.
The results form the basis for further research that could eventually lead to changes in equipment or rules for one of the most popular sports in Maryland and one of the fastest-growing sports in the country. About a half-million play organized lacrosse.
"Lacrosse is growing so fast, and we really need to play catch-up," said Steve Stenersen, executive director of Baltimore-based US Lacrosse. "We want to maintain the integrity of the sport and improve the safety of the sport."
The U.S. Centers for Disease Control and Prevention defines a concussion as a mild traumatic brain injury resulting from a jolt to the head that causes the organ to move rapidly inside the skull.
Impacts can be short-lived or long-term, and symptoms can surface immediately or days later. At first, they can include sensitivity to light and noise, headaches and memory loss. Delayed symptoms include fatigue, confusion, mood changes and depression.
The CDC estimates that there are between 1.6 million and 3.8 million sport-related concussions a year. More than half of the concussions among high school athletes are caused by football.
And while Stenersen said there is much to be gained from football studies, officials want to better understand lacrosse-related concussions. The group formed the Sports Science and Safety Committee and partnered with MedStar Research Institute.
A study published last year in the American Journal of Sports Medicine and just released revealed that concussions were the most common type of head, face and eye injury for both male and female lacrosse players in high school and college.
Male high school and college players suffered more concussions than their female counterparts, although females had more head, face and eye injuries in general. That may be because men wear helmets with face masks, but women do not and only began wearing goggles in 2004, after data was collected for the study. Also, males were more likely to sustain an injury from player-to-player contact, and females were hurt more often from contact with a stick or a ball.
Andrew Lincoln, director of orthopedic and sports health research for MedStar and the study's lead author, said concussions are tough to study because they are broadly defined and not easy to diagnose.
Symptoms can take a while to surface, and players might deny they are hurt to stay in the game. Athletic trainers can recognize symptoms, but not all schools have one. That leaves coaches and other players to spot a problem.
Many pro and amateur players take computerized tests to establish a baseline of their cognitive abilities before the season starts; after an injury, a second test shows a loss of abilities. The test is mandatory in the National Football League, but too expensive for many colleges and schools.
Lincoln said more studies are planned. One will study the effectiveness of the goggle rule for females.
On Feb. 13, US Lacrosse also said it and MedStar were awarded a $328,000 grant from the National Operating Committee on Standards for Athletic Equipment to study boys' and girls' high school lacrosse for situations that might result in concussions. Research will incorporate computerized video analysis of 800 games played in the Fairfax County, Va., school system this year and next.
"Our whole purpose is to inform the lacrosse community about risks and to offer data for intervention," Lincoln said.
The field is waiting, said Andrew Tucker, medical director at the Union Memorial Sports Medicine at Union Memorial Hospital and physician for the Ravens and the University of Maryland, Baltimore County lacrosse team.
Most of the college and professional athletes he sees have been playing for most of their lives, and at least one or two per team usually have had one or more concussions. But, he said, research has lead to changes.
For example, in the past few years, research based on pro football has led helmet manufacturers to adjust padding and face guards. Another change to game rules has helped protect the vulnerable quarterbacks.
Lacrosse officials are trying to determine if there is a better way to protect athletes' chests after a handful died over several years from shots to the heart, though more baseball than lacrosse players have suffered from the resulting commotio cordis, a disruption to the heart's activity.
Officials knew of no deaths among lacrosse players from concussions, but just ahead of this year's season, the governing group issued tips for parents on how to buy a properly fitting helmet.
Still, lacrosse is a "collision" sport, said UMBC coach Don Zimmerman.
In fact, one of his players recently suffered a concussion during practice; it was the team's second player to have one in the past several years. He and another player went for a ball and knocked helmets. The trainer ran onto on the field, and then he was taken to the hospital. He had been going to class and practice, but the trainer hadn't cleared him for the season opener last weekend. However, Zimmerman said he is showing steady improvement.
And Zimmerman's own son, a player at Boys' Latin, also suffered a blow to the head recently. He was able to walk off the field but told his father and the trainer he didn't feel right, so they took him to the hospital, where he spent the night for observation.
Zimmerman said he always ensures his players wear their equipment properly, evaluates all his drills to make sure players aren't unnecessarily in harm's way and forbids "head hunting" or purposefully going after opponents. Furthermore, UMBC has a trainer at every practice and a doctor at every game.
"But even within the rules, kids are going to get hurt because it's a rugged game," Zimmerman said. "There are still far more shoulder and knee injuries. But when [concussions] happen, it's a scary thing."
All this attention has already helped injured players because they've learned that delaying treatment or returning to play with a concussion can further harm them, said Gerard Gioia, director of the Safe Concussion Outcome, Recovery and Education Program at Children's Hospital in Washington.
He is still looking forward to more prevention.
"Lacrosse is a wonderful sport and a safe sport, but we need to think about how to reduce the risks even more," said Gioia, who was not involved in the US Lacrosse study. "The big benefit from this is what they can teach coaches, trainers and players."
meredith.cohn@baltsun.com
Study's Findings
High school girls' head, face and eye injury rate (0.54 per 1,000 athletic exposures) was significantly higher than that for high school boys (0.38 per 1,000 athletic exposures).
College women sustained a higher rate of injuries (0.77 per 1,000 athletic exposures) than college men (0.44 per 1,000 athletic exposures).
Concussions constituted a higher percentage of injuries among high school boys (73 percent) and college men (85 percent) than among high school girls (40 percent) and college women (41 percent).
Men sustained few facial injuries, whereas a significant proportion of women's injuries involved the face and orbital area.
[Source: MedStar Research Institute]
Buying a lacrosse helmet
Make sure it's approved by the National Operating Committee on Standards for Athletic Equipment, which tests equipment and sets standards.
Check the manufacturers' charts for the proper size for the player's head. Helmets are measured in inches.
A helmet should sit squarely on the head, with the front of the helmet about a finger width above the eyebrows to protect the forehead.
Helmet padding should offer firm and uniform pressure around the head. Forehead skin should move when the helmet moves.
Look for a four-point chinstrap on the helmet, which can be tightened so there is no slack.
Consider the player's locks at game time. After a significant haircut, the helmet must be refitted.
Proper helmet fit should never cause headaches.
Replace a helmet's screws and T-nuts at the beginning of each season.
The facemask should attach cleanly to the helmet and should be replaced when bent.
Review a specific manufacturer's recommendations for proper helmet fitting on its Web site or in the store.
[Source: US Lacrosse Sports Science and Safety Committee]