Resources, facts, and tools to help lacrosse parents deal with concussions.
Lacrosse’s popularity among boys and girls is increasing. And is it any wonder? Luke Hansen, Summit High School Boys Varsity Lacrosse coach, describes lacrosse as,
A combination of many sports; lacrosse requires the coordination and toughness of hockey, the strategy and free play of soccer, the fine athleticism and technique of basketball, and the raw power of football. There is an art to lacrosse in that no one handles the stick in the same way and, in a way, every player’s personality comes through in their stick skills.” 
Lacrosse is fast-paced, fun and provides opportunities for scholarships at the collegiate level. With more families getting involved in lacrosse youth leagues, there’s an increased need for parents to become educated about the kinds of lacrosse-specific injuries their kids might encounter.
Youth lacrosse players are approximately twice as likely as their college or adult lacrosse player counterparts to get injured. They’re also twice as likely as older players to get concussions. While older athletes tend to suffer chronic and acute injuries, half of all injuries suffered by younger players — who are still working on how to handle that stick and ball — are due to contact with equipment. 
While the most common injury is a blow to the head from a stick, ankle sprains account for 21% of all injuries for girls, and 16% for boys. Since suffering a jolt from a fall can also cause concussions, athletes who sprain their ankles or hit the ground hard may also be at risk for a possible concussion. 
Symptoms of concussion can include the following:
- Loss of consciousness (even briefly)
- Memory loss
- Dizziness or balance problems
- Nausea or vomiting
If your child is playing the challenging and exciting game that is youth lacrosse, here’s a heads’ up about everything you need to know about concussion prevention and management for youth lacrosse players.
Concussion Prevention in Youth Lacrosse
It’s a moment every parent would rather avoid — seeing a player go down on the field and then realizing, “Oh! THAT’S MY KID!!” While you can’t turn back the clock, you can take steps to prevent your child from getting injured in the first place. Prevention, as they say, is better than cure! And when it comes to preventing concussions, here at HeadCheck we’ve got your 6.
Parents should be familiar with differences in the rules and equipment between girls and boys lacrosse. For girls, intentional body-to-body contact is illegal, and stick checking must be directed away from the head toward the pocketed end of the stick only. Make sure kids are following the rules, and officials are enforcing them! Girls wear mandatory protective goggles and mouthpieces, and optional lightweight gloves and soft headgear. Boys lacrosse is higher contact, mandating the use of helmets with full face guards, shoulder pads, padded gloves, and mouthpieces and suggested use of elbow pads and protective genital cups. Equipment must be properly fitted and in good condition.
While it’s tempting to think that concussion prevention just comes down to having the right helmet, US Lacrosse observes that “contrary to popular belief, no helmet in any sport can prevent a concussion.”  Helmets aren’t designed to prevent concussions. Rather, they’re designed to reduce severe brain injury and prevent skull fracture.  It’s important to educate players about what helmets are designed to do — and not do!
While efforts are underway to develop concussion-reducing helmets, in the meantime you can ensure that your child’s helmet fits properly. Also, a study on custom-made, properly fitting mouthguards (as opposed to over-the-counter mouthguards) found that high school football players were less than “twice as likely to suffer mild traumatic brain injuries/concussions than those wearing custom-made, properly fitted mouthguards”. 
Interesting research is being conducted to assess whether “proactive strengthening of players’ upper back and neck muscles to decrease the chances of rotational head acceleration during a collision. Coaches may also train their team to anticipate collisions and falls properly.” 
And since stick injuries are so common amongst youth lacrosse players, stick handling should comprise a significant portion of practice time.
Becoming knowledgeable about concussions is the best safeguard you can take to ensure their prevention. Young athletes should be trained to recognize concussion symptoms such as:
dizziness, sluggishness, loss of memory, difficulty concentrating, sensitivity to light and sound, head pressure, headaches, nausea and vomiting, moodiness, disorientation, and difficulty balancing.
Coaches, peers, and parents must vigilantly assess the injured athlete for observable symptoms such as:
loss of consciousness, uncertainty about the game or position, forgetfulness, clumsiness, changes in mood or personality, slower speech, or the appearance of being stunned.
Prevention of Second-Impact Syndrome and Post-Concussion Syndrome
If a concussion has occurred, parents and players need to become educated for the prevention of Second-Impact Syndrome (SIS, when two concussions occur in a relatively short period of time) and Post-Concussion Syndrome (PCS, when symptoms last beyond the expected period of recovery). Programs such as ImPACT (Immediate Post-Concussion and Cognitive Testing) can be used to carefully monitor individuals recovering from a concussion.
