Marcia Frellick

June 12, 2015

CHICAGO — Rules that mandate safety equipment for male lacrosse players should extend to women and girls, according to a vote by American Medical Association (AMA) delegates.

The issue has become more important as interest in the sport increases; in the United States, the number of young girls playing lacrosse has nearly doubled in the past 10 years.

Currently, all male players and female goalies wear hard-shell helmets. Because the girls' game does not involve body contact, players other than goalies traditionally have not worn headgear. So far, Florida is the only state to mandate that all female players wear a soft form of headgear for play and practice.

Ann Kitt Carpenetti, vice president of operations with US Lacrosse, the national governing body, told Medscape Medical News that she had urged the AMA in a letter not to adopt the measure.

Although the demand for enhanced safety is valid, she explained that she was asking for time to let product development catch up with the international standards that US Lacrosse helped set only months ago.

There is no evidence supporting the benefit of wearing what's currently on the market, she said. And mandating a helmet for women in a sport where body contact is illegal just doesn't make sense.

She also explained that adding gear can lead to a gladiator effect, encouraging more aggressive play.

Even though the research isn't there, we know it's safer to jump out of an airplane with a parachute.

"We don't have skull fractures or catastrophic head injuries in women's lacrosse, which the helmets in football and men's lacrosse and hockey were designed to address," she pointed out.

Melissa Garretson, MD, speaking for the American Association of Pediatrics, said the impetus for the resolution comes from the speed at which the hard ball is hurled from the stick.

"I just don't think that middle-school or high-school or even some college kids are that accurate that they're never going to misthrow the ball. The reason goalies have to wear helmets is that the ball is hurled at them. That's the same reason the players should have the helmets," she said.

Although many delegates took a pro-helmet stance, not all agreed. A delegate from New England, who has a wife and daughter who coach the sport, said the subject should not be decided on "anecdotal evidence and emotion."

In arguing for the resolution, some cited a study demonstrating that behind strains and sprains, concussions are the most common type of injury for both sexes in lacrosse (Am J Sports Med. 2014;42:2082-2088).

During the study period, the injury rate was 1.96 per 1000 athlete exposures.

Injury rates occurred more often during competition than during practice (3.61 vs 1.23 per 1000 athlete exposures; rate ratio, 2.94; 95% confidence interval [CI], 2.65 - 3.27).

And boys had a higher injury rate than girls (2.26 vs 1.54 per 1000 athlete exposures; rate ratio, 1.47; 95% CI, 1.32 - 1.64).

Table. Most Common Injuries

Injury Boys, % Girls, %
Sprains and strains 35.6 43.9
Concussions 21.9 22.7


During competition, the most commonly injured body sites were the head and face (32.0%) and the lower leg, ankle, and foot (17.8%).

It comes down to common sense, said Louis Kraus, MD, delegate from the American Academy of Child and Adolescent Psychiatry, who was speaking for himself.

"Even though the research isn't there, we know it's safer to jump out of an airplane with a parachute," he said. "We don't need a double-blind study to show that."

Dr Kraus and Dr Garretson have disclosed no relevant financial relationships.


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