Philly.com Sports Doc
Posted: Friday, April 4, 2014, 5:45 AM
A 2007 study by Dick et al in the Journal of Athletic Training looked at injury rates for the men’s lacrosse using the NCAA injury surveillance system from 1988-2004. The results show a nearly 4 times higher rate of injury in games than in practice (12.58 versus 3.24 injuries per 1000 athlete-exposures [A-Es]).
Pre-season practice injury rates were more than twice that of in-season. In-season game injury rates were almost twice as high as those in the postseason (12.60 versus 7.54 injuries per 1000 A-Es).
A total of 48.1% of all game and 58.7% of all practice injuries were to the lower extremity. The upper extremity accounted for another 26.2% of game injuries and 16.9% of practice injuries, whereas 11.7% of game and 6.2% of practice injuries involved the head and neck.
Most game injuries (45.9%) resulted from player contact, whereas the rest were equally distributed between other contact (primarily contact with the stick) and no direct contact to the injured body part.
In games, knee internal derangements accounted for 27.3% of all severe injuries, followed by acromioclavicular joint injuries (7.3%), ankle ligament sprains (7.1%), and upper leg muscle strains (5.6%). Concussions accounted for 3% of severe game injuries.
In practices, these same areas, except for acromioclavicular joint injuries, accounted for most of the severe injuries. 45.9% of game injuries were associated with player contact, and 12.9% were associated with stick contact.
Contact with the ball was associated with only 3% of all game injuries. Most concussions (78.5%) were associated with player contact, with stick contact accounting for another 10.4%.
The majority of practice injuries (50.0%) involved no direct contact. 21% of both game and practice injuries restricted participation for at least 10 days.
Lower extremity injuries account for roughly half of all collegiate lacrosse injuries. The majority of injuries can be divided into the following for diagnoses: ankle sprains, knee internal derangements, upper leg strains, and upper leg contusions.
Ankle sprains account for 11.3% of game and 16.4% of practice injuries. These are primarily lateral ankle sprains which are caused by the ankle rolling inward during cutting and pivoting. Most ankle sprains are minor injuries and players can return quickly to practice and competition. These injuries should initially be evaluated by your team’s athletic trainer. Depending on the severity, players with minor injuries may return immediately with taping or bracing. More severe injuries may require time away from the sport and more substantial treatment including evaluation by a sports medicine physician and subsequent rehab.
There may be a period of immobilization and limited weight bearing depending on the extent of the injury. Rehab involves regaining range of motion and flexibility, strength, and balance with a gradual progression to full sports activities.
Knee internal derangements account for 9.1% of game and 7.1% of practice injuries. The two most common diagnoses are meniscus tears and ACL tears. Both of these are serious injuries and should be evaluated by a sports medicine physician. Although most of these injuries require surgery, there are some players who can finish the season. If an athlete is to finish the season with one of these injuries, he needs to undergo a structured rehabilitation program and meet specific objective goals before being cleared to return to sports.
Upper leg strains account for 7.5% of game injuries; 11.4% of practice injuries. These injuries are primarily hamstring strains. Hamstring injuries can be difficult to treat as seen by looking at the length of time missed on an NFL injury report. There is still debate on the best course of treatment for hamstring injuries. In my experience, the initial phase of treatment focuses on reducing pain and inflammation while regaining flexibility. The second phase involves regaining strength in the injured and initiating lower level sport specific activities. The final phase involves higher level sport specific activities and a structured return to sport progression.
Lastly, upper leg contusions account for 8% of game and 3% of practice injuries. These contusions are usually the result of players being hit by balls, sticks, or other players. These injuries are usually minor and involve decreasing pain, regaining flexibility, and regaining strength. Return to sports is usually fairly quick for most of these injuries.
Concussions are the 3rd most common game injury and 5th most common practice injury in collegiate lacrosse. The high rate of concussion is likely due to the contact form both stick and body checking. In this study, concussions resulted in only 3% of all injuries requiring greater than 10 days of missed time. This correlates with concussion research showing that that most concussions resolve within that time frame.
As we have learned from contact sports such as football and hockey, concussions are serious injuries and should be treated as such. An evaluation by a sports medicine clinician trained in concussion assessment should be performed in order to develop an appropriate treatment plan. This may include time away from the classroom as well as from the playing field.
Upper Extremity Injuries
AC joint injuries are the most common upper extremity injury in lacrosse accounting for 5.1% of game injuries and 1.9% of practice injuries. These injuries are usually self-resolving and improve with conservative care. AC joint injuries should be evaluated and treated by your athletic trainer. Treatment usually involves a period of rest and immobilization if needed. Initially, goals are to reduce pain and regain range of motion. Once symptoms resolve, a strength program should be initiated with a gradual progression back to sports.
Shoulder sprains/strains account for less than 3% of all injuries in men’s lacrosse. These are minor injuries that resolve with conservative care. As any injury, they should be evaluated by your athletic trainer who will develop a program to regain range of motion and strength with a supervised return to play, if any time away from the sport is needed.
Shoulder subluxations/dislocations account for less than 3% of all injuries. These are more serious and need immediate evaluation by your team’s athletic trainer with a referral to a sports medicine physician. These injuries require a longer time away from sports and a more prolonged rehabilitation program. Dislocations may require surgical stabilization which is why a physician consultation is needed.
Thumb fractures are another uncommon injury in lacrosse. They are almost always the result of being hit by a stick. These injuries are usually significant and require time away from sports and some type of physician treatment. This can be as minimal as splinting or as significant as surgery, depending on the severity of the fracture.
As you can see, ankle sprains and knee internal derangements (meniscus tears and ligament injuries) are the two most common injuries followed by concussions. Upper extremity injuries are much less common and usually less severe as well. Any injury should be evaluated by your athletic trainer to assess the severity of the injury and determine the appropriate plan of care.