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New Study Examines Head Injuries in Girls’ Lacrosse Using Video Analysis

February 20, 2012

Media Contact: Catherine Probst, 703-993-8813,

Shane Caswell

Fairfax, Va. – This spring, girls’ lacrosse players across the country will take to the field in what some have called “the fastest sport on two feet.” To help keep these players safe from injury, Mason researcher Shane Caswell embarked on a new study that used video analysis to take a closer look at the common interactions of the game that lead to head injuries, such as concussions or contusions, in high school girls’ lacrosse players.

Published online ahead of print in the American Journal of Sports Medicine, the study finds that most head injuries result from stick-to-head contact during aggressive play near the goal at the varsity level. In addition, the researchers determined that most of these head injuries resulted from unintentional stick contact, which suggests that head injury in girls’ lacrosse may be an indirect consequence of play, in which players position themselves in hazardous situations either purposefully or inadvertently.

For this study, Caswell, associate professor of athletic training and director of the Sports Medicine Assessment, Research and Testing (SMART) Laboratory in Mason’s College of Education and Human Development, partnered with two members of US Lacrosse’s Sports Science and Safety Committee: Andrew Lincoln of MedStar Health Research Institute, and Jon Almquist, a certified athletic trainer for Fairfax County Public Schools in Virginia. The researchers examined video footage of head injury incidents of nearly 2,500 girls’ lacrosse players between the ages of 14 and 18 years old during the 2008 and 2009 seasons.

According to Caswell, this is the first study to combine video analysis and injury data to report on the common injury mechanisms and game play characteristics that result in head injuries in scholastic girls’ lacrosse. Currently, girl’s lacrosse is played without the use of protective headgear.

“Previous reports of head injury in girls’ lacrosse have relied on eyewitness accounts to assess how and when injuries occur during the game,” says Caswell. “By capturing these incidents on video, we are able to objectively examine the characteristics of the game including the location of the injury on the field, number of players involved, field conditions and the score of the game when the injury occurred. Video analysis is also beneficial because it can capture detail when an incident occurs in a fraction of a second that may not be accurately reported by the injured player, parent, coach or other observer.”

The researchers began by gathering data from 529 varsity and junior varsity girls’ lacrosse games during the spring lacrosse seasons at 25 public high schools in Fairfax County. All on-field injuries were recorded by a certified athletic trainer in a game incident log. These injuries were communicated to a videographer who documented the approximate game time, score and nature of the injury.

For the purpose of this study, the researchers defined an incident as an injury to the head or facial region as evaluated by a certified athletic trainer and recorded in a sideline injury log.

After analyzing the results, the researchers found that 25 game-related head injuries (21 concussions and four contusions) were diagnosed by an athletic trainer during the two seasons. Of these, 14 were accurately captured on video and were determined to be game-related head injury incidents. All of the head injuries involved varsity level athletes and half occurred in the first quarter of the season. Eleven of the incidents were diagnosed as concussions and no penalty was called in 12 of the injury incidents.

Photo by Greg Wall. Courtesy of US Lacrosse.

The researchers discovered that the majority of the head injuries resulted from unintentional stick contact to the head. Most of these injuries occurred in front of the goal while defending a shot. Stick-related injuries accounted for five of the 11 concussions. The second most frequent cause of injury resulted from body-to-head contact in which the injured player was attempting to retrieve a loose ball and collided with an opponent’s head, shoulder or stick.

In nine of the 14 incidents, it was determined that the injured player did not have possession of the ball at the time of injury. Of these, video analysis showed that injuries occurred most often when players were competing for a loose ball or defending a shot. The regions of the playing field where injuries occurred most frequently were within the attack (the area surrounding the goal) and midfield areas.

According to the researchers, their findings support previous research that demonstrates the main cause of head injury in high school girls’ lacrosse is a result of stick contact to the head between two opposing players. They also found that limited skill is not a factor in head injury since all injuries occurred at the varsity level. This suggests, they say, a possible association between high skill level or intensity and head injuries in girls’ high school lacrosse.

Furthermore, the absence of penalty calls on most of these plays suggests a need to explore the extent to which current rules are enforced, as well as their effectiveness in preventing head injuries.

“While these findings help us better understand the nature of head injuries and incidents in a sport that continues to grow in popularity throughout the world, more research is needed to assess how prevalent these injuries are across all scholastic and collegiate women’s lacrosse and whether the game can be made safer by improved understanding of the rules by coaches and officials, better enforcement of existing rules, or the use of protective equipment,” says Caswell.

The study was sponsored by the National Operating Committee on Standards for Athletic Equipment and US Lacrosse.

About George Mason University

George Mason University is an innovative, entrepreneurial institution with global distinction in a range of academic fields. Located in Northern Virginia near Washington, D.C., Mason provides students access to diverse cultural experiences and the most sought-after internships and employers in the country.  Mason offers strong undergraduate and graduate degree programs in engineering and information technology, organizational psychology, health care and visual and performing arts. With Mason professors conducting groundbreaking research in areas such as climate change, public policy and the biosciences, George Mason University is a leading example of the modern, public university. George Mason University—Where Innovation Is Tradition.

About US Lacrosse

US Lacrosse, a 501(c)(3) nonprofit corporation, is the national governing body of men’s and women’s lacrosse. US Lacrosse has 400,000 members in 64 regional chapters around the country. Through responsive and effective leadership, US Lacrosse strives to provide programs and services to inspire participation while protecting the integrity of the game. To learn more about US Lacrosse, please visit the website.

About MedStar Health Research Institute

The MedStar Health Research Institute (MHRI) is the research arm of MedStar Health, the largest healthcare provider in the Maryland and Washington, DC regions.  MHRI’s associates and investigators provide scientific, administrative and regulatory support for research programs throughout the MedStar Health system.  These programs complement the key clinical services and teaching programs in the nine MedStar hospitals and 20 other MedStar Health entities.  To learn more, please visit the website.