Helmets needed for female lacrosse players

On April 8, the sports section in my local N.J. paper showed a picture of three female lacrosse players with their sticks up high in the air all reaching for a flying ball. Male players wear a full helmet and face mask, but these players wore only goggles and mouth guards. As a pediatrician who has had a lot of experience in treating head injuries in high school and college athletes, my question is this: Why we don’t protect the girls as well as the boys?

Yes, it is true the boys’ game is more aggressive, but anyone who knows these athletes realizes there is not much difference between them in their enthusiasm and commitment to win. The excuse put forth by U.S. Lacrosse is that if helmets are required the game will become more aggressive. That is not only a sexist viewpoint, it is like saying our children will ride their bikes in a safer way if we don’t have them wear bike helmets. I have seen many lacrosse injuries from not only sticks to the head, but impacts of the ball, too. It is a significant source of morbidity to female athletes.

In 2007, Randall Dick and associates, reviewing 16 years of NCAA injury data, found that 56% of above-the-neck injuries in women’s lacrosse resulted from contact with a stick and 20% from contact with a ball (J. Athl. Train. 2007;42:173-82). A 3-year prospective study by Dr. Richard Y. Hinton and his associates found that female players had higher rates of overall head injuries than their male counterparts, mostly involving contact with sticks and balls (Am. J. Sports Med. 2005;33:1305-14).

In 2001, a 10-year analysis of the National Electronic Injury Surveillance System by P.T. Diamond and S.D. Gale showed that the head and face were the most common areas injured, being significantly more prevalent in females (30%) than males (18%) (Brain. Inj. 2001;15:537-44). Their recommendation: “Women and children lacrosse players are at risk of serious injury to the head and face region. The use of protective head/face gear should be encouraged.”

Perhaps the most compelling study, by Andrew E. Lincoln, Sc.D., and associates, found that high school girls’ head, face, and eye injuries (0.54/1,000 athletic exposures) were significantly higher than for boys (0.38/1,000), and while concussions were higher in boys, girls sustained significantly more facial injuries, primarily resulting from stick or ball contact (Am. J. Sports Med. 2007;35:207-15).

In the early sixties, hockey players wore no helmets and goalies no masks. It does not seem that the addition of these pieces of safety equipment has ruined the game at all. Even though there is no checking in the girls’ lacrosse games, this does not prevent the inevitable accidents that occur in any sporting event. The above referenced articles support this. Many of these injuries are not only game injuries, but may carry lifelong consequences. Although the situation in professional sports is well known, my colleagues and I are seeing an increasing number of head injuries in all amateur sports, with women’s lacrosse making up a significant proportion of these incidents. When the governing bodies will not act, those of us who care for these athletes must speak up. Isn’t it time we protect the girls as well as the boys?

Patrick A. Caruso, M.D.

clinical associate professor of pediatrics

Mount Sinai School of Medicine

Morristown, N.J.

On April 8, the sports section in my local N.J. paper showed a picture of three female lacrosse players with their sticks up high in the air all reaching for a flying ball. Male players wear a full helmet and face mask, but these players wore only goggles and mouth guards. As a pediatrician who has had a lot of experience in treating head injuries in high school and college athletes, my question is this: Why we don’t protect the girls as well as the boys?

Yes, it is true the boys’ game is more aggressive, but anyone who knows these athletes realizes there is not much difference between them in their enthusiasm and commitment to win. The excuse put forth by U.S. Lacrosse is that if helmets are required the game will become more aggressive. That is not only a sexist viewpoint, it is like saying our children will ride their bikes in a safer way if we don’t have them wear bike helmets. I have seen many lacrosse injuries from not only sticks to the head, but impacts of the ball, too. It is a significant source of morbidity to female athletes.

In 2007, Randall Dick and associates, reviewing 16 years of NCAA injury data, found that 56% of above-the-neck injuries in women’s lacrosse resulted from contact with a stick and 20% from contact with a ball (J. Athl. Train. 2007;42:173-82). A 3-year prospective study by Dr. Richard Y. Hinton and his associates found that female players had higher rates of overall head injuries than their male counterparts, mostly involving contact with sticks and balls (Am. J. Sports Med. 2005;33:1305-14).

