The epidemiology of boys’ youth lacrosse injuries in the 2015 season

Youth lacrosse is one of the fastest growing sports in the US (US Lacrosse “Participation…” 2015) Research in youth lacrosse is limited, yet necessary, to drive the development of interventions to reduce injury incidence and severity. Our study utilizes a large sample of boys’ youth lacrosse players across eight leagues in four states, and estimated an injury rate higher than that previously reported (12.98 vs. 8.7/1000AE) (Lincoln et al. 2014). However, our study included an additional younger division (U9). Lincoln et al. (2014) noted that the highest injury rate was found in the younger division (U11). In our study, the overall-injury rate in the U9/U11 divisions was higher than that of the U13/U15 divisions (15.09 vs. 12.21/1000AE). In contrast, the TL-injury rate in the U13/U15 divisions was higher than that of the U9/U11 divisions (2.51 vs. 0.94/1000AE). This is expected since upper youth divisions, according to US Lacrosse rules, allow for more bodily contact (US Lacrosse “2015 rules…” 2015).

TL-injury rates (game?=?2.94/1000AE; practice?=?1.65/1000AE) utilized an injury definition consistent with previous research (Dick et al. 2007; Xiang et al. 2014), and were found to be lower than those in college (game?=?12.58/1000AE; practice?=?3.24/1000AE) (Dick et al. 2007). Youth injury rates were similar to high school rates (game?=?3.61/1000AE; practice?=?1.51/1000AE) (Xiang et al. 2014), particularly within the U13/U15 divisions. The similar findings may be due to US Lacrosse rules allowing more bodily contact in upper divisions (US Lacrosse “2015 rules…” 2015). However, unlike high school and college, where most injuries were due to player contact and non-contact (Dick et al. 2007; Xiang et al. 2014), the largest proportion of youth lacrosse injuries were due to equipment contact, with over a third from stick contact. Potential injury mechanism differences may highlight the overall lower skill level of youth lacrosse compared with high school and college levels. Given our data originating from only one season, continued surveillance is required to obtain more precise estimates of potential variations by division within youth lacrosse and across competition levels.

The proportion of boys’ youth lacrosse injuries due to checking were low. The 2015 US Lacrosse Boys Youth Rules prohibit body checking in the U9/U11 divisions, and allow for limited body checking in the U13/U15 divisions (US Lacrosse “2015 rules…” 2015). Further efforts to ensure proper development of stick and body checking skills through coaching education and rules enforcement are warranted in throughout all divisions.

As in previous youth lacrosse research (Lincoln et al. 2014), most injuries were minor and diagnosed as contusions. Findings may vary from those at the high school and college levels (Dick et al. 2007; Xiang et al. 2014), where most injuries were sprains and concussions, due to our injury definition including NTL injuries (Kerr et al. 2015). Nevertheless, ten concussions were reported, with most occurring in competitions and from player contact. This is similar to recent research that analyzed video footage in high school boys’ lacrosse, finding that all 34 concussions captured were due to player contact (Lincoln et al. 2013). More definitive information on player and opponent activity would be useful to determine whether concussed players (or those that experience another injury) were defenseless. Previous research identified nearly half of all concussions in high school lacrosse to be associated with defenseless hits (Lincoln et al., 2013). If the trend holds at the youth level, efforts to enforce existing rules to limit defenseless hits may be warranted.

Although our sample originates from eight leagues in four states, findings were based on a small proportion of boys’ youth lacrosse players estimated in the United States and one season (US Lacrosse “Participation…” 2015). Our findings may not be generalizable to other youth lacrosse players. Under-diagnosis and/or underreporting of injuries may have occurred if youth players opted not to seek on-site care, or experienced delayed onset of symptoms after leaving the youth lacrosse setting. However, ATs are experienced professionals trained to accurately detect injury. Lastly, team- and league-based variations, such as coaching experience and certification (US Lacrosse “Certification…” 2015), the rate of participation growth (US Lacrosse “Participation…” 2015), skill level, and the numbers of games and practices across a season were not accounted for in the study, yet should be in future research.

Our boys’ youth lacrosse injury rate was higher than those previously reported. However, this estimate may be more precise given the larger sample. Continued surveillance across multiple seasons while accounting for coach-, team-, league-, and location-based variations will provide additional information regarding the epidemiology of youth lacrosse injuries. In addition, interventions may be warranted to reduce injury incidence. This can include adoption of age-appropriate rules to reduce exposure to player contact, enforcement of rules limiting defenseless hits, and ensuring proper development of checking skills through coaching education.