Spring sports preview: Gearing up for lacrosse

For a certain group of athletes and fans, this is a particularly exciting time of year filled with preparation for and anticipation of another season of "the fastest growing sport in the country."

Don't purchase your plane tickets for Florida or Arizona, though, because the athletes in this sport are all over the Philadelphia area right now. Yes, Virginia, we are talking about lacrosse. This post is for lacrosse athletes of both genders and all ages—and for the folks who coach, train, and (or) love them—and will discuss a few things that may help keep you in the game and on the field.

The most common injury in both men and women's lacrosse is an ankle sprain. According to a study by Dr Richard Hinton, a sports medicine physician from Baltimore and team physician for US Lacrosse who looked at injury rates over three years for 2000 male and female high school lacrosse players, the most frequent injury that required medical attention and at least one day lost from practice or competition was an ankle sprain.

Ankle sprains can range from mild to severe and can be acute or chronic in nature. In a field sport involving running, cutting, and pivoting, an ankle sprain can be a nuisance at a minimum or have a major impact on function and performance in its more severe forms. As with other sports injuries, prevention is the best medicine.

In the preseason, pay attention to the ankles. Do they ever hurt? Swell? Give way frequently? If the answer is yes to any of these, there may be a higher risk for an ankle injury during the season and lost time away from the game. Strong ankles—motion, strength, balance—are a key way to keep you on the field.

The second most common injury in men's lacrosse may come as a surprise. The next most prevalent injury requiring medical attention and time away from the game is a concussion. For females in this age group, head and face injuries were the third most common injury after ankle sprains and knee injuries. As one might expect given the different rules between the games, boys were at three times higher risk to have a concussion than girls.

While no specific lacrosse helmet or particular headgear has been proven to reduce the incident of concussion, make sure the equipment is in good condition and fits well. If an athlete has had a previous concussion, studies have shown that they are more likely to have another concussion compared to athletes with no concussion history. Prevention may not always be possible when it comes to concussion, but the next best thing from a sports medicine perspective is early identification and intervention for a possible concussion.

Fortunately, in part because of increased awareness of the potential seriousness of sports-related concussions, there will be a heightened vigilance in the officiating and rules enforcement of lacrosse competition at all levels when it comes to protecting the head. At the US Lacrosse annual convention last month here in Philadelphia, officials were also discussing longer penalties for blows to the head, regardless of whether the contact was intentional or unintentional. A helpful resource for further information on concussions is www.cdc.gov/concussion; awareness and education are the best medicine for the challenge of concussions in sports, including lacrosse.

Finally, the lacrosse injury that causes the most time lost from sport is a knee ligament injury. The knee is the third most common body part injured for males and the second for females. While some fractures may take some time to heal, a serious knee ligament injury such as a complete tear of the anterior cruciate ligament (ACL) can take months to recover from and return to sport.

In a study of college athletes by Dr Anthony Beutler and colleagues at the Uniformed Services University, male lacrosse athletes suffered ACL injuries at twice the rate as the basketball athletes, and one and a half times the rate as the soccer athletes. In the same study, interestingly, female college lacrosse athletes had less ACL injuries than their counterparts in basketball and soccer, and overall had a similar ACL injury rate as the male college lacrosse players. Other studies have shown that female athletes are at increased risk—3-4 times more likely—to have an ACL injury when compared to males in similar sports with similar rules of contact such as soccer and basketball.

When it comes to an ACL injury, similar to ankle sprains, the best medicine is prevention. While it has not been shown in lacrosse athletes, injury prevention programs have been helpful in reducing knee injuries in sports such as soccer. Two of the more well-known sports medicine injury prevention programs, and publicly accessible by anyone, are the Prevention Injury and Enhancement Program (PEP) by the Santa Monica Sports Medicine Foundation and FIFA 11+ by the Federation Internationale de Football Association (use your favorite search engine to find the free programs on the web). An ACL specific injury prevention program will include improving strength, flexibility, plyometric training and agility training, and it may focus on sport specific skills.

Proper hydration and nutrition, as well as environmental concerns can affect participation and performance in the pre-season and during the season. Pay attention to eating right, staying hydrated, dressing appropriately and watching for signs of heat or cold illness. Get ready for lax, stay healthy and have a great season!

-By Gene Hong, M.D., C.A.Q.S.M., F.A.A.F.P.