In 2001, a 10-year analysis of the National Electronic Injury Surveillance System by P.T. Diamond and S.D. Gale showed that the head and face were the most common areas injured, being significantly more prevalent in females (30%) than males (18%) (Brain. Inj. 2001;15:537-44). Their recommendation: “Women and children lacrosse players are at risk of serious injury to the head and face region. The use of protective head/face gear should be encouraged.”

Perhaps the most compelling study, by Andrew E. Lincoln, Sc.D., and associates, found that high school girls’ head, face, and eye injuries (0.54/1,000 athletic exposures) were significantly higher than for boys (0.38/1,000), and while concussions were higher in boys, girls sustained significantly more facial injuries, primarily resulting from stick or ball contact (Am. J. Sports Med. 2007;35:207-15).

In the early sixties, hockey players wore no helmets and goalies no masks. It does not seem that the addition of these pieces of safety equipment has ruined the game at all. Even though there is no checking in the girls’ lacrosse games, this does not prevent the inevitable accidents that occur in any sporting event. The above referenced articles support this. Many of these injuries are not only game injuries, but may carry lifelong consequences. Although the situation in professional sports is well known, my colleagues and I are seeing an increasing number of head injuries in all amateur sports, with women’s lacrosse making up a significant proportion of these incidents. When the governing bodies will not act, those of us who care for these athletes must speak up. Isn’t it time we protect the girls as well as the boys?

Patrick A. Caruso, M.D.

clinical associate professor of pediatrics

Mount Sinai School of Medicine

Morristown, N.J.

On April 8, the sports section in my local N.J. paper showed a picture of three female lacrosse players with their sticks up high in the air all reaching for a flying ball. Male players wear a full helmet and face mask, but these players wore only goggles and mouth guards. As a pediatrician who has had a lot of experience in treating head injuries in high school and college athletes, my question is this: Why we don’t protect the girls as well as the boys?

Yes, it is true the boys’ game is more aggressive, but anyone who knows these athletes realizes there is not much difference between them in their enthusiasm and commitment to win. The excuse put forth by U.S. Lacrosse is that if helmets are required the game will become more aggressive. That is not only a sexist viewpoint, it is like saying our children will ride their bikes in a safer way if we don’t have them wear bike helmets. I have seen many lacrosse injuries from not only sticks to the head, but impacts of the ball, too. It is a significant source of morbidity to female athletes.

In 2007, Randall Dick and associates, reviewing 16 years of NCAA injury data, found that 56% of above-the-neck injuries in women’s lacrosse resulted from contact with a stick and 20% from contact with a ball (J. Athl. Train. 2007;42:173-82). A 3-year prospective study by Dr. Richard Y. Hinton and his associates found that female players had higher rates of overall head injuries than their male counterparts, mostly involving contact with sticks and balls (Am. J. Sports Med. 2005;33:1305-14).

In 2001, a 10-year analysis of the National Electronic Injury Surveillance System by P.T. Diamond and S.D. Gale showed that the head and face were the most common areas injured, being significantly more prevalent in females (30%) than males (18%) (Brain. Inj. 2001;15:537-44). Their recommendation: “Women and children lacrosse players are at risk of serious injury to the head and face region. The use of protective head/face gear should be encouraged.”

Perhaps the most compelling study, by Andrew E. Lincoln, Sc.D., and associates, found that high school girls’ head, face, and eye injuries (0.54/1,000 athletic exposures) were significantly higher than for boys (0.38/1,000), and while concussions were higher in boys, girls sustained significantly more facial injuries, primarily resulting from stick or ball contact (Am. J. Sports Med. 2007;35:207-15).

In the early sixties, hockey players wore no helmets and goalies no masks. It does not seem that the addition of these pieces of safety equipment has ruined the game at all. Even though there is no checking in the girls’ lacrosse games, this does not prevent the inevitable accidents that occur in any sporting event. The above referenced articles support this. Many of these injuries are not only game injuries, but may carry lifelong consequences. Although the situation in professional sports is well known, my colleagues and I are seeing an increasing number of head injuries in all amateur sports, with women’s lacrosse making up a significant proportion of these incidents. When the governing bodies will not act, those of us who care for these athletes must speak up. Isn’t it time we protect the girls as well as the boys?

Patrick A. Caruso, M.D.

clinical associate professor of pediatrics

Mount Sinai School of Medicine

Morristown, N.J.