HeadCheck Health’s concussion management software is designed to cover all aspects of concussion management, integrating diagnosis, recovery, and return-to-play, and coordinating players, coaches, parents, trainers, and medical professionals. Concussions are complex injuries, and it’s important that no detail falls through the cracks. Integrative management software reduces the chance that symptoms get overlooked, or that athletes return to play before they are fully recovered. Proactive concussion management that follows current regulations and protocols can help prevent SIS and PCS.
Youth Lacrosse Concussion Rates, Regulations and Protocols
How frequently do lacrosse players suffer concussions? And what are the lacrosse regulations and protocols for managing concussions?
Concussions are among the 5 most frequent injuries for boys and girls in high school lacrosse. Boy’s lacrosse has the third-highest rate of concussions (0.42 per 1000 athletic exposures), next to ice hockey (0.46 per 1000 athletic exposures) and football (0.91 per 1000 athletic exposures). Girl’s lacrosse has the second-highest rate (0.38 per 1000 athletic exposures), next to soccer (0.67 per 1000 athletic exposures).
US Lacrosse and Lacrosse Canada have developed guidelines for teams, clubs, and leagues to help them form a Concussion Management Plan (CMP). The Guidelines outline how to recognize concussion signs and symptoms, the initial actions that should be taken, the return to play protocols, and the reporting responsibilities to the governing sports association. Parents and players should be familiar with their association’s guidelines and educational materials, as well as any provincial or state guidelines. Organizations under US Lacrosse are awarded Gold Stick designation for having a CMP in place.
All CMPs would require “an athlete who exhibits signs, symptoms or behaviors suggestive of a concussion” to be “removed from practice or competition and not returned to play until evaluated by a health care professional with experience in the evaluation and management of concussions.” If an athlete is diagnosed with a concussion, they must not return to play that day. Medical/healthcare professionals should supervise concussion management and return to both academic/work and practice/play after a concussion. 
Physical and cognitive rest after a concussion is recommended for the first 24-48 hours. Apart from that, return to play is an individualized plan incorporating the athlete’s medical history related to the specific injury and taking into account the athlete’s changing condition as he or she progresses through the plan. The International Concussion in Sport (CISG) group recommends the following return-to-sport (RTS) general strategy:
- Symptom-limited activity
- Light aerobic exercise
- Sport-specific exercise
- Non-contact training drills
- Full contact practice
- Return to sport
Healthcare providers should provide written documentation for the RTS progression, which should be maintained by the league administrator or designated athlete safety coordinator. 
Concussions usually resolve within one to six weeks without medical treatment. But since all athletes suspected of concussion must be assessed by a medical professional, parents should expect and cultivate a team approach to managing their child’s concussion. Everyone from athletic trainers and coaches to school health officials, to physicians, psychiatrists, and physical therapists should be enlisted to appropriately manage diagnosis, treatment, and return to play.
Pediatricians can specialize in concussion treatment. Physicians who specialize in concussion treatment are neurologists and neuropsychologists. A concussion clinic can provide an integrative approach, looking at the health of the entire body to ensure treatment is effective and lasting. Physical therapists can help address dizziness and balance problems with special treatments or specific exercises, while functional medicine practitioners can provide holistic care that takes into account the connection between body, mind, and spirit, and the brain and the gut. Parents should know that diet, sleep and exercise are important factors in concussion recovery. Fascinating research into the role gut bacteria plays in repairing brain injuries is currently being conducted.
Concussions are complex injuries, but great strides are being made to get past the days where players who received a blow to the head were expected to keep quiet and stay in the game. Strategies and protocols are becoming increasingly evidence-based, new research is leading to better health outcomes, and technology is emerging to increase player safety and coordinate concussion management care — simplifying the process for all involved.
Here’s a helpful list of further resources to help parents become proactive in the safety of their young lacrosse players.
Tools and Resources
Review of advice for return-to-play from medical professionals by HeadCheck Health
HeadCheck Manager for helping coaches and teams without medical personnel follow their concussion policy.
HeadCheck Pro for leagues and teams with medical personnel to execute their concussion protocol.
 https://www.thecenteroregon.com/medical-blog/lacrosse-gains-popularity-bend/ (italics added).